Reasons for Ketones in Urine

What are ketones?

Everybody has ketones. The body produces ketones when there is not enough insulin that will convert sugar into energy. Ketones are chemicals produced by the liver from fatty acids. The liver then sends ketones into the bloodstream, so the tissues and muscles can utilize them as fuel. 

People without diabetes don't have an issue with this process. However, people with diabetes can have too much buildup of ketones in the blood, which can be life-threatening. If you have type 1 diabetes, you might need a ketone test. In type 1 diabetes, a person's immune system attacks the pancreas, which produces insulin. Without enough insulin, the levels of blood sugar rise. Individuals who have type 2 diabetes can also experience high ketone levels, but not as common as with those who have type 1 diabetes. 

Signs to Test for Ketones

Your doctor will probably ask for a ketone test when you have the following conditions:

• A blood sugar of more than 250 mg/dl for two consecutive days
• Frequent urination
• Excessive thirst
• Blurry vision
• Vomiting
• Dry mouth
• Fatigue
• You have an illness
• You have an injury
• You are pregnant

Tests for Ketones

Ketones are tested through a urine analysis. You can purchase a ketone test kit at your local drugstore and test your urine at home. A ketone test can also be done in your doctor's clinic. 

To test for ketones in your urine, you have to pee in a sterile container to get a urine sample. After collecting the urine sample, do the following steps:

• Dip the test strip into the urine sample. You can also hold the strip under your urine stream.
• Gently shake off excess urine from the test strip.
• You will notice that the test strip will change in color. the directions will tell you how long that takes.
• Follow the instructions and check the strip color against the provided chart in your test kit.
• The corresponding color will show you the ketone level in your urine.

Interpreting Results

The urine test for ketones will indicate if you have no ketones, trace amounts, moderate, or large amounts of ketones in your urine. Make sure that you take note of the results, so you can properly monitor your ketone levels as time goes by.

When you have a slightly elevated level of ketones in the urine, it could mean that ketones are starting to build up in your system or could indicate a missed shot of insulin. If you have missed an insulin shot, take the shot right away and check your ketone level after a few hours.

If your ketone test yields moderate to high levels, you might have diabetic ketoacidosis (DKA). If the levels are very high, do not delay and immediately seek medical attention by going to the nearest emergency room.

Causes of Ketones in Urine

1. Low-Carbohydrate Diet

A low-carbohydrate diet is often regarded as a ketogenic diet. When there is not enough carbohydrate to refuel glycogen stores, the body undergoes stages to burn fats instead. A consistent low-carbohydrate diet would result in the buildup of ketone in the body. Thus, people who follow a low-carbohydrate diet must be periodically tested for ketones to check if fat is indeed being burned. However, people who follow other types of diet to lose weight should also check their ketone levels since losing weight is certainly burning fat or losing fat.

Since ketones are by-products of fat metabolism, their presence in the urine or blood indicates that fat is being burned.

2. Uncontrolled Diabetes

High levels of ketone in urine may result from uncontrolled diabetes. Due to lack of insulin, the body is not able to break down glucose. Instead of using glucose as fuel, fat is metabolized. 

3. Starvation

Starvation ketones are formed since the body uses fat reserves instead of carbohydrates to obtain energy. The body breaks fat into fatty acids and glycerol. Glycerol is then converted into glucose and used as fuel. In the liver, fatty acids are converted into ketones. When blood glucose levels are low, starvation ketones are produced. In children, ketones are produced much faster than in adults. To correct the problem, carbohydrates should be immediately given to eat or drink.

According to the National Institutes of Health (NIH), hormones such as glucagon, epinephrine, and growth hormones increase during the state of starvation. They cause the fatty acids to be released from the fat into the blood. Usually, when the body is starving, ketones are present in the urine.

Starvation is usually due to bulimia, anorexia, alcoholism, and strict dieting. Starvation would also result from frequent diarrhea, fasting, high-protein diet, low-carbohydrate diet, and severe vomiting.

4. Alcoholic Ketoacidosis (AKA)

Ketones can also be present in the urine when a person consumes excessive amounts of alcohol. This metabolic syndrome is called as alcoholic ketoacidosis. This complication is usually seen among alcoholics. However, non-alcoholics of all age groups can also develop it.

