Skip to main content

Warning notification:Warning

Unfortunately, you are using an outdated browser. Please, upgrade your browser to improve your experience with HSE. The list of supported browsers:

  1. Chrome
  2. Edge
  3. FireFox
  4. Opera
  5. Safari

Ketones and diabetic ketoacidosis (DKA)

Ketones are a chemical that your liver produces when it breaks down fats.

If you have type 1 diabetes you should be able to measure your blood ketones.

Having low levels of ketones is not a problem if they are less than 0.6 millimoles per litre (mmol/l).

When you develop high levels of ketones they can lead to serious problems

Measuring ketones

Your diabetes team will give you:

  • a meter to test for ketones (ketone meter)
  • a prescription for ketone strips

You can tell if you have high levels of ketones in your blood by checking for them using your ketone meter. If you lose your ketone meter, contact your diabetes team for a replacement.

If your ketones are above 0.6 you will need advice on how to manage your insulin. This information is in the sick day advice booklet, or speak to your diabetes team.

Sick day advice for adults with type 1 diabetes (PDF, 677 KB, 9 pages)

Diabetic ketoacidosis (DKA)

High ketone levels may cause a serious problem called diabetic ketoacidosis (DKA).

Your body starts to break down fat for energy when there's not enough insulin. This can lead to a build-up of ketones in your blood. It can be life threatening and should be treated in hospital.

Check for ketones if:

  • your glucose is more than 11mmol/l
  • you feel unwell

DKA can develop quickly, over a few hours.

Common triggers for DKA include:

  • not taking your insulin
  • not taking enough insulin
  • infection or illness

Urgent advice: Contact your care team, call 999 or go to the emergency department immediately if

your glucose level is high and you have symptoms of DKA:

  • ketone levels over 3mmol/l
  • abdominal pain
  • fast breathing
  • feeling or being sick
  • your breath smells of pear drops or acetone
  • a sweet or metallic taste in your mouth

You will need treatment in hospital.

Emergency action required: Go to your nearest emergency department if:

  • your ketone level is above 3mmol/l
  • you start vomiting
  • you are unable to keep fluids down
  • you are unable to manage your glucose or ketone levels

This is a medical emergency.

If you need to call an ambulance dial 112 or 999 and ask the operator to put you through to the ambulance service.

Page last reviewed: 17 October 2023
Next review due: 17 October 2026