Keto And Urine: What's The Connection?

Ketones in urine, or ketonuria, is usually a sign of diabetic ketoacidosis (DKA). Ketones are produced when the body burns fat for energy, which happens when the body does not have enough glucose or insulin to use glucose. While trace or small amounts of ketones in urine are normal, high levels of ketones in urine can be dangerous and even life-threatening. This condition is called ketoacidosis and is most commonly associated with diabetes. However, it can also be caused by other factors such as chronic vomiting, diarrhea, alcohol use disorder, and low-carbohydrate diets.

Ketones in urine: what causes them

Ketones in urine, also known as ketonuria, are usually a sign that your body is using fat for energy instead of glucose (its preferred source). Ketones are acids produced when your body breaks down fat. While small amounts of ketones in your urine are normal and safe, larger amounts can be dangerous.

Causes of Ketones in Urine

There are several reasons why someone might have ketones in their urine, including:

• Diabetes: Diabetic ketoacidosis (DKA) is a severe complication of diabetes that can be life-threatening. It occurs when the body doesn't have enough insulin to use glucose for energy and so turns to fat, resulting in the production of ketones.
• Low-carb diet: Eating a low-carb or ketogenic diet can lead to ketosis, a state in which your body burns fat for energy instead of carbohydrates. This can result in ketones being present in the urine.
• Fasting: Not eating for a prolonged period can lead to ketosis and the production of ketones.
• Alcohol use disorder: Long-term excessive alcohol consumption can affect how the body absorbs nutrients and stores glucose, leading to fat breakdown and the production of ketones.
• Prolonged vomiting and/or diarrhea: If your body runs out of glucose due to prolonged vomiting or diarrhea, it may start breaking down fat, resulting in ketones in the urine.
• Eating disorders and starvation: Eating disorders such as anorexia can limit the amount of glucose in the body, leading to ketone production.
• Prolonged, intense exercise: Intense and prolonged exercise can deplete the body's stored glucose, causing it to break down fat for energy and produce ketones.

Testing for Ketones in Urine

Ketone levels in the urine can be measured through a urinalysis test, either at home or in a lab. Urine test strips are available over the counter and can indicate whether ketone levels are negative, trace, small, moderate, or large. Blood tests are also an option and are considered more accurate, but they are more expensive and less convenient.

Symptoms and Complications of High Ketone Levels

Moderate to high amounts of ketones in the urine can be a sign of ketoacidosis, a potentially life-threatening condition. Early symptoms of ketoacidosis may include increased urination, extreme thirst and hunger, nausea, vomiting, and fatigue. More severe symptoms can include shortness of breath, fruity-smelling breath, disorientation, and decreased alertness.

Complications of diabetic ketoacidosis may include low potassium levels and acute kidney failure, which can lead to loss of consciousness or even death. Therefore, it is important to monitor ketone levels, especially for individuals with diabetes or other risk factors, and to seek medical attention if levels become elevated.

Ketosis and keto diets

Ketosis is a metabolic state in which the body burns fat for energy instead of carbohydrates. This can be achieved through a low-carb, high-fat diet, fasting, or excessive exercise. When the body doesn't have enough glucose or insulin to use glucose, it starts breaking down fat for energy, which produces ketones. Ketones are acids that can build up in the blood and urine.

Ketones in Urine

Having some ketones in your urine is normal, especially for people on a keto diet or who are fasting. However, high levels of ketones in the urine can be dangerous and may indicate a condition called ketoacidosis. Ketoacidosis is a life-threatening condition that often affects people with diabetes, but it can also occur in people without diabetes who have high ketone levels.

Symptoms of Ketoacidosis

• Frequent urination
• Extreme thirst
• Extreme hunger
• Nausea and vomiting
• Shortness of breath
• Fruity-smelling breath
• Fatigue
• Weakness
• Confusion

Testing for Ketones

The most common ways to test for ketones are through a urine test, blood test, or breath test. Urine tests can be done at home using over-the-counter testing kits, while blood and breath tests are usually done in a medical facility.

