Ketone Testing

Who is at risk of developing ketones?

• People with type 1 diabetes
• People with type 2 diabetes who may be on medications that end in ‘flozin’ e.g. Empagliflozin, Dapagliflozin, Canagliflozin, Ertugliflozin

Glucose levels do not have to be raised to develop ketones. If a person with diabetes is vomiting, dehydrated, is acutely unwell, or has intercurrent illness they are at risk of developing ketones. This may lead to a serious complication called diabetic ketoacidosis (DKA). Blood ketone monitoring is a more accurate measure than those found in urine.

If ketone monitoring is performed and a blood ketone level is above 0.6 mmol/L or a urine ketone of 1 + or more should be reported to the GP or out of hours if appropriate.

Consent
Due to the invasive nature of ketone monitoring, informed consent should be obtained from the person prior to the procedure in line with the Nursing & Midwifery Council Code of Conduct (2021) and the mental Capacity Act (2020)¹Nursing and Midwifery Council (NMC) (2015) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates accessible from https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf²Mental Capacity Act (2020) Mental Capacity Act – Health Research Authority(hra.nhs.uk)nmc-code.pdf.

Ketone testing should not be performed unless individuals have been educated and trained do so. If you are employed as a carer you should only be performing this procedure as per your local guidance³Nursing and Midwifery Council (NMC) (2015) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates accessible from https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf⁴Mental Capacity Act (2020) Mental Capacity Act – Health Research Authority(hra.nhs.uk)nmc-code.pdf.