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Ketones In Urine: What You Need To Know
Updated on September 28, 2023
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Diet / Weight Loss
Ketones In Urine: What You Need To Know

Ketones are chemicals produced in the liver. They serve as an alternative energy source when low in sugar or glucose, the body’s primary energy source.

Think of it this way. Ketones are like the emergency cash in your wallet. Sugar or glucose is your credit card. While some depend on their cards because of the convenience, there are situations where they don’t work.

You can use ketones to spend energy when sugar or glucose aren’t available or don’t work. When your body is unable to use sugar or has none of it to burn, it turns to ketones.

Ketones are a safety net for your energy needs.

How Does the Body Produce Ketones?

Ketones are made in your liver using fat.

When you’re not eating a lot of carbohydrates, your body turns to fat for energy. Your body breaks down fat into fatty acids, and then these fatty acids are assembled into ketones, which serve as energy packets for your body.

Ketones are your body’s way of ensuring a backup energy source.

Your body naturally makes a small amount of ketones every day. However, some diseases can cause ketone levels to rise. 

Ketones leave the body through urine. High levels of ketones in the urine (ketonuria) mean your body cannot use glucose as its primary fuel. 

This usually occurs in people with uncontrolled diabetes (especially type 1 diabetes). Other conditions such as pregnancy, heart attack, and starvation can also cause ketonuria.1

Ketones In Urine: What You Need To Know 2

Ketones in Urine Test vs. Blood Ketones

There are two ways to test your ketone levels: blood and urine.

Blood Ketone Test

A blood ketone test measures the level of ketone bodies in your bloodstream. It is done using special strips and a blood ketone meter device.

Doctors use a blood test to measure ketone levels and make important treatment decisions.2

The test result can help doctors understand what's happening in your body. Monitoring your ketone level is recommended when following a ketogenic diet or having diabetes.

A blood ketone test can give a glimpse of your metabolic state. It's important to consult with a healthcare provider immediately when doing blood ketone testing, especially if the results are high.

Ketones in Urine Test

A ketones in urine test is a simple and easy way to determine the ketone level in your body.  You can do this using an at-home urine test kit. It involves placing a urine test strip in a urine sample. 

You’ll need to observe how the color of the urine test strip changes. Depending on the amount of ketones, the urine strip changes color. You can compare the color with a reference chart to tell the general level of ketones in your urine.

Some test kits can give direct results about your ketone level. It could output information such as having low, normal, or high ketone levels.

At-home ketones in urine test provides the following advantages over blood testing:

  • Convenience – You can do it in the comfort and privacy of your home without having to visit a doctor every time.
  • No blood needed – It’s less painful and anxiety-inducing since you don’t need to draw blood for ketones in the urine test.
  • Budget-friendly – The urine test strips are affordable and easy to find.
  • Simple – You don’t need any skill or technical experience to do the test.
  • Catch problems early – If you have uncontrolled diabetes or other health conditions, at-home ketones in urine tests can help you spot any issues early.

However, it’s important to note that urine tests can’t measure your precise ketone level like a blood test can. They can only show you the range your levels have been in since you last used the bathroom.3

What Are Normal Ketone Levels in Urine?

A ketones in urine test can tell you if you have no ketones, which is normal for most people. However, your results may also show anywhere from trace amounts to high ketone levels.

  • Trace Ketones – 20 mg/dl or below
  • Moderate Ketones – 30 to 40 mg/dl
  • High Ketones – more than 80 mg/dl

What Your Ketones Say About Your Health

A ketone test can tell you whether you burn fat or sugar for fuel. If your ketone levels are high, your insulin levels are low, and your body has switched to burning fat (ketosis). 

Let’s look at the most common ways to develop elevated ketone levels.

1. You Might Have Diabetes

The most common cause of high ketones is diabetes. People with diabetes have issues making and processing insulin, which can affect ketone levels.

This is why a ketones in urine test is part of a routine checkup. If you have diabetes, doctors would recommend ketone testing if your blood sugar is above 300 mg/dL. 

When blood sugar levels are this high, it often means insulin is dangerously low and ketone levels are high. This can put you at risk of developing diabetic ketoacidosis.1

Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening diabetes complication. It occurs when the body can’t make enough insulin.

Ketones build up in the bloodstream during DKA, which causes the blood to turn acidic. This can cause damage to the kidney, brain, and other organs.4

Signs and symptoms of DKA include: 

  • Stomach pain
  • Extreme thirst
  • Urinating more than normal
  • Nausea and vomiting
  • Breath that smells “fruity”
  • Confusion
  • Weakness and fatigue

In pregnant women, elevated maternal urinary ketones are a sign of gestational diabetes. Gestational diabetes is a type of diabetes that occurs only during pregnancy. 

2. You’re Exercising Too Much

Regular exercise is great for your health. However, too much can overwork your body. 

Too much exercise can cause both blood sugar and insulin levels to drop. Low insulin forces your body to burn fat, causing your ketone levels to rise.

