I don’t understand urine ketone testing. The strips read, “negative, trace, small, moderate, and large”, but my doctor gives me numbers like “40.” How do these things relate to one another?

Ketones result from the body’s burning of fat when glucose is not available to be used for energy. A person with type 1 diabetes is more at risk for developing ketones than a person with type 2 diabetes. Their presence might might mean that your diabetes is out of control, and they can be dangerous leading to eventual DKA [diabetic ketoacidosis] which can require hospitalization. If this ever occurs, you should contact your doctor or diabetes educator immediately. Test for ketones whenever your blood sugar is over 240 mg/dl [13.3 mmol/L] or you are ill.

We typically refer to ketone levels as being, “small, moderate or large”; small meaning 15 mg/dl, moderate meaning 40 mg/dl, and large meaning 80-160 mg/dl. Moderate or large amounts of ketones in the require immediate action to prevent life-threatening complications.

SH
Additional comments from Lois Schmidt Finney, diabetes dietitian:

“Immediate action” means drinking as much water as possible, giving insulin(based on your team’s recommendations to bring the glucoses down), and checking urine for ketones and blood glucoses in about an hour or less. Call your diabetes team if the high blood glucose and ketones are still present, but call your health care team right away if there is vomiting or large ketones or you just need reassurance.

LSF