Large Ketones! Help!

I’ve had excellent blood sugars all week. I attribute this to IF and LCHF eating. However, the other day, I came home from work and randomly did a ketone test, which said I have Large Ketones. I freaked out, since I’ve recently had DKA 2x, and immediately drank a lot of water and SF powerade and beef broth with extra salt. After about an hour or so of that, my ketones went to small, then by end of night were at trace. I drank an enormous amount of water. The next morning, they were trace again. All that day, trace. This morning, trace. Did some errands after breakfast, came home, just tested and they are Large again!!

I know almost nothing about ketones.

What is going on with me?? Should I be concerned? I hear you can expect to have ketones if low carbing, but I also know I had large ketones when I had DKA so I’m very, very nervous.

Can someone please let me know what could be going on?? What level of ketones is “good” for nutritional ketosis?? but not dangerous (ie DKA)

Ketones are a natural byproduct of fat burning. You burn fat when your carbohydrates stores are depleted, either because of exercise, fasting, or whatever. There’s nothing dangerous about them, ordinarily.

When BG is extremely high due to lack of insulin, the body will burn fat to attempt to produce the energy it’s not getting from glucose (since the glucose is accumulating in the blood stream and the body’s cells are essentially starving). In that circumstance, DKA is a strong possibility.

So the general rule is, ketones with low or close to normal blood sugar normal and are not a danger signal in any way. Large amounts of ketones accompanied by very high BG readings, are a major danger signal.

Like most things in physiology, the balance is what matters. Context is everything.

As always, if you are seeing a pattern that doesn’t seem to comply with the above description—or are seriously worried about it for any reason—talk to your doc!

What about Large ketones with normal blood sugars?? that’s still okay?? Large as in 2nd to the darkest color on the chart on the ketostix bottle, but feeling fine and normal blood sugar??

If it has you really worried (and it sounds as though it does), keep a log (with times) of what you eat and what your BG and ketone readings are, and show it to your doctor. As mentioned, high ketones with normal blood sugar levels are not usually a problem. But it’s always possible that some other strange metabolic imbalance is going on. Better safe than sorry. always.

Thank you, David. This puts my mind at ease. I will log the info.–good idea, and present it to my doctor at my next appt. I would go to emerg ASAP if I felt sick or threw up, etc. I just don’t understand the whole ketones business. All I’ve learned is its okay to be in nutritional ketosis but bad to be in keto acidosis, yet both are signaled by ketones present…I think the difference is blood sugar levels…but I’m not sure it’d that simple. I sure wish I knew more. I’ll keep reading!

as said, there are normal dietary ketones and on low carb, you can sit between 1-5 but 1-3 is about right…

then there are high BG and ketones that need acting on by having more insulin

this should help you get your head around it and dietary LC ketones are seen as starvation here…and also when you are sick and your bloods are everywhere