If your blood sugar is too low (hypoglycemia), you may experience symptoms such as:

  • Dizziness
  • Shakiness
  • Hunger
  • Feeling tired
  • Excessive sweating
  • Fast heartbeat

3. You’re Dehydrated

Ketones can build up in your blood if you’re dehydrated. The higher your ketone levels, the more dehydrated you are. 

The most common way to become dehydrated is by simply not drinking enough water. Dehydration can also occur if you’ve been vomiting or have diarrhea. 

Excessive sweating from exercise or sauna use can dehydrate you as well. Other causes of dehydration include:

  • Diabetes
  • Kidney disease
  • Certain medications, such as diuretics and laxatives

4. Your Weight Loss Diet Is Working

High ketone levels aren’t always signs of an underlying health condition or poor health. This is especially true if you’re on a weight-loss diet.

Low-carbohydrate diets, intermittent fasting, and keto diets like Atkins can all cause your body to enter a state of ketosis. Ketosis is when your body burns fat and produces ketones for energy. 

Ketosis can help you lose weight and make your body more efficient at burning fat. It also enables you to avoid significant increases in blood sugar levels that can trigger junk food cravings.5 

If your ketone levels are normal, your body burns fat, and your weight loss diet works. 

When Is the Best Time to Test Ketones in Urine?

Studies show that the best time to test for ketones is in the early morning (after you wake up) and at night (after dinner).6 If you’re monitoring your ketone levels at home, you should:

  • Perform the test at the same time each day
  • Compare your results

Regular ketone testing can be helpful for people who are on low-carbohydrate diets or keto diets like Atkins. It can tell you whether you need to make changes for effective weight loss.

Should You Test for Ketones At Home?

A ketone test isn’t usually part of a routine checkup. But you may want to consider testing if:

  • You have diabetes and show signs of diabetic ketoacidosis (DKA)
  • Your latest blood glucose test says your levels are above 300 mg/dL
  • You are pregnant (especially if you’re in the 2nd or 3rd trimester)
  • You’ve been vomiting or have diarrhea

An at-home ketone test can help you assess your health. Your results can help you decide which steps to avoid complications or improve your current health.

You can also test for ketones if you’re on a keto, low-carb, or fasting diet—or if you’ve been using weight loss apps that promote identical diets. This can help you find out if they’re working.

Use urine test strips that instantly measure your ketone levels in numbers.

Health Dangers of High Ketone Levels

High ketone levels can lead to some health dangers, including:

Diabetic Ketoacidosis (DKA)

DKA can be a life-threatening health problem, especially for people with diabetes. It happens when there's not enough insulin to control blood sugar levels.

This health issue is due to having a high concentration of ketones in the blood, very high blood sugar, and severe dehydration.

You might feel extremely thirsty, pee a lot, have nausea, vomiting, stomach pain, and confusion. In the worst cases, you might end up in a coma or even lead to death.

Metabolic Acidosis

Excessive ketones can make your blood more acidic, a condition called metabolic acidosis.

This puts extra stress on your organs, especially your kidneys. It may result in symptoms such as nausea, vomiting, rapid breathing, and confusion.

Electrolyte Problems

Ketosis can impact your body’s electrolyte balance. Severe imbalance can affect heart rhythm and muscle function. Because of this, you might experience problems like heart palpitations, muscle cramps, and weakness.


Excess ketones are removed from the body through urine, which means you pee more. This can lead to dehydration over time.

Prolonged dehydration can lead to problems like kidney strain and reduced blood volume, potentially causing kidney damage.

Bone Health Problems

If you stick with a super low-carb keto diet for a long time and have a high level of ketones, it can affect your bones because you might not get enough calcium.

If unmanaged, it can lead to worse bone problems like osteoporosis.

Reduced Mental Alertness

High ketone levels can lead to impaired cognitive function, confusion, and difficulty concentrating. In severe cases, it could even lead to coma.

If you ever feel any symptoms of having high ketone levels, talk to a healthcare provider immediately. Consider it a medical emergency, especially if you have diabetes.

If you're on a keto diet, check in with a doctor or dietitian to ensure you do it safely.

Updated on September 28, 2023
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6 sources cited
Updated on September 28, 2023
  1. Ketone Bodies (Urine).” University of Rochester Medical Center. “Blood Ketones: 

  2. Ketones in Blood.” MedlinePlus.

  3. Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis” The Review of Diabetes Studies.

  4. Diabetes & DKA (Ketoacidosis)” American Diabetes Association.

  5. Food cravings during acute hypoglycaemia in adults with Type 1 diabetes” Physiology and Behavior.

  6. Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?” National Center for Biotechnology Information: National Library of Medicine.

Will Hunter
Will Hunter
Content Contributor
Will is a content writer for KnowYourDNA. He received his B.A. in Psychology from the University of California, Los Angeles. Will has 7 years of experience writing health-related content, with an emphasis on nutrition, alternative medicine, and longevity.
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