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Assessing Metabolic Status
with ß-Hydroxybutyrate
A Significant Advance
in Diabetes Self-Management
Ketone Production
 In periods of insulin deficiency,
triglycerides are metabolized for energy
 Fatty acids are transformed into ketones,
acids that allow fat-derived energy to be
utilized
 Circulatory ketone levels increase
Diabetic Ketoacidosis (DKA)
 Occurs when excessive levels of ketones
accumulate and the body becomes acidotic
 It is a potentially life-threatening condition
 -hydroxybutyrate is the predominant
ketone associated with DKA
Who Is at Risk?
 People with type 1 diabetes—especially
children and pump users
 Pregnant women with any form of diabetes
Common Contributors to DKA
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Infection
Inadequate available insulin
Stress
Acute illnesses
Inappropriate sick-day management
The Prevention of DKA
 Accurate ketone-level measurements
 Proper insulin management
When to Test for Ketones
The American Diabetes Association recommends that people
with diabetes test for ketones in the following situations:
 During acute illness or stress
 When blood glucose levels are consistently
over 300 mg/dL
 During pregnancy
 When symptoms of ketoacidosis—nausea,
vomiting, abdominal pain—are present
Types of Ketones Tested
 Acetoacetate—the most
commonly measured
 Acetone
 -hydroxybutyrate—the predominant
ketone associated with DKA
Ketone Testing Methods
 Urine
– acetoacetate or acetone levels
 Blood
– -hydroxybutyrate levels
Urine Ketone Testing
 Urine is applied to a reagent strip or tablet
 Color variation indicates the ketone level
in the urine
Disadvantages to Urine
Ketone Testing
 The results are not real time
 The readings are qualitative—color comparisons
indicate high, medium or low levels
 Sulfhydryl drugs, including the ACE inhibitor
captopril, may cause false-positive results
 High doses of vitamin C can cause
false-negative results
 Does not detect -hydroxybutyrate
Blood Ketone Testing
 Measures -hydroxybutyrate
 Presently limited to the laboratory
or office setting
 Benefits: real-time, reliable accuracy,
quantitative readings