5. Exercise 

Muscles burn fat and glucose to obtain fuel during exercise. Fat will be the primary fuel if glucose levels are low, and ketones will be produced if the body burns fat without glucose. People who are lean and efficient in burning fat usually use a lot of glucose and when they engage in high-intensity workouts, ketones are formed in the blood. 

Sometimes, blood glucose can rise due to exercise, especially when insulin levels are low. The liver converts stored glycogen into glucose during exercise to obtain energy. However, if the insulin level is low, the muscles cannot utilize glucose leading to a rise in blood glucose levels. 

When people with type 1 diabetes have trace ketones and they continue to exercise, the level of glucose in their blood will increase, which will also lead to increased levels of ketones in the blood. Although diabetic ketoacidosis due to exercise is rare, it is still necessary to take precautions. Certain guidelines have been set by the American Diabetes Association about exercise, blood glucose, and ketones. 

• Do not exercise if your blood glucose levels are over 250 mg/dl and the presence of ketones is detected.
• Use with caution if your blood glucose levels are more than 300 mg/dl and ketones are not present.
• If your blood glucose level is more than 250 mg/dl and ketones are not present in the urine or blood, then you can exercise. However, stop after 15 minutes and check your blood glucose level if it has risen or dropped. If your blood sugar level is fine, then you can continue exercising. Always follow your doctor's advice when it comes to managing your blood glucose levels.

6. Diabetic Ketoacidosis

Most people don't have to worry about ketones. However, for those who have diabetes, especially type 1 diabetes, having ketones could indicate that their diabetes is out of control.

When you are sick and dealing with an infection or high-stress levels, your body may make ketones, which can appear in your urine or blood. Ketones are relatively strong acids, and when they are present in the blood, the ability of hemoglobin to bind with oxygen is impaired, which may affect the normal functioning of the muscles and other organs.

In people with type 1 diabetes, high levels of ketones may further cause dehydration and diabetic ketoacidosis (DKA). However, DKA is rarely seen in people with type 2 diabetes. The reason is that the pancreas of people with type 2 diabetes is still able to burn some amount of glucose.

7. Illness

If a child has type 1 diabetes, then illness associated with diarrhea and vomiting due to gastroenteritis may cause low blood glucose levels. If the illness is accompanied by fever, blood glucose levels may rise due to high-stress levels. However, if the blood glucose level constantly remains high for a number of hours, which is more than 15 mmol/L, then the child may develop symptoms such as excessive thirst and frequent urination.

Ketone levels may rise and may cause nausea, vomiting, decreased fluid and food intake, and dehydration. In people with type 1 diabetes, even common ailments may cause ketone levels to rise leading to diabetic ketoacidosis.

8. Pregnancy

The presence of moderate levels of ketone in the urine is common, and there has been no definitive research to support the fact that the presence of ketone in urine during pregnancy can affect the unborn child.

The body becomes resistant to insulin during pregnancy. Even if carbohydrates are sufficient in the body, they are still not converted to obtain energy. Excess ketones are formed due to the conversion of fatty acids into energy. Thus, small amounts of ketone during pregnancy may appear in the urine. Excessive amounts of ketone in the urine during pregnancy may indicate long intervals between meals and certain nutritional disorders. Thus, a balanced diet containing simple carbohydrates should be followed during pregnancy.

Other Causes

Ketone bodies may appear in the urine due to other conditions as well. They include:

• Dehydration
• Hyperthyroidism
• Other metabolic disorders such as renal glycosuria, alkalosis, lactation, and glycogen storage disease

Clinical Significance

Usually, ketones are absent in urine. When they are present, it usually indicates that instead of carbohydrates, the body is losing fats to obtain energy. Individuals with uncontrolled diabetes have high ketone levels. In such cases, the body's ability to metabolize carbohydrates is impaired.

The presence of ketones can be detected when individuals are dealing with psychological stress, prolonged vomiting, fasting, rapid weight loss, and strenuous exercise. A valuable aid to managing and monitoring individuals with diabetes is by detecting the presence of ketone in their urine.