What Should I Do If I Have Ketones in My Urine?

Medically Reviewed on 2/23/2022
ketones in urine
If your urine reports show moderate or high levels of ketones, consult your doctor right away.

A small amount of ketones in your body is normally seen if you are fasting or following the famous “keto diet.” However, in some cases, high ketone levels can cause serious illness or even death due to consequent acidosis.

  • If your urine reports show moderate or high levels of ketones, consult your doctor right away. This is a sign that your diabetes is out of control or that you are becoming ill due to it.
  • If you are unable to contact your diabetes care team, go to the nearest emergency room or urgent care center.

General treatment guidelines to control ketones include:

  • Drinking plenty of water or other calorie-free fluids to aid in the removal of ketones from the body
  • Taking insulin as directed by the physician to lower your blood glucose level
  • Rechecking your blood glucose and ketone levels every three to four hours
  • Exercising until your ketone levels are controlled by your doctor

Levels of ketones in the urine

  • Normal/negative:
    • Less than 0.6 millimoles per liter (mmol/L)
  • Low to moderate:
    • 0.6 to 1.5 mmol/L
  • High:
    • 1.6 to 3.0 mmol/L
  • Very high:
    • Higher than 3.0 mmol/L

When ketones accumulate in the blood, they cause the body's pH to become acidic. The body tissues cannot optimally function at acidic pH. This indicates that your diabetes is out of control or that you are becoming ill with a serious infection.

Ketone levels that are too high can poison the body. When levels become too high, you can develop diabetic ketoacidosis, a diabetes complication that can result in a coma or even death.

What is ketonuria?

Ketonuria is a medical condition characterized by the excretion of higher-than-normal levels of ketone bodies in the urine. Symptoms of ketonuria vary according to the underlying cause. 

The following are some of the most common symptoms of ketonuria:

  • Fruity smelling breath: This is due to the fruity odor of acetone that is released from the lungs.
  • Frequent urination: Urination occurs more frequently than usual as the body attempts to rid itself of ketone bodies.
  • Nausea and vomiting: Other electrolytes, such as sodium and potassium, may be disrupted because of the increased level of ketone bodies in the body. A change in the concentration of these electrolytes can cause nausea and vomiting.
  • Dehydration and excessive thirst: Dehydration and excessive thirst are caused by frequent urination, nausea, and vomiting.
  • Confusion and disorientation: Prolonged ketonuria may affect the brain, causing a lack of focus and confusion.
  • Heavy breathing


Diabetes: What Raises and Lowers Your Blood Sugar Level? See Slideshow

6 causes of ketonuria

The following are the primary causes of ketonuria:

  1. Low insulin levels:
    • When the body's insulin levels are low, it cannot efficiently move sugar into cells or store it as fuel in the liver. Instead, body fat and proteins are used, resulting in the production of a large number of ketones as by-products.
    • Ketonuria is caused by metabolic abnormalities such as diabetes mellitus or glycogen storage disease, both of which are associated with low insulin levels.
  2. Dietary conditions such as ketogenic diet or starvation:
    • A low carbohydrate diet, also known as a ketogenic diet, could be the source of ketonuria.
    • People on this diet tend to consume low carbohydrates, which causes the body to use available fats and protein, resulting in the release of ketones as a by-product.
    • Similarly, as a result of lack of food consumption, the insulin level in the body decreases during starvation.
    • When the reserved glucose is depleted, the body begins to feed on the protein and fat in the body, producing ketone bodies as an alternative fuel source.
  3. Pregnancy:
    • The change in pregnancy hormone prevents body cells from consuming glucose, resulting in a sugar deficiency.
    • As a result of the low carbohydrate intake, fat and protein metabolism begins and causes ketosis.
  4. Digestive disturbances:
    • If the absorption of carbohydrates is hampered due to digestive system disturbances, the body glucose level may fall.
    • The body then uses the muscles and fats to generate the required energy, increasing the levels of ketone bodies in the urine.
  5. Prolonged alcohol consumption:
    • Heavy alcohol consumption, especially when combined with poor nutrition, depletes hepatic glycogen stores, and ethanol metabolism further impairs gluconeogenesis.
  6. Other causes:

What is nutritional ketosis?

When blood ketone bodies levels increase, the body enters nutritional ketosis. This occurs when the body begins to burn its fat reserves as its primary fuel source rather than carbohydrates.

  • When you begin a low-carb diet, your body begins to release fatty acids from its fat reserves. Fatty acids are then transported to the liver and converted into ketone bodies (in the process of ketogenesis).
  • These ketone bodies, or ketones, then serve as the body's and brain's new source of energy. You will enter ketosis if you limit your carbohydrate intake to a minimum. 
  • Consume no more than 50 grams of carbohydrates per day. This will cause a change in your metabolism, causing your body to replace carbohydrates as the primary source of energy with fats.

To achieve nutritional ketosis, you should follow a ketogenic diet plan that includes:

  • Low carbohydrate content (to maintain the state of ketosis)
  • High protein content (to protect your muscles)
  • Vitamins and minerals in the right proportion

Advantages of nutritional ketosis

Ketosis can have a positive effect on some health conditions.

  • Reduces weight
  • Reduces the risk of diabetes
  • Reduces the levels of low-density lipoprotein (bad) cholesterol and increases the levels of high-density lipoprotein (good) cholesterol
  • Reduces swellings in the body
  • Boosts the lymphatic circulation
  • Good for people who have epilepsy

Disadvantages of nutritional ketosis

Disadvantages of nutritional ketosis include:

It's important to distinguish between nutritional ketosis and diabetic ketoacidosis. 

Ketoacidosis is a condition that occurs when a person's body is unable to produce insulin, a hormone that prevents the production of ketones. This is true for people who have type I diabetes or who have advanced type II diabetes.

Nutritional ketosis is considered safe for people with obesity and overweight. However, one should not overdo it.

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Medically Reviewed on 2/23/2022
Image Source: iStock Images

Ketone Bodies (Urine): https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=ketone_bodies_urine

KETONES — THE 6 MUST-KNOWS: https://beyondtype1.org/ketones/

Checking for Ketones: https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/monitoring-diabetes/checking-for-ketones/

Ketones: https://www.rch.org.au/uploadedFiles/Main/Content/diabetes/Ketones%20PDF.pdf