Are ketones always dangerous if you have diabetes?

No. Small amounts of ketones can occur during fasting, exercise, or carbohydrate restriction. However, elevated or rising ketones in someone with diabetes can indicate insufficient insulin. Your ketone level, blood glucose, symptoms, medications, and overall circumstances determine how concerning the result is.

What ketone level is considered dangerous?

Blood beta-hydroxybutyrate below 0.6 mmol/L is generally considered normal. Levels above this require increasing attention, particularly if you have diabetes and are sick or have high blood glucose. A blood ketone level of 3.0 mmol/L or higher represents significant ketonemia and requires urgent medical assessment for possible DKA.

What does it mean if you have ketones in your urine?

Urine ketones mean your body has been breaking down fat for energy. Trace amounts may occur during fasting or carbohydrate restriction. Moderate or large amounts can indicate an increased risk of ketoacidosis in someone with diabetes, particularly when accompanied by high blood glucose or DKA symptoms.

Can you have ketones with normal blood sugar?

Yes. Ketones can occur during fasting, carbohydrate restriction, prolonged exercise, pregnancy, or illness without high blood sugar. People taking SGLT2 inhibitors can also develop euglycemic DKA, in which dangerous ketosis and acidosis occur without the severe hyperglycemia traditionally associated with DKA.

Which is better for checking ketones: blood or urine?

Blood beta-hydroxybutyrate testing provides a more current assessment and is generally preferred when evaluating possible DKA. Urine strips can still be useful when blood ketone testing is unavailable, but urine results may lag behind current blood ketone levels.

Blood Ketones

Management

Ketones and Diabetes: What Your Ketone Levels Mean
ByKen Gri, Founder of DiabetesKnow May 22, 2020August 27, 2026

Read More Ketones and Diabetes: What Your Ketone Levels Mean