Questions about ketones and testing

(A continuation of my last post about my ER visit. I apologize if I overlapped info here)

I have read a lot about ketone testing but can’t seem to quite grasp exactly what I should do. I just recently started testing for them, and have only done it twice. Once after my sugar had been above 250 all day, and another being last night and today after being sick with a fever, high blood sugar and then going to the ER to be on the safe side.

I just posted about my ER visit but I’ll shorten down to the ketones here: I tested last night, moderate. Drank water (sugar was not going down no matter what I was doing, coasting around 200-250). Tested later, trace amounts. Tested again negative.

I drank more and more water. Tested again and large amounts showed up. Then I had a bout of diarrhea so I knew I needed to go to the ER. I was drinking my weight in water and it wasn’t enough.

How often do you need to test, and how long do they stay in your body? If I test and end up negative but they come back, but I’m not vomiting and can keep down fluids, should I bother with the hospital? I worry about dehydration and know how fast DKA can happen. But if I know I can drink fluids all day and I can get hydrated, is it something to worry about?

I was told today in the ER (the ketones came back negative there, but I had IV fluids by the time my urine sample was taken), that I shouldn’t worry as long as I can keep fluids down. Since I have a viral infection, my sugars will run higher but if I rest and stay hydrated I should be fine.

But if I test positive for ketones and they go away, then come back, isn’t that of concern? I’m not sure. I don’t want to run to the ER every single time just to get IV fluids while this virus runs its course. Any clarification would help! thanks!

Over 51 years of type 1 diabetes, I’ve had bouts of occasionally very high blood sugar, which was the normal state for patients before the home glucometer was invented and it became possible to get valid measurements of glycose levels. Not once have I ever had DKA, not even at diagnosis, though I still check once a week. Generally you only have to worry about DKA if you have an infection.

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They taught me to check for ketones when my BG is 250 or over. I have yet to have even a trace, even though I’ve tested many times.

What would take me to the emergency room? Vomiting continuously and not being able to eat in any way shape or form.

I tried for three hours to avoid going to the hospital, but ended up waking up a roommate. I would also go the emergency room if I couldn’t get my BG to budge or get it under 300 for three hours–including shots for correction (I’m on a pump) and opening up a brand new vial of insulin.

When in doubt–go to the emergency room. Period.


You did the right thing. it’s not to be taken lightly.
this should help for next time. again, if there are any doubts get to hospital.

Session 4. Ketones, Ketoacidosis, and Hyperglycemia. - Dr. Bernstein’s Diabetes University

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Thanks everyone for the suggestions! I’m having a better day today and not so stressed about what to do. I appreciate it!!

It’s usually fairly easy to recognize the presence of ketones since the patient’s breath smells like nail polish. Sometimes patients become acclimatized to the scent of their own breath and can’t detect it, so just ask someone else to smell it and tell you what they think.

i test when my meter tells me my pump tells me to check for it when i enter the bg before a meal. so ill do it then which is 250 or higher. i do the water thing as well. i check again for myself an hour after i checked it the first time. once i am throwing up and peeing way too much i know i have high levels of ketones and go to the ER. but i think everyone will be different. i check at 250 and higher and go from there.