Ketones in urine:
what the result means.
Ketones show up in urine when the body burns fat for energy instead of sugar. In a healthy person this often happens after fasting, vomiting or a low-carbohydrate diet, and it settles on its own. In a person with diabetes, especially type 1, ketones can be an early warning of a dangerous condition called DKA. This page explains how to read the result and when to act.
How to read the result
Labs and home strips show ketones as words or plus signs. The figures below are approximate and differ a little between brands.
| On the report | Roughly | What it usually means |
|---|---|---|
| Negative / Nil | 0 | No ketones found. |
| Trace | about 5 mg/dL | A very small amount. Common after an overnight fast. |
| Small / 1+ | about 15 mg/dL | Small amount. Common with fasting, vomiting or a low-carb diet. |
| Moderate / 2+ | about 40 mg/dL | Moderate. With diabetes, check sugar and blood ketones and call your doctor. |
| Large / 3+ | 80 mg/dL or more | Large. With diabetes, this needs urgent medical care. |
Common, usually harmless causes
Fasting
An overnight fast, a long gap between meals, or a roza. The body switches to burning fat.
Vomiting or loose motions
Very common in children with a stomach bug, because they are not eating.
Low-carb or keto diets
Cutting rice, roti and sugar sharply makes the body burn fat.
Heavy exercise
Long or intense exercise, especially on an empty stomach.
Pregnancy
Morning sickness, and especially severe vomiting in pregnancy (hyperemesis).
Before or after surgery
Long fasting periods around an operation.
Why ketones matter more in diabetes
In type 1 diabetes, ketones usually mean the body does not have enough insulin. Without insulin, sugar cannot be used for energy, so fat is burnt instead. If this continues, ketones build up in the blood and make it acidic. This is diabetic ketoacidosis (DKA), and it needs hospital care. Children over 7 years of age with DKA are admitted at Caspian. For a younger child, go to the nearest hospital with a children's emergency department.
- Check ketones when sugar is above 250 mg/dL for a few hours, during any illness, or with vomiting.
- Ketones with high sugar mean you need insulin, fluids and your sick-day plan. Water alone does not clear them.
- Ketones with normal sugar can still be serious in people taking diabetes tablets in the gliflozin (SGLT2 inhibitor) group, and in pregnancy.
- Never stop basal insulin when ketones appear, even if the person is not eating.
Which test to use
Urine strips are cheap and easy, but they show what the kidneys collected over the last few hours, and they change with how much a person drinks. A blood ketone meter, using a finger-prick strip, shows the level at that moment. For people with type 1 diabetes, a blood ketone meter is the better choice on sick days.
| Blood ketone (mmol/L) | What it means | What to do |
|---|---|---|
| Below 0.6 | Normal | Carry on. Recheck if still unwell or sugar stays high. |
| 0.6 to 1.4 | Slightly raised | Follow your sick-day plan, drink fluids, take insulin as your plan says, recheck in 2 hours. |
| 1.5 to 2.9 | High, risk of DKA | Call your diabetes team now. Follow the sick-day plan for extra insulin. Recheck within 1 to 2 hours. |
| 3.0 or above | Very high, possible DKA | Go to the nearest hospital emergency department or call 108 now. |
Ketones during Ramzan
Small ketones are common during a roza in people without diabetes. For people with type 1 diabetes, fasting carries real risk, and many are advised not to fast. If you plan to fast, speak to your doctor before Ramzan for a written plan. If ketones rise during a fast, or sugar goes very high or very low, the advice from diabetes guidelines is to break the fast and check your sugar.
More for families
living with type 1
What families ask us
Is trace ketone in urine normal?
Trace ketones are common after an overnight fast or a skipped meal and are usually not a concern in a person without diabetes. In type 1 diabetes, check sugar and, if possible, blood ketones, especially if you are unwell.
What level of ketones in urine is dangerous?
In a person with diabetes, moderate (2+) ketones need a call to your doctor, and large (3+) ketones need urgent medical care. For a blood ketone meter, 1.5 mmol/L or above is high and 3.0 mmol/L or above needs hospital care.
Can fasting cause ketones in urine?
Yes. Fasting, including roza, is one of the most common reasons for small ketones in urine in people without diabetes. They usually clear once you eat and drink.
I have ketones in urine but normal sugar. What does it mean?
Without diabetes, this is usually from fasting, vomiting or a low-carb diet. With diabetes, it can still be serious, especially in people taking gliflozin (SGLT2 inhibitor) tablets or in pregnancy, so speak to your doctor the same day.
Are ketones in urine during pregnancy a problem?
Small ketones are common with morning sickness. Ketones with repeated vomiting, inability to keep fluids down, or with diabetes in pregnancy need a doctor's review the same day.
How do I get rid of ketones in urine?
Without diabetes, eating carbohydrates and drinking fluids usually clears them. With diabetes, ketones are cleared by insulin, fluids and your sick-day plan. Water alone is not enough. Call your diabetes team if ketones are moderate or large.
Is a keto diet safe for someone with type 1 diabetes?
Ketones from a keto diet in a healthy person are not the same as DKA. In type 1 diabetes, very low-carb diets can make ketones and lows harder to judge. Speak to your doctor before starting one.
References
- Phelan H, Hanas R, Hofer SE, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Sick day management in children and adolescents with diabetes. Pediatric Diabetes 2022;23(7):912–925.
- Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycemic crises in adults with diabetes: a consensus report. Diabetes Care 2024;47(8):1257–1275.
- American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes, 2026. Diabetes Care 2026;49(Suppl 1).
Ketones on the report?
Ask us today.
If you have diabetes and ketones are showing, call or WhatsApp us with your sugar and ketone readings. For vomiting, fast breathing or drowsiness, go to the nearest hospital emergency department.
Caspian Healthcare
Opposite Post Office, Vijay Nagar Colony,
Hyderabad, Telangana 500057
Get directions on Google Maps
Asad, patient coordinator. Call or message on WhatsApp, both reach the same number.
9:00 am – 1:00 pm and 3:00 pm – 9:00 pm
Friday 3:00 pm – 9:00 pm · Sunday closed
By prior appointment only
What to bring to the first visit
- •Recent HbA1c and any lab reports
- •Current insulin doses, written down
- •Glucometer or CGM data, even a photo of the app is fine
- •Your child, if at all possible, this decision is partly theirs
- •A written list of your worries. Do not leave any of them out.
Written by your doctor
It's Not the Sugar
A Doctor's Guide to Type 1 Diabetes for Parents, Children, and Everyone Who Loves Them
Diagnosis day, insulin, carb counting the Indian way, school, sport, lows, festivals, money, and growing up with type 1.
Read it on Amazon