Ketone Checks Diabetes: What You Need to Know About Testing and Management

When you have diabetes, a condition where the body can’t properly use blood sugar for energy. Also known as hyperglycemia, it can trigger your body to break down fat for fuel—producing ketones, acidic molecules that build up when insulin is low. Too many ketones make your blood too acidic, leading to a life-threatening condition called diabetic ketoacidosis, a medical emergency that happens mostly in type 1 diabetes. That’s why regular ketone checks, a simple test to measure ketone levels in blood or urine are not optional—they’re a survival tool.

Ketone checks matter most when your blood sugar is over 240 mg/dL, you’re sick, stressed, or missing insulin doses. Even if you feel fine, high sugar + rising ketones = danger. People with type 1 diabetes are at highest risk, but some with type 2—especially if they’re on SGLT2 inhibitors—can also develop ketoacidosis. You don’t need to test daily, but you should know the signs: nausea, fruity breath, confusion, extreme thirst, or frequent urination. A home ketone meter gives you a number in minutes. Levels under 0.6 mmol/L are normal. Between 0.6 and 1.5 mmol/L means you’re at risk—drink water and check again in 2 hours. Above 1.5 mmol/L? Call your doctor. Don’t wait.

Many people think ketones only show up when they’re starving or on a keto diet. That’s not true. In diabetes, ketones mean your body is running out of insulin, not that you’re burning fat efficiently. It’s a warning, not a goal. That’s why insulin therapy isn’t just about lowering sugar—it’s about stopping ketone production before it spirals. Even small delays in insulin can turn a manageable spike into a hospital trip. And yes, this is why some people with diabetes carry ketone test strips in their wallet or purse.

What you’ll find in the articles below are real, practical guides on how to handle high ketones, when to go to the ER, how insulin dosing affects ketone levels, and why some medications increase your risk. You’ll also see how other conditions like infections or missed meals can trigger this process—and what to do about it. This isn’t theory. It’s what keeps people alive.