People with diabetes must monitor their blood sugar and ketone levels to prevent complications. In some cases, people may experience euglycemic diabetic ketoacidosis. This refers to when a person has high ketone levels but normal blood sugars.
Glucose is the body’s primary source of energy. When people consume carbohydrates, they release glucose, raising blood sugar levels. However, if glucose is not available, the body can break down fats in the bloodstream, producing chemicals called ketones, and use these for fuel instead.
Insulin is a hormone responsible for allowing glucose in the blood to enter cells. This provides them with the energy to function.
People living with diabetes may not make enough insulin, or their cells may be resistant to insulin. In this scenario, blood sugar can become high, as the cells are unable to use it. As a result, a person may experience a severe complication called
However, in some cases, blood sugar levels may remain in a normal range, but people still have high ketone levels.
In this article, we look at what can cause high ketone levels with normal blood sugar.
High ketones with normal blood sugar may arise due to
They also explain that it may develop when someone uses sodium-glucose cotransporter 2 (SGLT2) inhibitors. SGLT2 inhibitors are a newer type of oral diabetes medication that includes:
Doctors may also
EDKA may be
- major illness
- reduced food intake
- persistent vomiting
- reduced insulin dosages
The American Diabetes Association (ADA) advises that DKA is a serious condition that can lead to a diabetic coma or even death. DKA may happen to anyone with diabetes, though it is rarer in people with type 2 diabetes.
People with diabetes may develop DKA when there is an overload of ketones in their blood, making it more acidic.
According to the National Health Service (NHS) in the United Kingdom, a ketone blood test reading of 3 millimoles per liter (mmol/L) or above means that someone has a very high risk of DKA and should get medical help immediately.
Additionally, lower readings of 0.6 to 1.5 mmol/L mean a person is at a slightly increased risk of DKA and should test again in 2 hours.
The ADA advises that with DKA, early symptoms may include:
- frequent urination
- thirst or dry mouth
- high blood glucose
- high ketone levels
Then, other symptoms appear, including:
- persistent tiredness
- dry or flushed skin
- nausea, vomiting, or abdominal pain
- difficulty breathing
- a fruity odor on the breath
- difficulty paying attention or confusion
- shortness of breath
- generalized malaise
- loss of appetite
- abdominal pain
The ADA recommends testing for ketones with a simple urine test strip. They suggest testing for ketones when blood glucose exceeds 240 mg/dL. In addition, when someone is ill, such as with the flu or a cold, they should test for ketones every 4–6 hours.
People can ask a healthcare professional about ketone urine test strips.
People should contact their doctor if a urine test shows high levels of ketones or if they have any signs or symptoms of DKA or EDKA.
It is possible for a person to have high levels of ketones and normal blood sugar levels. This may be due to SGLT2 inhibitors causing euglycemic diabetic ketoacidosis.
It is advisable for people living with diabetes to monitor their blood sugar and ketone levels and look out for signs or symptoms that could indicate DKA or EDKA. If a urine test shows high levels of ketones, it is advisable to contact a doctor.