Blood ketone level clarification

(MooBoom) #42

Ketones fluctuate constantly- and they only give you information about a transient moment in time. They also only tell you about ketones in circulation, not how many your body is producing and using.

Early in a keto-ers journey their body may produce quite a lot of detectable ketones, as their body isn’t clued into how many are needed for efficient functioning. As lipolysis kicks in and the keto-er becomes fat adapted, it’s quite possible the body will only produce enough ketones to allow for efficient functioning and this will result in decreased detectable ketones in the blood, as ketones are being efficiently created and utilised- not over produced.

In short- don’t chase ketones.

Please read this super helpful link, it will answer your questions I hope!


Yah, it’s cheaoer too ! I think makes a lot of sense to measure fasting glucose nearly daily to see how things are coming , then ketones every now and then to confirm ketotic state. Post prandial glucose can informal well. What did what I are just do ?

(Lauren G. ) #44

Thank you for this… I keep having mini meltdowns about the numbers and I am trying not to. Glad to know I am not alone.

(August Freire) #45

Did you ever figure this out? I too was already slim built and went on ketosis and have lost more weight than I care to (10 lbs). I just tried my first carb refeed meals, 2 dinners and 1 preworkout meal in order to try to gain some muscle fullness / weight.

(Shorty M De Souza) #46

I’m 160 lbs at 4feet 11inch i been on keto this is my 4th week some days my blood meter says low and some days 1.5 even 2.0 but I’m ranging now at 0.3 or 0.4 soo if I’m in ketosis why aren’t i loosing weight??
Can u please help or get someone to help me I’m so lost…i feel good energy is good my macros are 20g carbs. 78grams protein and 100 grams fat …PLEASE HELP

(Shorty M De Souza) #47

Me too i am doing everything right and mine are low I’m freeking out I’m not loosing either

(Jon H.) #48

@Shorty_M_DeSouza so I have seen many females it seems to take a little longer to get into the weight loss. Be it hormones or what not I don’t know. Several friend have had this issue one after giving birth. Give it some more time or per the saying kcko. It will happen.

(Jeanne Wagner) #49

Ok according to that chart I may be approaching ketoacidosis?!?

So here’s the info. Pretty new to this way. Type II diabetic for 12 yrs. Just a couple months in and not completely settled in the eating properly yet (I rely too heavily on heavy whipping cream for instance. I don’t put some in my coffee, I have some coffee with my hwc.) I use pee sticks just to see if I’m registering. I understand they are unreliable. A lady at work gave me her expired bottle and nothing showed. That could mean I just wasn’t in ketosis yet, though. It was about a month ago. It was also before I started intermittent fasting, and my first 3-day fast. I did it all within one week. Four days of 24-hr intermittent fasting and then a 3-day weekend fast. This was just last week 1/22/18-1/28/18.

So I got a brand new bottle of sticks. The day after my 3-day fast I checked and it went immediately to the darkest color. I checked again the next day and it was still the darkest color. That chart on the bottle shows that being 160 mg/dL. I looked up conversions online and that seems to equal 8.8888 mmol. BUT that 160 number is just the number on the bottle to show what a really high reading is. What if the actual number is higher than that?

I feel fine, but I’m concerned now. I had heard you’re not at risk of ketoacidosis until it reaches 30, and that type II diabetics cannot enter into ketoacidosis. This chart shows 10 as being in trouble. Should I run to the doctor and make sure I’m ok?

(Todd Allen) #50

The pee sticks are the least accurate way to measure ketosis. They mostly stop working once you are fully fat adapted and your body is using ketones as a primary fuel instead of pissing them away. People going into ketoacidosis feel ill. If you are experiencing vomiting, confusion, abdominal pain, excessive thirst and crazy urination you may want to run (or crawl) to the doctor and make sure you are ok.

There are better tests than pee sticks. Blood ketone strips are the gold standard, though I think blood glucose testing gives better bang for the buck. If you are not severely metabolically deranged you’ll find your blood glucose dropping when ketones rise (though BG is high in ketoacidosis). Breath testing ketones is my favorite due to the exceptional ease and lack of cost.

(Duncan Kerridge) #51

The pee sticks cannot give you an accurate reading - they are drastically affected by your level of hydration. If you have some / any colour on the stick it means there are ketones in your pee, that’s it, that’s all they can reliably measure.

You need to test blood ketones to get any kind of accurate / repeatable reading. And if you’re feeling fine, you’re fine. Remember for diabetic ketoacidosis both your blood glucose and ketones have to be high at the same time, you would have symptoms. What is your blood glucose reading?

