Understanding Ketones in Diabetes
By: Maxwell Horowitz, M.D.
What Are Ketones?
Ketones (also called ketone bodies) are chemicals your body produces when it breaks down fat for energy instead of using glucose (sugar). The three main ketones are beta-hydroxybutyrate, acetoacetate, and acetone. Your body normally produces small amounts of ketones during fasting, prolonged exercise, or when following a very low-carbohydrate diet. However, in people with diabetes, high ketone levels can signal a serious problem.
When Do Ketones Become Dangerous in Diabetes?
When you don't have enough insulin in your body, your cells can't use glucose for energy. This can be due to missed insulin doses, or being sick with an infection. This can also occur in someone who has a new diabetes diagnosis and has high blood sugar. Your body then breaks down fat rapidly, producing large amounts of ketones. This can lead to diabetic ketoacidosis (DKA), a life-threatening emergency characterized by high blood sugar, high ketones, and dangerous acid buildup in your blood. Warning signs of DKA include excessive thirst and urination, nausea, vomiting, abdominal pain, extreme fatigue, shortness of breath, fruity-smelling breath, and confusion. DKA can develop over just a few hours and requires immediate medical attention.
Who Should Monitor Ketones?
You should check your ketones if you have type 1 diabetes, a history of DKA, or take SGLT2 inhibitor medications such as empagliflozin (Jardiance), canagliflozin (Invokana), or dapagliflozin (Farxiga). Check your ketones when you have unexplained high blood sugar (above 200-250 mg/dL), symptoms of illness like fever or infection, nausea or vomiting, or abdominal pain. Pregnant women with diabetes should be especially vigilant about checking ketones, as DKA poses serious risks during pregnancy.
How to Monitor Ketones at Home
You can check ketones using either urine test strips or blood ketone meters. Blood ketone testing is preferred because it measures beta-hydroxybutyrate (the main ketone during DKA) and provides more accurate, real-time results. Urine strips only detect acetoacetate and can remain positive for up to 48 hours after ketones have cleared from your blood, which can be misleading during recovery. Many blood glucose meters can also measure blood ketones using special ketone test strips with a finger prick sample. If your ketones are elevated, follow your "sick day rules": drink plenty of water, take extra rapid-acting insulin as directed by your doctor, continue
your basal insulin even if you're not eating, check your blood sugar and ketones frequently, and seek medical help if ketones continue to rise or you can't keep fluids down. Studies show that people who use blood ketone monitoring during illness have fewer emergency department visits and hospitalizations compared to those using urine testing.
When to Seek Emergency Care
Go to the emergency room immediately if you have moderate to high ketones that don't improve with insulin and fluids, persistent vomiting that prevents you from staying hydrated, confusion or altered mental status, or severe abdominal pain. Early detection and treatment of high ketones can prevent DKA and save your life. Talk to your diabetes care team about obtaining ketone testing supplies and developing a personalized action plan for managing high ketones at home
For more information on diabetes management, chronic kidney disease, weight loss or nutrition education please call 561-659-6336 ext 8012 to schedule an appointment today. Please enjoy our December 2025 Living Well with Diabetes Newsletter
Introducing the New MiniMed INSTINCT Sensor
By: Monika Lambertson MS, RD, LD/N, CDCES
The much-anticipated MiniMed Instinct Sensor is now available! The Instinct joins the Guardian 4 and Simplera Sync sensor options for the 780g insulin pump system. When paired with a compatible sensor, the 780g pump is able to use SmartGuard technology to adjust basal insulin automatically and give small correction doses every five minutes, as needed. These correction doses help keep blood sugars at target and reduce blood sugar spikes, such as when a meal bolus is missed. The Instinct sensor is made exclusively for MiniMed by Abbott, the makers of the Freestyle Libre sensor line. The Instinct sensor is small (about the size of two stacked pennies) and features an all-in-one design, meaning it has a built-in transmitter and is fully disposable. With a single hand, one can easily apply the sensor to the back of one’s upper arm without taping. Further, the Instinct sensor has a 60-minute warm-up period and lasts up to fifteen days without any need for calibrations! For best communication, the pump and sensor should be positioned on the same side of body. The MiniMed Mobile app version 3.1.1 or later is required to start the Instinct sensor session, but for those without a compatible smartphone, a controller with the installed app will be provided. A pump software update to version 6.61 or later completed through the MiniMed Mobile app is required to use the Instinct sensor, which also allows use of any of the other compatible sensors (Guardian 4 and Simplera Sync).
Eligible in-warranty customers may have already received an email with instructions on how to access the software update. If not, visit Diabetes.shop or call 800-646-4633, option 2 (Monday–Friday, 8 a.m.–6 p.m. CT) to determine your eligibility for the Instinct sensor. A prescription for the Instinct is required. Once you have completed the software update and received your new sensors, please contact our education line at 561-659-6336 ext 8012 to schedule a training session with one of our certified educators.
If you would like more information about diabetes management, glucose monitoring, diabetes nutrition, heart healthy or kidney friendly meal ideas please call our office to schedule a consult with one of our Certified Diabetes Care and Education Specialists at 561-659-6336 ext 8012.
Healthy Meal Planning Class & Pre-Diabetes Sessions are available! Join our classes to stay motivated in 2026 & feel great!
Boynton Beach Location
6056 Boynton Beach Blvd.
Boynton Beach, FL 33437
Tuesday February 17th 10am-12pm
Pre-Diabetes Class
West Palm Beach Location (Virtual on ZOOM!)
Temple Israel 1901 N. Flagler Drive
West Palm Beach, FL 33401
Tuesday February 17th 10am-12pm
If interested attending this program please contact our scheduling department at (561) 659-6336 Extension 8012 today!
At Healthy Living with Diabetes we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended. You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 659-6336 ext. 8012. We would love to hear from you!
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