Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis

Rev Diabet Stud. Winter 2016;13(4):217-225. doi: 10.1900/RDS.2016.13.217. Epub 2017 Feb 10.


Diabetic ketoacidosis (DKA) remains a common medical emergency. Over the last few years, new national guidelines have changed the focus in managing the condition from being glucose-centered to ketone-centered. With the advent of advancing technology and the increasing use of hand-held, point-of-care ketone meters, greater emphasis is placed on making treatment decisions based on these readings. Furthermore, recent warnings about euglycemic DKA occurring in people with diabetes using sodium-glucose co-transporter 2 (SGLT-2) inhibitors urge clinicians to inform their patients of this condition and possible testing options. This review describes the reasons for a change in treating DKA, and outlines the benefits and limitations of using ketone readings, in particular highlighting the difference between urine and capillary readings.

Publication types

  • Review

MeSH terms

  • Combined Modality Therapy / economics
  • Confounding Factors, Epidemiologic
  • Diabetic Ketoacidosis / economics
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / metabolism
  • Diabetic Ketoacidosis / therapy*
  • Emergency Medical Services / economics
  • Emergency Medical Services / trends
  • Health Care Costs
  • Humans
  • Ketone Bodies / blood*
  • Ketone Bodies / urine
  • Ketones / blood*
  • Ketones / urine
  • Point-of-Care Testing / economics
  • Prevalence
  • Secondary Prevention / economics
  • Severity of Illness Index


  • Ketone Bodies
  • Ketones