High blood sugar can lead to diabetic ketoacidosis, or DKA, in people who have type 1 diabetes (it’s very rare for type 2). DKA happens when there is a buildup of ketonesKetonesOrganic compounds produced when the body breaks down fats and fatty acids to use as fuel. This is most likely to occur when the body does not have enough sugar or carbohydrates or the body cannot use sugar effectively. Because high levels of ketones are dangerous, a urine test is one way to check the level of ketones in your body. in the blood. Ketones are made when the body uses fat for energy instead of sugar. This can happen when the cells don’t get the sugar they need to use for energy.

Symptoms of DKA that may require ketone testing include:

• Blood sugar above 240 mg/dL and not falling
• Intense thirst or dry mouth
• Need to urinate often
• Lack of appetite, or stomach pain
• Vomiting or nausea
• Blurry vision
• Fever or warm, dry, or flushed skin
• Diffculty breathing
• Feeling weak
• Sleepiness
• Fruity odor on the breath

How to test for ketones

• Over-the-counter test strips are used to measure the amount of ketones in the urine. These strips are available without a prescription in most local pharmacies

• Some blood sugar meters also check for ketones in the blood

What level of ketones is considered dangerous?

Your diabetes care teamDiabetes care teamYour diabetes care team may include: a primary care doctor, a diabetes and hormone doctor (endocrinologist), a registered nurse, a diabetes educator, a dietician, a heart doctor (cardiologist), a foot doctor (podiatrist), an eye doctor (ophthalmologist/optometrist), a kidney doctor (nephrologist), a dentist, a pharmacist, and a mental health professional. will often tell you what level of ketones is dangerous. If they have not, call your doctor if a urine test shows moderate or large amounts of ketones.

What is the most important information I should know about ketones?

• Test for ketones every 4 hours during illness. DKA can be common when people with type 1 diabetes are sick. Even if blood sugar tests are normal, if you’re nauseous or vomiting, check your urine for ketones

• Seek emergency help if ketones do not go down, or if you’re vomiting and cannot stop

• Avoid activity when ketones are elevated and blood sugar is high

Hyperosmolar hyperglycemic syndrome, or HHS, is a severe condition. It happens when high blood sugar levels cause an unusual increase in urination. This can lead to dehydration.

If your blood sugar levels are running high, but you don’t know why, you may need medical attention. Your doctor can tell you what blood sugar levels and symptoms are associated with HHS, and when you should call someone from your diabetes care team if you experience them.

What are common reasons you should call your doctor?

• Your blood sugar goes above your goal for more than 2 test results
• You feel ill, have a fever, feel sick to your stomach, or are vomiting
• You are scheduled to have surgery or have recently had surgery
• You have any questions about what blood sugar levels are too low or too high