Appearance of Acetone (Ketone Bodies) in a Diabetic Patient

Insulin deficiency, along with increased levels of counter-regulatory hormones such as glucagon and adrenaline, leads to reduced utilization of glucose and carbohydrates as an energy source. As a result, the body begins to use fats and proteins instead, which leads to the production of ketone acids.

The body attempts to neutralize these ketone acids using various buffering systems, the most important of which is bicarbonate present in the blood. However, with continued and excessive production of ketone acids, the body’s buffering capacity becomes overwhelmed, leading to increased blood acidity (metabolic acidosis). This condition is extremely dangerous and may lead to death.

The presence of ketone bodies in diabetic patients is closely related to insulin levels in the blood. Therefore, it is a common complication in Type 1 diabetes (which primarily affects children), while it is rare in Type 2 diabetes.

Early diagnosis depends on urine testing for ketone bodies. This test should be performed urgently whenever there are any changes in the patient’s condition noticed by the patient, family, or physician.

Causes of Ketone Formation
1-Neglecting insulin doses on time:
Patients with Type 1 diabetes typically require 3–4 insulin injections daily. Missing even one dose may lead to ketone body formation. Some patients mistakenly believe they can skip insulin if they are not eating. This is incorrect. Insulin must be taken on schedule, and meals should be adjusted accordingly.
For example, if a meal cannot be eaten after insulin injection due to loss of appetite or persistent vomiting, a glass of juice can be used as a substitute.

2-Infections or illness:
Any infection (such as sore throat, urinary tract infection, or other illnesses) may trigger ketone formation. It is important to emphasize that loss of appetite during illness should not lead to reducing insulin doses, as infections actually increase the body’s insulin requirement.
-Delayed diagnosis of Type 1 diabetes:
Late detection of Type 1 diabetes may result in ketone formation at the initial presentation of the disease.
-Idiopathic cases:
In approximately 25% of cases, ketone formation may occur without an identifiable cause.

Symptoms
1-Worsening symptoms of hyperglycemia such as persistent thirst, frequent urination, fatigue, and general weakness.
2-Abdominal pain and vomiting. In such cases, urine testing for ketones using test strips is strongly recommended in all Type 1 diabetic patients.
3-Increased respiratory rate and shortness of breath.
4-In advanced cases, reduced concentration and awareness may occur, and the patient may progress to coma.

Important Note
All Type 1 diabetic patients should keep urine ketone test strips at home. Testing should be done immediately by the patient, family, or healthcare provider whenever any abnormal symptoms are noticed.

Diagnosis
Diagnosis is based on the presence of ketone bodies in the urine of a diabetic patient. Ketones are often associated with significantly elevated blood glucose levels. However, ketones may also appear even when blood glucose levels are within normal range. Therefore, if symptoms suggest ketone formation, urine testing should be performed urgently regardless of blood glucose level.

Treatment
The presence of ketone bodies in urine is a medical emergency that usually requires hospital admission, preferably in a specialized center.Treatment includes close monitoring, intravenous fluids, and insulin therapy.
During transfer to the hospital, oral fluids should be given, preferably those containing electrolytes, such as tomato juice or vegetable soup, to help maintain hydration and electrolyte balance.