Making Sense of Ketones with Diabetes

Learn what ketones are, how they are measured, and what to do with the information

Some people with diabetes have a higher risk for diabetic ketoacidosis (DKA) – which can be a frightening complication (click here for a background on DKA). Type 1 patients are at higher risk than type 2 patients, and among type 1 patients, those who are on a class of drugs called SGLT-2 inhibitors are more susceptible to DKA. The good news is that keeping tabs on ketone levels at home can help lower the chance of this complication. This article will break down what ketones are, how and when to measure ketones, and what to do with different ketone levels.

For more in-depth information on when it is most important to measure ketones, click here for our deep dive on DKA.


Good article, except for one glaring error where it states:

Possible DKA: in excess of 3.0mmol/L

That is absolutely incorrect, DKA range is minimum of 10.0mmol/L, and generally in excess of 20.0mmol/L.

The insulin all of us T1D’s inject does a lot of things, one of which is put the brakes on rising ketones and or DKA. In other words, if you’re worried about your ketone levels, increase your basal or take a bolus of our favourite drug.

For the record, I’m on a Keto diet and do have a Freestyle Libre Ketone meter. My 5AM ketone readings are typically 1.5-3.0mmol/L, and I’ve recorded ketones as high as 6.9 when doing extended (48 hour) fasts. Both fasting and exercise increase ketone levels, which makes sense as the body produces them as it metabolizes fat (Lipogenesis),

Interesting article, and a timely one for me as I just started taking Jardiance a month ago. So far I’m a big fan, but the caveat, as noted, is the risk of spilling ketones at a lower BG than you’d normally expect, which is why it’s off-label for T1s. But I produce a smidgeon of endogenous insulin, which gives me a safety buffer against DKA, so my endo thought I was a good candidate. It has been fantastic for me, really helping to flatten out post-prandial spikes, so I’m able to manage with less insulin and consequently fewer problems with hypos as well. Started me on a half-pill and even at that my TDD has dropped ~15 units. Just switched up to a full dose (10mg) and am now adjusting my basals downward accordingly, which should also help with weight loss.

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Yes interesting and accurate to my experiences.
I am a well controlled T2 on LCHF way of eating. I looked into The Keto programs.
It seemed a lot more restrictive , plus I was not really interested in doing all the calculations for micro nutrients. I did buy a Keto Mojo meter to see where I was on the Keto scale. With out changing anything I typically was 1.2 to 2.7 (which might be expected noted by the article.).
My current A1c is 5.7 without medication.