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Assessing Metabolic Status with ß-Hydroxybutyrate

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

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Assessing Metabolic Status with ß-Hydroxybutyrate

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

  2. Ketone Production • 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 • Circulatory ketone levels increase

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

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

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

  6. The Prevention of DKA • Accurate ketone-level measurements • 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 • When blood glucose levels are consistently over 300 mg/dL • During pregnancy • When symptoms of ketoacidosis—nausea, vomiting, abdominal pain—are present

  8. Types of Ketones Tested • Acetoacetate—the most commonly measured • Acetone • -hydroxybutyrate—the predominant ketone associated with DKA

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

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

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

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

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