(Jeanne Wagner) #52

Last night it was 91 and this morning it was 94. I am still doing 24-hr intermittent fasting. I’m pretty good at knowing when my bc goes up and down really high/low and I’m not feeling any of the effects.

(Duncan Kerridge) #53

A quick browse around for diagnosing DKA is a blood glucose level of over 250-300.

That’s before they even start looking at ketone levels.

(Jeanne Wagner) #54

Ok I’ll look into it more too, but that info puts me at more ease. Thanks!

(Jeanne Wagner) #55

I have been eyeing some cheap breath monitors on eBay. I found a thread on here that talks about them at length. Now I have analysis paralysis! Amazon doesn’t seem to carry any of the cheap ones. I was hesitant to buy but I think I need to.

(Todd Allen) #56

I’ve been super happy with one I got through ebay for about $3 with shipping from China. They are quite variable though. I’ve got a couple more expensive ones that are less sensitive and only useful when I’m deeply in ketosis. But still I think of all of them as bargains compared to most anything else I’ve bought in pursuit of better health.

(Jeanne Wagner) #57

Yeah I just don’t want to wait a month for it to come from China. I saw something out of Texas (I’m in Fl) that I might go for. Free shipping only deals. The trap with eBay is a $3 product and $15 shipping! Sneaky buggers.

(Todd Allen) #58

I think mine was $2.95 with free shipping from China. Sometimes the shipping is super slow and once I never received an item from China and too much time elapsed to make an ebay dispute claim for refund. But for little items the shipping is often as fast if not faster than items ordered from inside the US.

(Richard Morris) #59

They can, it’s very rare. What normally puts the brakes on ketone production is an increase in production of your own insulin. If you have been a type 2 diabetic for a long time you may need to inject insulin because you can’t make enough. If such a person stops injecting their insulin then that’s one case where a type 2 diabetic might experience run away ketogenesis (15 mmol/l and higher along with high glucose). Most type 2 diabetics make too much insulin … for them it’s not such a problem.

Another case is a type 2 diabetic who can’t put on a lot of body fat (known as a TOFI - thin on the outside, fat on the inside) who does an extended fast without adequate energy resources (body fat). I have known such people to see very high levels of ketones (up around 10 mmol/l), but not runaway levels and not with high glucose.

Finally sometimes people who have damage to their livers (eg: Alcoholic liver disease) may see moderately high levels (ie: up around 7 mmol/l). I’m not sure of the mechanism here, but we rely on our livers so much more when we go keto that any pre-existing damage could affect our results when we push things (which is what a fast is).

Pee sticks really only tell you you are making ketones - they are designed for a type 1 who would follow up a glucose test showing they had too much glucose with one to see if they are making ketones and then go to emergency if they were. The low carb/atkins world picked them up as a touch stone to see if your diet was working … but for those purposes it’s just really a binary thing … I’m making ketones or I’m not making ketones.

That’s the most important criteria. At the first sign not feeling fine, it’s time to call the fast. It’s not a competition.

BTW I think you were using a conversion rate for glucose (1 mmol/l = 18 mg/dl). Mmol/l is a concentration not a mass measurement like mg/dl so each molecule you measure will have a different conversion rate. Acetoacetate which is the ketone that pee sticks measure is roughly 1 mmol/l = 10 mg/dl so 160 mg/dl would be more like 15 mmol/l

But short of a blood ketone test I don’t think we can say what your ketone levels were. All we really know is you are making some, and feel fine … that’s probably a great outcome.


If I were diabetic following a LC diet, I’d buy a blood ketone meter. The expense should be covered by insurance, but even if it’s not, it’s worth paying for out of pocket. Diabetics need accurate information about what’s going on with their body because things can go sideways quickly when you’re varying diet. IMHO, safety is worth $100 (buys meter and 50 strips).

(Jeanne Wagner) #61

Thank you for the reply, Richard. I think I’ll go ahead and invest in the blood monitor. Yeah I’m still here, still feeling fine. :wink: Had some heart palpitations this morning but I’m having a hard time keeping up with the salt intake. I downed about 1/2 tsp sea salt, drank 3/4 c pickle juice and put some salt in my drinking water and 3 hrs later I was fine. I’ve had them since my 20s, now in my late 40s. I can usually get them to stop within seconds or a couple minutes. Anyway, lots of amazing information in this community you’ve built. (I had an ekg and stress test about 12 yrs ago, and everything was ‘perfectly normal.’ Lots of things can happen when you are bad most of the years after the tests… Time to do it again, I think.

Thank you again!!