Ketone strips are a tool used to measure the level of ketones in urine, primarily by individuals following a ketogenic (keto) diet. They can also be used by diabetic individuals. These strips use a color-coding system to indicate the level of ketones in your urine, which can help determine if the keto diet is having the desired effect. High levels of ketones in urine indicate high amounts of fats in the urine.
What are Ketones?
Ketones are acids that are made in your liver. Everyone has them, whether you have diabetes or not. You produce ketones when you don't have enough of the hormone insulin in your body to turn sugar (or “glucose”) into energy. You need another source, so your body uses fat instead. Ketone production is the result of your liver turning fat into ketones and sending them into your bloodstream. Your muscles and other tissues can then use them for fuel. The breakdown of ketones is known as ketosis. Your body also will go into ketosis if you're not eating enough carbohydrates.
How Ketone Strips Work
Ketone test strips detect the amount of ketones in your urine, specifically, the ketone body acetoacetate. The strips have a small absorptive pad at one end, which you place in your urine stream.
Using Ketone Strips
Ketone strips are readily available at drugstores, large pharmacies, and in the pharmacy section of most large grocery stores. Look in the dietary supply section, or in a section dedicated to diabetic medical equipment. To use them:
- Collect a Urine Sample: Urinate into a disposable plastic cup to collect the urine sample. You can purchase disposable plastic cups at any grocery store.
- Dip the Strip: Dip about ¼ inch (0.64 cm) of the chemically sensitive end of the strip in a urine sample or urinate directly on the strip. Be sure to dip in the tip that contains the ketone-sensing chemicals. If you're urinating while seated, try not to dip the ketone strip into the toilet water. For most individuals, it's easiest simply to urinate directly onto the strip. Do this over a toilet.
- Wait: As your urine reacts with the chemicals on the urine strip, the strip will turn a yellow, maroon, or purple color. Follow the directions printed on the side of the packaging, which will tell you how long you should wait. Typically, you need to wait 40 seconds (or the time indicated on the packaging).
- Compare the Color: Look at the ketone-strip container; it will have a series of colored squares on one side. Compare the color of the strip to the indicators on the packaging to find your ketone level. It may be the case that the color of your urine strips fits in between 2 of the color squares on the packaging.
- Interpret the Results: 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. The colors will also correspond to numerical values: 0.5, 1.5, 4.0, etc.
If you’re new to keto and are trying to determine how deep into ketosis you are, it’s best to test at the same time every day. Since your hydration level plays a role in your test results, it’s best to test at a time when your hydration will be relatively the same each day. In general, you should aim for moderate to high ketones as you’re transitioning into ketosis. Using ketone test strips is an affordable and effective way to make sure you’re staying on track, especially in the beginning phases of keto.
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Understanding the Color Chart
The color of your ketone strip indicates the concentration of ketones in your urine. The darker the color, the higher your ketone levels.
- Light Colors: Indicate a low concentration of ketones.
- Dark Colors: Indicate a high concentration of ketones.
If you've recently started a keto diet, your body will be eliminating large amounts of ketones through the urine. This will result in a deep, maroon-colored urine strip, which correlates to a “Large” amount of ketones in your urine. When you begin a ketone diet, your ketone strip will turn a dark maroon or purple. By the time you're a few months in to the diet, though, your urine-strip results will lighten, and may only indicate a “Moderate” amount of ketone in your urine.
Drawbacks of Ketone Urine Strips
Of all the ways to test ketones, urine test strips tend to provide the least accurate results. This is due to a number of reasons, one of them being the switch to BHB, as previously mentioned. Foods and beverages can create harmless color changes in your urine that have nothing to do with ketosis. For instance, some people find that when they consume a large amount of beets, it shows up in their urine as a light pink color. Furthermore, your state of hydration will impact the concentration of ketones on the urine stick.
