January 13, 2016
Question from Kaleva, Michigan, USA:
I would like to understand ketones better. What causes them? How do they affect the body? How are they formed?
Ketones are chemicals indicating that the body fat is being used (metabolized). They show up in the blood and urine chemically as ketoacids and when associated with severe insulin deficiency (new diagnosis of diabetes without the body producing insulin, someone who does not take all their insulin doses correctly every day, someone who is ill and needs extra insulin, someone undergoing surgery or other kinds of stress, someone taking high doses of prednisone or cortisone, etc). They can be measured in a laboratory or can be measured in an office or clinic or at home with blood ketone strips or urine ketone strips. They also show up (not related to diabetes) when someone is burning their own body fat for any reason so that someone who is successfully losing weight, losing body fat, would also have measurable ketones. In this circumstance, ketones would be a desirable and positive finding confirming the successful weight loss for the obesity.
In diabetes with a lack of insulin, excess ketones (moderate or large on such urine strips like Ketostix) can indicate a dangerous and potentially lethal condition called DKA, diabetic ketoacidosis. With DKA, there is severe insulin deficiency, dehydration, weight loss from the dehydration, salt and water deficiency, often potassium salt excess, acidosis because the ketone bodies are acids and with such excess ketones comes potential death from the water and salt imbalances plus the acidosis. If not identified, prevented, treated and corrected properly, the DKA can lead to coma and death from cardiac, respiratory arrest or brain failure. We believe that DKA is almost always preventable with proper education about sick days, public awareness campaigns to try to let diagnosis be made early rather than late (thus avoiding the severe DKA), ketone testing availability and education and optimal treatment.