IF YOU HAVE KETONES,
STAY IN COMMUNICATION
WITH YOUR HEALTH CARE TEAM.
injected or pumped insulin to
keep blood glucose and ketones
in check. In fact, many people are
diagnosed with type; 1 following an
episode of DKA. People with type; 2
diabetes don’t make enough insulin to
maintain normal blood glucose levels, but
the insulin they do produce is usually
enough to suppress ketone formation.
They may develop DKA amid extreme
bodily stress, such as a serious infection.
Stress hormones during illness can
cause insulin, injected or produced by
the body, to work less effectively,
bringing on higher ketone levels, says
Nicole Glaser, MD, professor of pediatrics
at the University of California Davis
School of Medicine. Missing insulin doses
or using expired insulin, which is less
effective, can also spur the production
Another problem that can increase
the risk for DKA is a pump malfunction.
If your cannula or needle kinks or has a
blockage (what’s known in pump speak as
an occlusion), insulin may not get into your
body—and you may not become aware of
this until it’s too late. Ketone production
and the processes of DKA will generally
begin developing by about four to six hours
in that situation, Glaser says, resulting in
DKA within a day if untreated.
If your meter or continuous glucose monitor
(CGM) persistently reads 250;mg/dl or
greater despite attempts to lower
glucose with extra insulin, check for
ketones, says Adrian Vella, MD,
professor of medicine in the
Division of Endocrinology
at the Mayo Clinic in
Rochester, Minnesota. Other reasons to
test for ketones: You’re sick with an
infection or other illness, or you have
symptoms of ketoacidosis (see “Ketones
Rising,” p.; 31), regardless of blood glucose
level, says Glaser.
While rare, it is possible to develop
DKA without high blood glucose—
what’s known as euglycemic diabetic
ketoacidosis (eDKA). The main cause
of eDKA is an illness that involves
vomiting and very little food intake for
prolonged periods of time, Glaser says.
Drugs in the SGLT- 2 inhibitor class can
also increase the risk of eDKA. In both
cases, glucose levels may be in the 100
to 200;mg/dl range, rather than the
500;mg/dl or higher typical of DKA. SGLT- 2
inhibitors lower blood glucose by causing
you to excrete excess
glucose through the urine.
Because doctors expect
blood glucose to be higher
with DKA, this can lead to
a missed DKA diagnosis.
The FDA recently issued
a warning regarding this
potential side effect of SGLT- 2 inhibitors.
Because the problem is more common
with type; 1 diabetes, these drugs
shouldn’t be used by people with type; 1.
Euglycemic DKA can sometimes occur in
people with type; 2.
A simple at-home test for blood or
urine ketones will let you know if large
quantities of ketones are present. Both
types of strips will give you an accurate
reading, but blood tests re;ect ketone levels
in real time. Levels in the urine re;ect what
happened in the past several hours, as
urine was accumulating in the bladder.
HERE’S WHAT TO LOOK FOR WHEN
BLOOD KETONES—A blood ketone meter is
designed to check for ketones using a test
strip and ;nger-stick blood sample. At this
time, the Nova Max Plus meter is available in
the United States. A level of 1;mmol or higher
warrants a call to your doctor to work out a
treatment plan, which may include drinking