1. Assessing Metabolic Status with ß-Hydroxybutyrate A Significant Advance in Diabetes Self-Management

2. Ketone Production In periods of insulin deficiency, triglycerides are metabolized for energy In periods of insulin deficiency, triglycerides are metabolized for energy Fatty acids are transformed into ketones, acids that allow fat-derived energy to be utilized Fatty acids are transformed into ketones, acids that allow fat-derived energy to be utilized Circulatory ketone levels increase Circulatory ketone levels increase

3. Diabetic Ketoacidosis (DKA) Occurs when excessive levels of ketones accumulate and the body becomes acidotic Occurs when excessive levels of ketones accumulate and the body becomes acidotic It is a potentially life-threatening condition It is a potentially life-threatening condition -hydroxybutyrate is the predominant ketone associated with DKA -hydroxybutyrate is the predominant ketone associated with DKA

4. Who Is at Risk? People with type 1 diabetesespecially children and pump users People with type 1 diabetesespecially children and pump users Pregnant women with any form of diabetes Pregnant women with any form of diabetes

5. Common Contributors to DKA Infection Infection Inadequate available insulin Inadequate available insulin Stress Stress Acute illnesses Acute illnesses Inappropriate sick-day management Inappropriate sick-day management

6. The Prevention of DKA Accurate ketone-level measurements Accurate ketone-level measurements Proper insulin management Proper insulin management

7. When to Test for Ketones The American Diabetes Association recommends that people with diabetes test for ketones in the following situations: During acute illness or stress During acute illness or stress When blood glucose levels are consistently over 300 mg/dL When blood glucose levels are consistently over 300 mg/dL During pregnancy During pregnancy When symptoms of ketoacidosisnausea, vomiting, abdominal painare present When symptoms of ketoacidosisnausea, vomiting, abdominal painare present

8. Types of Ketones Tested Acetoacetatethe most commonly measured Acetoacetatethe most commonly measured Acetone Acetone -hydroxybutyratethe predominant ketone associated with DKA -hydroxybutyratethe predominant ketone associated with DKA

9. Ketone Testing Methods Urine Urine –acetoacetate or acetone levels Blood Blood – -hydroxybutyrate levels

10. Urine Ketone Testing Urine is applied to a reagent strip or tablet Urine is applied to a reagent strip or tablet Color variation indicates the ketone level in the urine Color variation indicates the ketone level in the urine

11. Disadvantages to Urine Ketone Testing The results are not real time The results are not real time The readings are qualitativecolor comparisons indicate high, medium or low levels The readings are qualitativecolor comparisons indicate high, medium or low levels Sulfhydryl drugs, including the ACE inhibitor captopril, may cause false-positive results Sulfhydryl drugs, including the ACE inhibitor captopril, may cause false-positive results High doses of vitamin C can cause false-negative results High doses of vitamin C can cause false-negative results Does not detect -hydroxybutyrate Does not detect -hydroxybutyrate

12. Blood Ketone Testing Measures -hydroxybutyrate Measures -hydroxybutyrate Presently limited to the laboratory or office setting Presently limited to the laboratory or office setting Benefits: real-time, reliable accuracy, quantitative readings Benefits: real-time, reliable accuracy, quantitative readings