Ketones are substances produced when cells cannot access glucose as an energy source, leading to fat metabolism. High ketone levels can indicate ketoacidosis, a severe complication in diabetes.
Dr. Marcin Pacek, Senior Director of Medical and Scientific Affairs at Nova Biomedical, recently discussed the critical role of ketone measurement in diabetes management and other conditions.
Overview of Ketones
Ketones are produced when cells are unable to access glucose for energy, forcing the body to metabolize fat instead. While they serve as an alternative fuel during fasting, elevated ketone concentrations (ketonemia) can lead to diabetic ketoacidosis (DKA)—a severe complication most common in type 1 diabetes, but also occurring in type 2 diabetes and patients on SGLT2 inhibitors.
Types of Ketones
Three ketones exist in humans:
- Beta-hydroxybutyrate (BHB): >80% of total ketones; the primary ketone measured in blood.
- Acetoacetate (AA)
- Acetone
Measurement Methods
- Blood BHB measurement: Recommended for diagnosis and monitoring of DKA. Point-of-care meters (e.g., Nova StatStrip) enable reliable self-testing.
- Urine measurement: Measures AA and acetone, but can be misleading due to delayed excretion and persistence of acetone after DKA resolution.
Clinical Guidelines
Leading organizations (ADA, ISPAD, JBDS) recommend blood BHB testing for DKA diagnosis and monitoring. Elevated glucose (>250 mg/dL) with high blood ketones indicates probable DKA.
Benefits of Early Detection
Early DKA diagnosis reduces morbidity and mortality. Studies show blood ketone monitoring shortens ICU stays and reduces costs compared to urine testing.
COVID-19 and DKA
A study of COVID-19 patients in North London found:
- ~64% developed DKA
- Higher mortality in DKA patients
- Non-diabetic patients also developed ketosis, suggesting COVID-19 may directly trigger DKA.
Expert source: Dr. Marcin Pacek, Senior Director, Medical & Scientific Affairs at Nova Biomedical.