How to Use Ketone Strips to Measure Ketosis

Medically Reviewed on 8/24/2022
Ketone Strips
Ketone strips are used when you’re on the ketogenic diet.

Ketone strips are usually small strips that are used to measure the level of ketone in your urine. These strips have color codes that indicate the level of ketones in your urine.

In people with diabetes, a high level of ketones in urine may indicate a dangerous condition called diabetic ketoacidosis.

How to use urine ketone strips


  • Wash your hands.
  • Collect the urine sample in a clean container.
  • Hold the end of the strip in the urine sample for a couple of seconds.
  • Shake the strip in the container to remove any excess liquid.
  • Wait for 15 seconds until the color of the strip changes.
  • Compare the color of your ketone strip with the color chart.
  • Discard the urine strip.
  • Wash your hands.
  • The best way to do a ketone strip test is to compare it with the previous readings.

To keep the results accurate and reliable, do the following:

  • Collect a clean-catch urine sample.
  • Replace the cap of the strips after every use.
  • Do not expose the strips to sunlight or moisture.
  • Do not remove the desiccants.
  • Do not touch the testing area with your hands.
  • Check the expiry date before testing.

What is a ketone in urine test?

  • The level of ketones in the urine is measured by a urine test.
  • Normally, glucose in the blood is used by cells in the body for energy.
  • If your cells do not get enough glucose, they break down fats for energy, which produces a substance called ketone.
  • Having a minimal amount of ketone is normal, but high levels of ketones in urine or blood may disturb the pH balance, making the blood more acidic; the condition is called ketoacidosis.
  • Ketoacidosis is the most common complication of diabetes and is called diabetic ketoacidosis.
  • Diabetic ketoacidosis is common in people with type I diabetes but can be developed in type II diabetes.
  • Diabetic ketoacidosis is a medical emergency, which may be life-threatening.

What are ketone test strips?

  • Ketone strips are made from a special type of paper that contains chemicals that change color on coming in contact with ketones in the urine.
  • This is an easy, quick, and accurate method of measuring ketones in your body.
  • These test strips can be easily used at home or in a pathological lab.
  • They are used to detect ketones in our bodies. They measure acetoacetate, which is the second most abundant ketone excreted through urine.
  • A urine test is a noninvasive method that provides results in seconds. It is the most convenient ketosis testing method. The procedure can be done morning and evening preferably at the same hour to have the highest and most reliably detectable values of ketones.
  • Moreover, ketone strips are used when you’re on the ketogenic diet. They can be beneficial when you’re just starting your keto. They are not considered a must when you’re on a ketogenic diet. These strips are useful when you’re having a cheat day or diet break.


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What are the 3 types of ketone strip tests?

Three types of ketone strip tests include:

  1. Urine type
  2. Blood type
  3. Breath type

Among all these three types of ketone strip tests, the most commonly used is urine type.

When to do the ketone strip test

  • The best time to do a ketone strip test is early in the morning on an empty stomach.
  • You can choose another time although you may ask your doctor if any medications you are on may interfere with the test.
  • It is important to test ketones early in the morning after sleep because your body will rest and clear the food taken in before night, which gives accurate results.

How to interpret ketosis urine strip results

  • Ketone strips usually have light beige color, which gets darkened as the level of ketones increases.
  • If the ketone bodies are detected in your urine, the deeper the color of the strip will be.

Reference for different ketone levels

  • Negative (no ketones): You are not in ketosis
  • Trace (0.5 mmol/L): Light nutritional ketosis
  • Small (1.5 mmol/L): Light nutritional ketosis
  • Moderate (4.0 mmol/L): Increased ketone levels as a result of exercise or fasting
  • Large (8.0 mmol/L): Usually as a result of prolonged fasting; not sustainable in the long term
  • Larger (16 mmol/L): Usually as a result of prolonged fasting; not sustainable in the long term
  • Note: mmol/L stands for millimoles per liter, and it refers to the concentration of ketones in a specific amount of liquid—in this case, your urine. 
  • In a well-formulated ketogenic diet, the ketosis falls between 0.5 and 2 mmol/L.
  • High ketones are not good for everyone.

How accurately do ketone strips measure ketosis?

  • Ketone strips are not always accurate. Inaccurate results could be possible in a few circumstances.
  • Ketones in urine don’t give a true indication of what’s happening in the body.
  • Ketones that are unused by the body are excreted through urine.
  • Urine strips only measure the unused or excessive ketones that our body doesn’t use.
  • Blood ketone levels are more accurate than urine ketone test strips.

What are the benefits of ketone strip testing?

Benefits of ketone strip tests include:

  • Determine dangerously high blood ketones
  • Check if your body is in ketosis

How often does ketone testing have to be done?

  • It is not necessary to test ketone very often.
  • If you want to check out of curiosity, maintain a certain fasting protocol and do the testing.
  • Better to track the ketone levels once a week or as advised by your doctor.
Medically Reviewed on 8/24/2022
Image Source: iStock image,Diabetes. What is ketoacidosis how to do ketone testing, benefits of ketone testing