- Limited Accuracy: Ketone urine strips only test for the ketone body acetoacetate. As you get deeper into ketosis and become keto-adapted, your body will begin to efficiently convert acetoacetate and, as a result, produce more of the ketone beta-hydroxybutyrate (BHB), which cannot be detected using urine test strips. For this reason, experienced keto dieters who have been in ketosis for a while may present with very few ketones on their test strips. In this case, it’s best to switch over to a more accurate method that measures BHB, such as a blood test.
- Hydration Levels: Hydration levels can affect the concentration of ketones in the urine, leading to inaccurate readings.
- Interference: Certain prescription medications may interfere with the accuracy of the ketone strip results. These include meds used to treat UTIs.
- Color Changes: Foods and beverages can create harmless color changes in your urine that have nothing to do with ketosis. For instance, some people find that when they consume a large amount of beets, it shows up in their urine as a light pink color.
Advantages of Ketone Urine Strips
One of the biggest benefits of ketone urine strips is that they’re relatively quite inexpensive. Urine test strips come in a small container and don’t require anything other than the strip itself (no fancy add-ons). They are also pretty hassle-free. Reading your results with a keto test strip is incredibly straightforward. The only way to go wrong here is if you wait too long to read the results. If you get distracted and wait longer than about a minute to compare to the color chart, you’ll get a reading that falsely shows higher ketone levels than it should.
Alternative Methods for Measuring Ketones
- Blood Ketone Meters: Blood ketone meters are the more accurate way to measure your level of ketosis. They show an exact and real-time measurement of the ketones in your blood, which is considered the “gold standard.” The biggest drawbacks of the blood strips are that they can get expensive quickly. Some slight drawbacks of blood ketone meters are their accuracy per device and their failed readings. Blood ketone readings will vary (though not greatly) between device and strips, even if they’re from the same brand. Remember as well that you do have to prick your fingers to draw a sample of blood for each reading. You can frequently find deals online for a free meter since they are cheap. The meter companies usually use a proprietary strip that only works on their machine - so they are more interested in you purchasing strips. The four most recommended blood ketone monitors on the market are Keto-Mojo, Nova Max Plus, Precision Xtra, and KetoSens. Ultimately, the blood ketone meter you end up choosing will most likely come down to the price of the test strips. However, if you’re looking to track both blood sugar and ketone levels, KetoSens will not be the device for you.
- Breath Ketone Meters: Breath ketone meters are becoming more and more popular because of their simplicity. You connect it to your computer via USB and blow into it. They range from $150-200, so they are a pretty expensive upfront cost. We recommend that if you’re new to ketosis, you wait to buy one until you’re at a more advanced level. While breath meters are expensive upfront, it is much cheaper than the regular purchases of blood ketone strips. Research shows that there is a pretty good correlation between acetate in the breath and the level of blood ketone meters, but can vary as you get deeper into ketosis. While they are much more accurate than the urine sticks, they can vary widely against the results of a blood ketone meter. We recommend that if you’re on a budget, but you still want to have mostly accurate ketone readings, try Ketonix. Note: Ketonix on Amazon is from a third-party seller that is currently gouging prices.
Ketones and Diabetes
For individuals with diabetes, ketones in the urine or blood are a bad thing. Individuals with type-1 diabetes also need to track the levels of ketone in their blood, for medical purposes. 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.
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Diabetic Ketoacidosis (DKA)
Ketones can have an appetite-suppressing effect. In most cases, restricting carbs below 35 grams per day is all that is needed to enter ketosis and experience these benefits. Ketones are acids your body makes when it has to use body fat for energy instead of glucose (sugar). As your body breaks down fat, it makes ketones - they’re byproducts of this process. Like other chemical byproducts your body makes, ketones eventually leave your body through your urine (pee). But they can be in your blood, as well. Having ketones in your urine is called ketonuria.
The single most important aspect of the keto diet is to avoid high blood sugar and keep the levels of ketones in your body steadily elevated. A ketone test can warn you of a serious diabetes complication called diabetic ketoacidosis, or DKA. An elevated level of this substance in your blood can mean that you have very high blood sugar. Too many ketones can trigger DKA, which is a medical emergency. Regular tests you take at home can spot when your ketone levels run too high. Then you can take insulin to lower your blood sugar level or get other treatments to prevent complications.
