The ketogenic diet (KD), characterized by its very low-carbohydrate, high-fat, and moderate-protein composition, has gained popularity for its potential health benefits, including weight loss and blood sugar control. A key goal for individuals following a keto diet is to achieve and maintain ketosis, a metabolic state where the body primarily burns fat for fuel instead of glucose. Ketone test strips are a tool used to monitor ketone levels in urine, providing feedback on the effectiveness of the diet.
What are Ketone Test Strips?
Ketone test strips are small slips of paper designed to measure the amount of ketones in urine. These strips use a color-coding system to indicate ketone levels, with higher levels suggesting that the keto diet is having the desired effect of promoting fat breakdown. Ketones are acids produced in the liver when the body doesn't have enough insulin to turn sugar (glucose) into energy and are detectable in breath, urine, and blood.
Types of Ketone Tests
Ketones can be measured through urine, blood, or breath tests.
Urine Tests
Urine tests, readily available at drugstores and pharmacies, involve dipping a chemically sensitive strip into a urine sample and comparing the resulting color change to a chart on the packaging. These tests are non-invasive and convenient, providing results in seconds. However, urine tests reflect ketone levels from the past few hours and may not be as accurate as blood tests.
Blood Tests
Blood tests, either conducted at a healthcare provider's office or using at-home kits, measure blood ketone levels of beta-hydroxybutyrate (BHB). These tests are considered more accurate than urine tests but are also more expensive and invasive, typically involving a finger prick. Some glucose monitors can also test blood ketone levels, eliminating the need for a separate device.
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Breath Tests
Breathalyzer tests are a newer method that detects acetone, a type of ketone, in the breath. While affordable, breath tests are currently considered less reliable than blood and urine tests for individuals at risk of diabetic ketoacidosis (DKA).
How to Use Ketone Urine Test Strips
Ketone urine test strips are an easy and affordable way to monitor ketone levels, especially for those new to the keto diet. Here's a step-by-step guide on how to use them:
- Collect a urine sample: Urinate into a disposable plastic cup. Disposable plastic cups can be purchased at any grocery store. Alternatively, urinate directly onto the strip over a toilet, being careful not to contaminate the strip with toilet water.
- Dip the strip: Dip about ¼ inch (0.64 cm) of the chemically sensitive end of the ketone strip into the urine sample. Ensure that the tip containing the ketone-sensing chemicals is submerged.
- Wait: Follow the directions printed on the packaging to determine how long to wait for the strip to react. Typically, this is around 40 seconds or the time indicated on the packaging.
- Compare the color: Compare the color of the strip to the color indicators on the packaging to determine the ketone level. The colors usually correspond to numerical values, such as 0.5, 1.5, or 4.0.
Interpreting Ketone Urine Test Strip Results
As urine reacts with the chemicals on the urine strip, the strip will turn a yellow, maroon, or purple color. The color of the urine strips may fit in between 2 of the color squares on the packaging. Once you've matched your urine-strip color with a color square, look closely to find the number and description that correlate with the color. Here's a general guide to interpreting the results:
- Dark maroon or purple: Indicates a "Large" amount of ketones in the urine, which is common when starting a keto diet as the body eliminates excess ketones.
- Lighter colors: As the body adapts to the keto diet, urine-strip results will lighten, potentially indicating only a "Moderate" amount of ketones.
- No ketones/Trace amounts of ketones: May indicate that the body is efficiently using ketones for fuel, which is common in individuals who have been on a keto diet for an extended period.
Factors Affecting Ketone Urine Test Strip Accuracy
Several factors can influence the accuracy of ketone urine test strips:
- Time of day: Ketone levels can vary throughout the day, so testing at the same time each day is recommended for consistency. Research indicates that ketonuria is highest in the early morning and post-dinner urine.
- Hydration: Dehydration can lead to increased ketone levels in urine, while excessive hydration can dilute the concentration.
- Medications: Certain prescription medications, such as those used to treat urinary tract infections (UTIs), can interfere with the accuracy of the results.
- Expired test strips: Expired test strips may produce inaccurate results, including undetectable ketone levels. Check the expiration date on the container and discard strips after they expire, typically within 3-6 months after opening.
- Adaptation: As the body adapts to using ketones for fuel, it becomes more efficient at producing them, leaving less unused and potentially resulting in lower readings on urine strips.
Ketone Levels and What They Mean
Ketone values vary depending on the test you’re taking. Also, what’s considered a normal or high ketone level can vary from person to person. The chart below provides general guidance on what blood ketone levels mean for your DKA risk and what actions you need to take.
