Ketones with normal blood sugar

If anyone has been reading my other posts you may know that I am new to the omnipod. I have been a diabetic for 10 years. Last night however was my first scare with high blood sugar and ketones. I got my blood sugars back down and stable over night, but woke up and I still have ketones. I also did not eat any carbs since 1pm yesterday. Could this be why I still have ketones? I have since then eaten breakfast. Hoping ketones go away.

@gsmergss - Any idea the level of ketones? Are you using urine strips for testing.

Don’t be alarmed at low level ketones, especially if you’ve not eaten for 12 hours or more (essentially a 12 hour fast). Trace ketones are normal under these circumstances.

At the same time, be cognizant that using a pump, if your insulin delivery is impaired for more than 4-6 hours, you can develop ketones far more rapidly than a T1D who’s injecting basal insulin.

If ever in doubt, injections (MDI) of insulin will throw the brakes on ketosis.

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I think I am definitely getting enough insulin because my levels are normal. I think they were so high yesterday because I wasn’t taking enough insulin for the food I was eating.

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@gsmergss I’m a low-carber (I intentionally avoid all carbs) and I’ve been in ketosis for some time. I have lower levels of ketones (1.5 mmol/L), certainly nowhere near approaching DKA levels.

I still requires insulin to manage sugars produced by my body metabolizing non-carbohydrate substrates (“Glycogenesis”). A little insulin has minimal impact on ketone levels. My total daily dose (TDD - basal and bolus combined) is 16-18 units per day.

If (when) I do 72 hour fasts, I cut my basal dose by 25-30%, and I’d still need 9-10 units per day eating nothing.


this is a good guide

If using urine testing, the test vial or package insert includes a color panel with a gradient of colors similar to this one captured from this site.


If urine ketones show a negative, trace, or small amount of ketones, there’s no need to worry. It’s when the urine shows moderate or large ketones that you need to respond appropriately.

@Terry4 yes thank you that I understand when your BG levels are high. But my levels are normal so I’m wondering if/what the danger is at that point when BG levels are normal but there are still ketones and how to get them down. My CDE/Pump trainer said that as long as levels are low, the ketones are probably do to not eating for a number of hours and should resolve with the addition of carbs.

No need to try to get small or trace levels of ketones down, especially with normal blood glucose levels. Low levels of ketones are present in non-diabetic people often after sleeping a full night. Ketones are a healthy alternate fuel for the body. Human evolution provides this fuel to cope with times of food scarcity.

The lesson here is that ketones exist across a spectrum in a healthy metabolism and are not to be feared at the lower levels. Unfortunately, diabetes education can give the impression, due to the real fear of DKA or high levels, that any ketones are bad. This is not true.


@gsmergss I wholeheartedly agree with what Terry mentioned about health professionals and diabetes education in general giving the wrong impression of a realistic ketone scale, what to ignore and when to have a real fear of DKA (which occurs at SERUM ketone levels of > 15mmol/L (or > 270 mg/dl).

You should also be aware there are 3 chemically different endogenous ketone bodies produced by the body, and each is measured differently (and a couple taken with a grain of salt):

  1. Acetone - produced and expired by the lungs (breath tastes like nail polish remover). A poor indicator of actual ketone levels
  2. Acetoacetic acid - a breaktone product of ketosis and a sign the body is using your own fats for energy. The bodies ability to produce acetoacetic acid slows down for people who intentionally avoid carbs, so this is also not an accurate measure.
  3. Beta-hydroxybutyric acid (BHB) - the serum (blood) level of ketones. What the doc’s and labs measure. Most accurate. A reading of well over 10mmol/l, and generally exceeding 20 mmol/l (360 mg/dl if you prefer) indicates you’re in DKA.

One 2010 study admits that though ketonuria’s relation to general metabolic health is ill-understood, there is a positive relationship between the presence of ketonuria after fasting and positive metabolic health. In other words normal healthy people have ketones, especially in the morning.


Dehydration maybe? Thats about the only thing I can think of as about 2 years ago I had the flu and became severely dehydrated and ended up in the hospital with DKA yet my BGs were below 200.

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No I’m not sick it was more than likely because I hadn’t eaten for 15+ hours because I also feel fine. No sock symptoms or DKA symptoms or anything like that.

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from the link above, for those on higher carb