Ketone Monitoring

Diabetic ketoacidosis (DKA) is a marker of absolute insulin deficiency. It occurs predominantly in people with type 1 diabetes but can occasionally occur in individuals with type 2 diabetes or gestational diabetes. This is especially true in times of illness and with the increasing use of sodium-glucose co-transporter 2 (SGLT-2) inhibitors causing what is known as euglycemic DKA.

It is therefore even more essential an individual with diabetes understands:

Exactly what diabetic ketoacidosis is
The likelihood an individual with diabetes is at risk of DKA
If there is a likelihood of DKA, how to prevent it from occurring.
The best way to check for DKA.
What to do if DKA does occur

People with an increased risk of DKA (those newly diagnosed with type 1 diabetes or who have been started on SGT2 inhibitors) should be referred to a Credentialled Diabetes Educator for education on sick day management.

In Australia when an individual is diagnosed with diabetes, they are registered on the NDSS (National Diabetes Services Scheme). The NDSS aims to enhance the capacity of people with diabetes to understand and self-manage their life with diabetes and to access services, support, and subsidised diabetes products. Products include (but limited to) blood glucose monitoring stirps, urine ketone monitoring strips and needles and syringes to deliver insulin to the body when it is not producing adequate amounts. (https://www.ndss.com.au/about-the-ndss/registration/ ).

While there is some question whether urine ketone monitoring strips have the same level of sophistication as blood ketone monitoring strips), the former is covered by the NDSS. (https://www.ndss.com.au/wp-content/uploads/order-forms/blood-glucose-testing-strips-order-form.pdf )
There are several reasons for blood monitoring to be more accurate than urine.

A colour chart is used to determine the level of ketones in the urine. This is often misread or misinterpreted. It is also exceedingly difficult for those who are coloured blind. Blood ketones are read digitally, similarly to blood glucose.
There is a time delay for ketones to show in the urine. Blood ketones are much more time sensitive.
At low concentrations, most ketone bodies are reabsorbed by the kidney. However, this low level may be impacting on a person’s health.
An open bottle of ketone stirps should be discarded after three months.

Due to the fact the cost of the blood ketone strips is not covered on the NDSS, it is considered acceptable that monitoring of ketones with urine strips is more beneficial than no monitoring. It should be encouraged and included with all sick day management plans. Again a timely referral for those diagnosed with diabetes to a Credentialled Diabetes Educator can be an essential part of their journey.