Urine ketone testing is often overlooked, but it is an essential part of care for patients with type 1 diabetes. The individually foil-wrapped strips are convenient to carry. Type 2 diabetes patients are normally ketosis-resistant, but during periods of severe trauma, infection, or illness can become ketotic and even develop full-blown DKA. Thus, a useful practice is to have all diabetic patients monitor urine ketones during severe illness.
Patients with type 1 diabetes should check urine ketones when their blood sugars are consistently over 240 mg/dl. This is especially critical for patients on insulin pumps since it may indicate malfunction of their pump delivery system.
Pregnant women (including those with gestational diabetes) are advised to monitor urine ketones every morning.
Positive urinary ketones do not always indicate sickness. Ketones are a byproduct of fat metabolism, and their presence with normal blood sugars can indicate fat mobilization in a patient who is actively trying to lose weight by restricting calories. However, patients with type 1 diabetes who are restricting their calories for weight management may also restrict their insulin, resulting in metabolic decompensation and DKA in the absence of marked hyperglycemia. This is especially common in teenage girls who desire rapid weight loss such as during prom season. Thus, patients should carefully monitor urinary ketones and glycemia during periods of caloric restriction.
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