Interpreting Test Results

Test results for ketones in the urine can be negative or abnormal. Abnormal results fall into three categories: small, moderate, or large levels of ketones. Small levels of ketones are normal, especially for people trying to lose weight or maintain healthy blood sugar levels. However, moderate to large levels of ketones can be dangerous and require immediate medical attention.

Ketoacidosis

When the body doesn't have enough insulin, it starts breaking down fat too rapidly, producing ketones. Insulin plays a crucial role in helping glucose enter cells in the body. Without enough insulin, the cells don't get the glucose they need for energy, and the body turns to fat as an alternative energy source. This process of breaking down fat for energy is called ketosis, and it leads to the production of ketones, which are acids or chemicals created when the body breaks down fat. While small amounts of ketones in the urine are normal, moderate to high levels can be dangerous and indicate ketoacidosis.

The symptoms of ketoacidosis include frequent urination, extreme thirst, extreme hunger, nausea, vomiting, shortness of breath, fruity-scented breath, fatigue, weakness, and confusion. It is important to seek immediate medical attention if you experience any of these symptoms, as ketoacidosis can be life-threatening. Treatment for ketoacidosis usually takes place in a hospital, where individuals receive insulin, fluids, and other treatments to correct high blood sugar levels and replace lost fluids and bodily chemicals.

To prevent ketoacidosis, it is important to manage your diabetes effectively. This includes making healthy eating and physical activity a part of your daily routine, taking diabetes medications or insulin as directed, and monitoring your blood sugar levels regularly. Additionally, it is crucial to learn the warning signs of ketoacidosis and check your urine and blood regularly for ketones, especially when you are sick or experiencing stress. Early detection is key to treating and managing diabetes and preventing serious complications.

Urine and blood tests for ketones

Ketones are acids that your body produces when it breaks down fat for energy instead of glucose, its go-to source. While trace or small amounts of ketones in your urine are normal and safe, moderate to large amounts are dangerous and can lead to a life-threatening condition called ketoacidosis.

Urine Tests for Ketones

Urine ketone testing kits are available over the counter and are a convenient way to check ketone levels. They are usually test strips that you dip into your urine sample, which you collect by urinating into a clean container. The strip will then change colour, and you can compare this new colour to a chart that comes with the kit to determine your ketone level. Urine tests are a cheaper and more convenient method than blood tests, but they are not as accurate and may not be covered by insurance.

Blood Tests for Ketones

Blood tests are more expensive than urine tests, but they give accurate readings of your current ketone levels and are less messy to use. To test for blood ketones, you can use a home meter and blood test strips. Wash and dry your hands, insert a blood ketone test strip into the meter, prick your finger with a needle, and place a drop of blood onto the testing area. The result will display on the meter.

When to Test for Ketones

People with diabetes should test their urine or blood for ketones when:

• Their blood sugar is higher than 240-250 milligrams per deciliter (mg/dL) for two days in a row.
• They feel sick, nauseated, or have been injured.
• They want to exercise, but their blood sugar level is over 250 mg/dL.
• They have missed an insulin injection.
• They are on their period.
• They have been unable to eat.
• Their insulin pump stops working.

Symptoms of ketone buildup

Ketones are acids produced by the body when it breaks down fat to use as energy instead of glucose (sugar). Ketones are byproducts of this process and eventually leave the body through urine or blood.

When ketones build up in the blood, they can cause a condition called ketoacidosis, which is life-threatening and requires immediate medical attention. Ketoacidosis occurs when the body can't produce enough insulin, which is key to helping sugar enter cells in the body. The body then begins to break down fat as fuel, which causes a buildup of ketones in the bloodstream.

• Extreme thirst (polydipsia) and a very dry mouth
• High blood glucose (blood sugar) levels
• High levels of ketones in the urine
• Constant fatigue
• Nausea, vomiting, or abdominal pain
• Shortness of breath or difficulty breathing
• Fruity-smelling or "keto" breath
• Feeling disoriented, agitated, or confused (altered mental status)
• Decreased alertness
• Lightheadedness
• Muscle stiffness or aches
• Frequent urination

If you experience any of these symptoms, especially if you have diabetes or are at risk for developing it, seek immediate medical attention. Ketoacidosis can lead to severe illness or even death if left untreated.

Frequently asked questions