Symptoms of DKA include high ketones in urine, increased thirst, increased urination, high blood sugar, nausea, fruity breath, difficulty concentration, and tiredness.
When to Test for Ketones if You Have Diabetes
If you live with diabetes, your doctor will probably tell you to test your ketones when:
- Your blood sugar is higher than 250 milligrams/deciliter (mg/dL) for two days in a row.
- You're sick or you've been injured.
- You want to exercise and your blood sugar level is over 250 mg/dL.
- You've missed an insulin injection.
- You're pregnant.
- You're on your period.
- You've had surgery.
- You've been unable to eat.
- Your insulin pump stops working.
You should also take the test if you begin to experience some of the signs of DKA such as:
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- Thirst
- Fruity-smelling breath
- Frequent urination
- Dry mouth or dehydration
- Headache
- Dry skin
Additional symptoms include:
- Fatigue
- Red skin
- Nausea, vomiting, stomach pain
- Trouble breathing
- Confusion
If your blood sugar level is high or you're sick, check your ketone levels every 4 to 6 hours. If you are pregnant and have been diagnosed with gestational diabetes, test yourself every morning before you eat breakfast.
Managing Ketone Levels
If your test shows a trace amount of ketones, it may mean your levels are starting to build. What you can do to bring down your ketone levels:
- Drink extra water to flush them out of your body.
- Test your blood sugar every 3 to 4 hours.
- Do not exercise if both your blood sugar and ketone levels test high.
- Eat a carbohydrate -- raising your blood sugar can help lower your ketone levels.
- Drink a carbohydrate-rich beverage like apple or orange juice.
You can make lifestyle changes to keep your ketone levels in a safe range. 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.
Everyone is different, so know your own ketone levels and when you should test them. 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. If you live with diabetes, be sure to take your insulin as directed and on a regular schedule. Sometimes your body just needs a bit of extra insulin to keep your blood sugar regulated. The events of everyday living -- an illness, injury, operation, your period or pregnancy -- can make your ketone levels rise. It's important to pay attention to what your body is telling you and to be ready and able to test and act quickly in the event your ketone levels are too high.
Nutritional Ketosis
Nutritional ketosis is achieved by consuming low-carb/high-fat foods, usually combined with fasting, the body starts producing ketones as it breaks down fats for energy. Higher-than-normal levels of ketones in the bloodstream trigger ketosis, which is touted to have several health benefits.
Monitoring Ketone Levels on a Keto Diet
Monitoring of ketone levels is warranted for individuals on a keto diet. It helps them regulate their dietary requirements based on their body's metabolic condition. A urine ketone test allows you to determine if the body is in a healthy (safe) state of ketosis, where a steady production of ketones signifies that your body is using the stored and consumed fat as an energy source.
A keto diet is considered safe as long as too many ketones do not accumulate in your blood. Keto-flu, the body's response to a sudden drop in blood glucose levels, is a typical consequence of a keto diet. It occurs in the early stages of a ketogenic lifestyle and manifests as muscle cramps, fatigue, mood swings, sleeplessness, and constipation. Some remedies can help alleviate these acute symptoms.
It is essential to keep track of your nutritional needs. Nutritional imbalance sometimes occurs, causing problems such as extreme weakness and fatigue, inability to concentrate, mood swings, anemia, and chills, which require prompt attention to avoid any risks or complications, such as those due to ketoacidosis. Any nutrition plan should, therefore, be adopted after consultation with a nutritionist or a healthcare professional. Ketone buildup in the bloodstream due to nutritional ketosis or fasting can be particularly risky for those with diabetes or other medical conditions involving the kidneys, liver, and gallbladder. Therefore, regular monitoring of blood and/or urine ketone levels is strongly recommended for these at-risk groups.