Ketones are organic compounds that consist of an atom of oxygen and one of carbon. They are a by-product of human metabolism and are generated when the body starts decomposing the fat cells in order to get more energy. Ketones are acid in nature and their level increases in the blood of people who suffer from diabetes. They lack the required insulin to transport glucose from the blood flow to cells, so the body has to decompose its fat reserves. Psychological stress is also known to increase the level of ketones. They are toxic if present in high amounts for a long time, this disease is named ketosis.

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Strong stress is common cause for increased levels of ketones and other harmful compounds in the blood. During long and severe periods of stress, the body produces an excessive amount of hormones that reach the blood stream and end up in urine. Their presence disrupts the flow of insulin, which prevents glucose from reaching the cells and generates more ketones that are required to break up fat cells.

Too many ketones are a clear sign that the body is incapable of producing enough insulin and might signal a very dangerous disease. Diabetes patients must monitor their level of ketones at all times, in order to avoid complications. Ketone levels are a key factor in deciding the insulin dose needed by a person for the restoration of metabolic balance. Injected insulin compensates the missing amount and can prevent damage to the body.

Ketone overproduction can lead to several health problems and has a number of warning signs. Usually, the affected person starts to become confused, with moments of amnesia and disorientation and even passing out for no obvious reason. If these signs are ignored and the ketone levels remain high, the condition becomes very serious and can lead to coma or death.

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It is very important to check the amounts of ketones present in the body. Modern science offers several very effective ways to do so. The best are blood tests, which measure the exact levels of ketones and compare them to the normal limit. The amount of ketones can also be estimated indirectly by monitoring the levels of blood glucose. If there is too much sugar in the blood, it means that it can't enter the cells and probably ketone levels are increasing to compensate for this. The best moment to check glucose is 1-2 hours after a meal. If the levels are normal, it is almost certain that the body is working properly and there is no excess of ketones.

People who suffer from ketosis must respect the prescribed treatment and any other advice of their doctor. The cure might consist not only of medication but also other changes that are needed in order to help the body restore its normal metabolism, such as regular physical exercise or a special diet.

The normal amounts of ketone can only be estimated by a medical professional. The results can vary a lot, starting from zero to very high amounts. There is no universal scale but here are some general ketone levels: any amount under 0.6 millimoles per litre (mmol/L) is considered negative. Low and average ketone levels start from 0.6 and end at about 1.5 mmol/L. All results between 1.6 to 3.0 mmol/L are high, while levels over 3.0 mmol/L are extremely high and dangerous.

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Treatment for high ketone levels

Ketone levels are usually slow to build up and can be equally slow to reduce. Even with treatment, diabetic ketoacidosis is only cured after a few days. Find below some of the most common treatments for this disease.

Intravenous (IV) fluid replacement

Since diabetic ketoacidosis normally causes excessive urination, the patient loses a lot of body fluids. Restoring fluid balance intravenously has the added advantage of diluting the blood sugar content.

Electrolyte replacement

Frequent urination caused by diabetic ketoacidosis also decreases the body's reserves of electrolytes. These are compounds like chlorine or essential minerals, including sodium and potassium. Electrolyte imbalance impairs muscular activity and can even hurt the heart.

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Insulin is the most common treatment for people who suffer from diabetes. It is usually administered by injection and restores the body's ability to convert blood sugar into energy. Insulin therapy requires monitoring the glucose level closely, sometimes testing them once per hour. The treatment stops when the levels of both glucose and ketones return to normal.

Keep in mind that diabetic ketoacidosis can sometimes be caused by other diseases. For example, severe digestive problems that trigger violent vomiting can lead to it. In such cases, the doctor will treat the root disease as well.

What are the warning signs of ketoacidosis?

Any person with diabetes can suffer from diabetic ketoacidosis but it is a lot more common in Type 1 diabetes. While people with Type 2 diabetes produce insufficient levels of insulin, Type 1 patients don't make it at all.

Diabetic ketoacidosis is a disease with a slow progress and sometimes the first severe symptom is vomiting and immediate medical help should be requested. There are a number of early signs of the disease that can be monitored. Besides testing for increased amounts of ketones in urine or high levels of sugar in the blood, other early warning signs are excessive urination and thirst or a very dry mouth.

Some more serious symptoms can appear later. These include irregular respiration, excessive tiredness, dry skin, vomiting, stomach pain, nausea or a fruity breath. The lack of concentration is also common, as well as confusion.

When do ketones occur in the body?

The body uses as fuel a simple type of sugar named glucose. However, insulin is required to transport the glucose from the blood stream to the cells, where it is burned for energy. If not enough insulin is available, the body must find another energy source and starts to convert its fat reserves. This process generates ketones, which can be dangerous if their level becomes too high in the blood.

Ketones are normally associated with high amounts of blood glucose, which are a clear sign of imbalance. Blood sugar levels of more than 250 mg/dl almost certainly mean there are too many ketones as well. This can evolve into a very serious disease, diabetic ketoacidosis, which affects people with Type 1 diabetes and rarely those who suffer from Type 2 as well.

The American Diabetes Association has identified three main situations when ketoacidosis can occur. The most common one is a lack of insulin, either caused by diseases or by improper treatment, such as skipping a prescribed dose. It can also start due to improper nutrition, for example a sick person who doesn't eat enough. Finally, glucose levels can decrease too much during sleep, which raises the ketone production in the morning in order to compensate.


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