Assessing Metabolic Status with Assessing Metabolic Status with ß-Hydroxybutyrateß-Hydroxybutyrate

A Significant AdvanceA Significant Advancein Diabetes Self-Managementin Diabetes Self-Management

Ketone ProductionKetone Production In periods of insulin deficiency, In periods of insulin deficiency,

triglycerides are metabolized for energytriglycerides are metabolized for energy Fatty acids are transformed into ketones, Fatty acids are transformed into ketones,

acids that allow fat-derived energy to be acids that allow fat-derived energy to be utilizedutilized

Circulatory ketone levels increaseCirculatory ketone levels increase

Diabetic Ketoacidosis (DKA)Diabetic Ketoacidosis (DKA) Occurs when excessive levels of ketones Occurs when excessive levels of ketones

accumulate and the body becomes acidoticaccumulate and the body becomes acidotic It is a potentially life-threatening condition It is a potentially life-threatening condition -hydroxybutyrate is the predominant -hydroxybutyrate is the predominant

ketone associated with DKAketone associated with DKA

Who Is at Risk?Who Is at Risk? People with type 1 diabetes—especially People with type 1 diabetes—especially

children and pump userschildren and pump users Pregnant women with any form of diabetesPregnant women with any form of diabetes

Common Contributors to DKACommon Contributors to DKA InfectionInfection Inadequate available insulinInadequate available insulin Stress Stress Acute illnesses Acute illnesses Inappropriate sick-day managementInappropriate sick-day management

The Prevention of DKAThe Prevention of DKA Accurate ketone-level measurements Accurate ketone-level measurements Proper insulin managementProper insulin management

When to Test for KetonesWhen to Test for KetonesThe American Diabetes Association recommends that people The American Diabetes Association recommends that people with diabetes test for ketones in the following situations:with diabetes test for ketones in the following situations:

During acute illness or stressDuring acute illness or stress When blood glucose levels are consistently When blood glucose levels are consistently

over 300 mg/dLover 300 mg/dL During pregnancyDuring pregnancy When symptoms of ketoacidosis—nausea, When symptoms of ketoacidosis—nausea,

vomiting, abdominal pain—are presentvomiting, abdominal pain—are present

Types of Ketones TestedTypes of Ketones Tested Acetoacetate—the most Acetoacetate—the most

commonly measuredcommonly measured AcetoneAcetone -hydroxybutyrate—the predominant -hydroxybutyrate—the predominant

ketone associated with DKAketone associated with DKA

Ketone Testing MethodsKetone Testing Methods UrineUrine

– acetoacetate or acetone levels acetoacetate or acetone levels

BloodBlood -hydroxybutyrate levels-hydroxybutyrate levels

Urine Ketone TestingUrine Ketone Testing Urine is applied to a reagent strip or tabletUrine is applied to a reagent strip or tablet Color variation indicates the ketone level Color variation indicates the ketone level

in the urinein the urine

Disadvantages to Urine Ketone Disadvantages to Urine Ketone TestingTesting The results are The results are notnot real time real time The readings are qualitative—color comparisons The readings are qualitative—color comparisons

indicate high, medium or low levelsindicate high, medium or low levels Sulfhydryl drugs, including the ACE inhibitor Sulfhydryl drugs, including the ACE inhibitor

captopril, may cause false-positive resultscaptopril, may cause false-positive results High doses of vitamin C can cause High doses of vitamin C can cause

false-negative results false-negative results Does not detect Does not detect -hydroxybutyrate-hydroxybutyrate

Blood Ketone TestingBlood Ketone Testing Measures Measures -hydroxybutyrate-hydroxybutyrate Presently limited to the laboratory Presently limited to the laboratory

or office settingor office setting Benefits: real-time, reliable accuracy, Benefits: real-time, reliable accuracy,

quantitative readingsquantitative readings