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HealthInfo West Coast-Te Tai Poutini


One dangerous, and relatively common, complication of type 1 diabetes is a condition called diabetic ketoacidosis – often called DKA.

When your body doesn't have enough insulin, it doesn't move glucose into your cells, which become starved of energy. Your body then burns fat to get energy.

Burning fat releases chemicals called ketones, which are acidic and poisonous. The scientific name for one of the main ketones is beta-hydroxybutyrate.

Your kidneys can clear small amounts of ketones, but they can't cope with large amounts. As a result your blood ketone level increases, causing DKA, which is potentially life-threatening.

When am I at risk of producing ketones?

Ketosis is a minor increase in ketones, and is not always dangerous. It can happen if you are fasting, on a low-carbohydrate diet, or have drunk too much alcohol. If you are experiencing ketosis, you will have slightly more than the usual level of ketones in your blood.

Only people with type 1 diabetes are at risk of DKA. If you have type 1 diabetes, there are two situations in which it might happen:

If you use an insulin pump you can develop ketosis more quickly than people using injections, because you have no background insulin.

How do I know if I am producing ketones?

ketonesIf you are producing ketones, you may have some of the following symptoms:

Testing for ketones

Many people with type 1 diabetes have a ketone testing meter. If you are not sure if you should have a meter, ask your normal diabetes care team.

You should test for ketones if your blood glucose level is persistently higher than 14 mmol/l or if you have an infection.

Where to get ketone testing strips

You can get blood ketone test strips and a meter on prescription.


Get medical help if:

Interpreting ketone test results

No matter what your ketone level, if your blood glucose is below 4 mmol/l treat for low blood sugar (hypoglycaemia). Seek medical help if your blood glucose stays low or your ketones stay high.

Ketone level

What to do

more than 1.5 mmol/l



  • If your blood glucose is below 8 mmol/l, try to eat some extra carbohydrate, such as a sandwich, yoghurt, or a banana.
  • If your blood glucose levels are high (persistently above 14 mmol/l) you will need extra insulin – follow the recommendations you have been given for managing sick days.
  • Test your blood glucose and ketones every hour. You may need to have several extra doses of insulin.
  • If your ketones are decreasing, this is reassuring. You can stop extra monitoring and ketone tests once your ketones are below 1.4 mmol/l.

Seek medical help if:

  • your ketones are increasing despite extra insulin
  • your ketones (beta-hydroxybutyrate) are greater than 4 mmol/l and don't come down within two hours
  • you are feeling unwell.

1-1.4 mmol/l

  • This is slightly high. You should adjust your insulin according to he recommendations you have been given for managing sick days.

less than 1 mmol/l

  • Your ketone levels are reassuring, but you may need to adjust your insulin if your glucose is high according to the recommendations you have been given for managing sick days.

Information provided by the Canterbury DHB. Adapted by the West Coast DHB. Page created February 2017.


Page reference: 352958

Review key: HIDTO-44405