High Ketones: What They Mean, Why They Matter, and What to Do

When your body starts breaking down fat for energy, it produces high ketones, chemicals made by the liver when insulin is low and the body burns fat instead of glucose. Also known as ketone bodies, they’re not always bad—many people aim for mild ketosis on low-carb diets. But when ketone levels climb too high, especially in people with diabetes, it can lead to a dangerous condition called diabetic ketoacidosis, a life-threatening buildup of acids in the blood due to insufficient insulin.

High ketones aren’t just a diabetes issue. They can show up during fasting, extreme exercise, or after severe illness. But the real danger comes when your body can’t use sugar because of low insulin, and it keeps burning fat nonstop. That’s when ketones pile up, your blood gets too acidic, and your organs start to struggle. People with type 1 diabetes are most at risk, but type 2 diabetics can slip into ketoacidosis too—especially if they’re sick, skipping insulin, or on certain newer diabetes drugs like SGLT2 inhibitors. You don’t need to be diabetic to have elevated ketones, but if you are, ignoring them can land you in the ER.

Knowing the signs matters. Thirst, frequent urination, nausea, confusion, and fruity-smelling breath are red flags. A simple urine strip or blood ketone meter can tell you if levels are rising. Most home meters show levels under 0.6 mmol/L as normal, 0.6 to 1.5 as slightly elevated, 1.6 to 3.0 as high, and over 3.0 as dangerous. If you’re diabetic and your ketones are above 1.5 while your blood sugar is over 250, call your doctor. Don’t wait. Don’t assume it’s just "keto flu." This isn’t the same as feeling tired on a new diet—it’s a medical emergency.

The posts here cover the real-world side of this issue. You’ll find guides on how medications like SGLT2 inhibitors can raise ketone risk, how to monitor your levels at home, and what to do if you’re sick and your insulin isn’t working right. There’s advice on avoiding dangerous drug interactions that worsen ketone buildup, how to read your lab results, and even how stress and infections can push ketones into the danger zone. These aren’t theoretical discussions—they’re from people who’ve been there, and from clinicians who’ve seen the fallout.

Whether you’re managing diabetes, trying keto, or just saw "high ketones" on a lab report, this collection gives you the clear, no-fluff facts you need. No jargon. No hype. Just what to watch for, when to act, and how to stay safe.