Overview
Ketones Reveal a Mismatch Between Fuel and Insulin
Ketones are alternative fuels produced when the body cannot use glucose effectively and shifts toward fat breakdown.
Ketones are alternative fuels produced when the body cannot use glucose effectively and shifts toward fat breakdown. In diabetes, this usually reflects inadequate effective insulin. Fatty acids are converted into three ketones: beta-hydroxybutyrate (β-HB), acetoacetate, and acetone. During diabetic ketoacidosis (DKA), β-HB is the predominant ketone. This matters because a blood β-HB measurement gives the clearest view of the active ketone burden. Urine strips provide a less precise, semiquantitative estimate reported as trace, +, ++, or +++. Ketones alone do not equal DKA. Fasting, prolonged vomiting, very-low-carbohydrate intake, and alcohol use can also produce ketones. DKA is the dangerous combination of insulin deficiency, ketonaemia, metabolic acidosis, dehydration, and progressive physiologic stress.