Blood, Not Urine, Test Better for Diabetics with Ketones in Blood

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Sick days, illness, undue stress or persistent hyperglycemia (high blood sugars) are all conditions that require patients to test for ketones in the blood.  “But what is the best approach for testing?  I don’t know what to do.” It’s questions like these (that I often hear) which alert me to the fact that many patients are not given adequate training or information to care for the demands of diabetes.

Many parents and patients are in the dark about the best method to test for Diabetic Ketoacidosis (DKA), which occurs when your body produces “very high levels of blood acids called ketones.” (Mayo Clinic)  While this lack of knowledge may be a unique problem for many international communities – something tells me it’s not.  I am always shocked when I hear that health care professionals have neglected to tell patients critical self-care information, and the same goes for important updates or changes in practice — the category which I believe this particular issue belongs.  There is an infinite and ever-changing amount of information that needs to be exchanged from diabetes medical teams to new or existing patients and family.  Sometimes it just doesn’t happen.

Gold Standard for DKA Testing

Do you know that the gold standard for testing ketones is blood, NOT urine. (American Diabetes Association, 2000).  It’s been 11 years since that standard was published and yet,  many patients probably continue to rely on a vial of Ketostix (Bayer) safely tucked away in the medicine cabinet, hardly used and perhaps out-of-date.  It wouldn’t matter much, as generally, these types of urine-ketone tests can be inaccurate.  Why?   Test strips are interpreted according to color coding, resulting in false positives and negatives.  These false outcomes can occur for a variety of reasons including certain adverse drug interactions, acidic urine, increases in Vitamin C intake and more.  According to diabetes educator Marlyn Crane (“Role of Blood Ketone Testing in Sick Day Management”):

Urine testing cannot provide the precision required for
at-home prevention, identification, and treatment of DKA.

whereas, Blood tests for ketones

provide a real-time measure of ketonemia by testing for the sub-
stance that is most indicative of risk for DKA.

Now that we have established that blood testing is the best way to assess blood ketone levels, what types of technology are available?  It is hard to believe that only one company provides a blood ketone meter for home use and that company is Abbott Labs:

The meter:  Precision Xtra (also called the Optium outside the US)
Tests blood glucose and blood ketones, but uses different strips for each which must be purchased separately

The best tactic for acquiring this product if you already have a meter that you are reluctant to give up, is to buy one, but only use it for ketone testing.   Keep it handy along with a box of strips which have a healthy expiry date.  If you find yourself with ketones in the blood, the best approach is to call your doctor.  This way you’ll know exactly how much more insulin to take, what kinds of things the doctor may prescribe (drink more fluids, for example) and how often to monitor.  DKA is not something to take lightly.  As a patient who had a BS of 1200 mgdl (66 mmol) on the day of diagnosis, I remember how horrible DKA felt.  I don’t believe any of us want to experience that terrible feeling again.