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| Result | Ketone Level | Actions Needed |
|---|---|---|
| Normal | Less than .6 millimoles per liter (mmol/L) | None |
| Low to moderate risk of DKA | .6 to 1.5 mmol/L | Contact your healthcare provider for advice |
| High risk of DKA | 1.6 to 2.9 mmol/L | Visit the ER |
| Very high risk of DKA | More than 3.0 mmol/L | Visit the ER |
A urine test will show that you have:
- No ketones
- Trace amounts of ketones
- Moderate levels of ketones
- High amounts of ketones
Blood test results:
- Less than 0.6 millimoles per liter (mmol/L) = normal
- 0.6 to 1.5 mmol/L = slightly high
- 1.6 to 2.9 mmol/L = moderately high
- Higher than 3mmol/L = very high
Ketones and Diabetes
For individuals with diabetes, particularly type 1, monitoring ketone levels is crucial. High levels of ketones in the blood can indicate dangerously high blood sugar levels and may lead to diabetic ketoacidosis (DKA), a life-threatening condition. Symptoms of DKA include high ketones in urine, increased thirst and urination, high blood sugar, nausea, fruity breath, difficulty concentrating, and tiredness.
It's recommended that diabetics do not use urine strips for this purpose, though. If you have diabetes, you can develop diabetic ketoacidosis (DKA), which can be life-threatening. This is more common with Type 1 diabetes but can occur with Type 2 diabetes, as well.
When to Check Ketone Levels for Diabetics
Your healthcare provider will advise you on when or how often you should check your levels if you have diabetes. They may advise you to check when:
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- You have symptoms of DKA.
- You’re sick or injured.
- You’ve missed one or more insulin injections.
- Your blood sugar levels are higher than 240 milligrams/deciliter (mg/dl).
- You’re pregnant. (Insulin levels can be more challenging to manage during pregnancy. If you have diabetes, you may need to take extra care to monitor your insulin and ketones during pregnancy).
What Happens if Ketone Levels are High?
High ketone levels can make your blood too acidic and toxic. This is what happens with ketoacidosis. Diabetes-related ketoacidosis (DKA) is the most common type of ketoacidosis.
What are the Common Treatments for High Ketones?
Treatment depends on how high your levels are. Your healthcare provider may guide you on steps to lower your levels at home before they get dangerously high. A ketone test can warn you of a serious diabetes complication called diabetic ketoacidosis, or DKA.
Ketosis vs. Ketoacidosis
It's important to distinguish between ketosis, a natural metabolic state achieved through a ketogenic diet, and ketoacidosis, a dangerous condition primarily affecting individuals with diabetes. While both involve the presence of ketones in the body, ketoacidosis is characterized by dangerously high levels of ketones and blood sugar, leading to a potentially life-threatening acidic state.
Alcoholic Ketoacidosis
People with alcohol use disorder are at risk of alcoholic ketoacidosis. People with a history of heavy drinking may develop dangerously high levels of ketones. This usually happens after binge drinking and vomiting, which prevents you from getting enough nutrition. Like DKA, alcohol-related ketoacidosis is a medical emergency that requires immediate treatment.
What to Do if Ketone Levels Are High
If ketone test results indicate moderate to high levels, especially for individuals with diabetes, it's crucial to take prompt action:
- Contact your healthcare provider: Seek guidance on how to lower ketone levels and whether medical intervention is necessary.
- Drink extra water: Flush out ketones by increasing fluid intake.
- Test blood sugar frequently: Monitor blood sugar levels every 3-4 hours.
- Avoid exercise: Refrain from physical activity if both blood sugar and ketone levels are high.
- Consume carbohydrates: Raising blood sugar levels can help lower ketone levels. Consider drinking a carbohydrate-rich beverage like apple or orange juice.
- Review insulin regimen: Ensure that insulin is being taken as directed and on a regular schedule.
Lifestyle Changes to Maintain Safe Ketone Levels
- Keep a food and insulin routine: Eat meals that keep your blood sugar levels in check.
- Understand your insulin pump: How it works, and what to do in case it fails.
- Know your ketone levels and when you should test them: Everyone is different.
- Be ready to test in case you have signs of DKA.
- Carry backup insulin to treat ketones in case of an emergency.
- Always wear a medic alert ID so that people know you have diabetes and can act quickly.
The Ketogenic Diet: A Guide to Achieving Ketosis
The ketogenic diet requires a significant reduction in carbohydrate intake, typically to less than 50 grams per day, and an increase in fat consumption. This shift in macronutrient ratios forces the body to rely on fat for fuel, leading to the production of ketones and the state of ketosis.
Macronutrient Ratios for a Keto Diet
- 65-90% of calories from fat
- 10-30% of calories from protein
- Less than 5% from carbs
Time to Reach Ketosis
For healthy individuals, it can take several days on a keto diet to go into ketosis and a few more weeks thereafter to become keto-adapted.