Ketones in the blood can be detected well before ketones in the urine be detected, offering you the opportunity to treat sooner than you would if you waited for urine testing. (Have you ever tried to make a three year old pee on command?) Also, being able to test with a finger stick eliminates the need to find a bathroom to test if you’re away from home. (How many of you carry urine ketone strips when you’re out shopping or at an amusement park? And if you do, do you like the thought of peeing on a strip in a filthy public bathroom?)
Two studies from February 2006 demonstrate clear medical benefit from blood ketone testing. The first study (Diabetic Medicine 23 (3), 278-284) showed a significant reduction in hospitalizations during sick days (38 vs. 75 per 100 patient days) for people who used blood ketone testing compared with urine ketones testing. Staying out of the hospital is a very powerful argument for using blood ketone testing. The second study (Diabetes Technol Ther. 2006 Feb;8(1):67-75) showed that, for patients using insulin pumps, blood ketone testing could identify interruptions in insulin flow faster and more accurately than even blood glucose monitoring and could thus help pumpers prevent DKA better than if they didn’t use blood ketone testing.
While some argue that the cost of blood ketone testing is much higher than urine ketone testing (about $4 per blood ketone strip versus as low as $0.10 per urine ketone strip), annual testing costs will likely be about the same if you check for ketones about 10 times per year, which is about what our readers reported in a recent poll. Urine test strips have a 90-day lifetime, after which they must be replaced. Priced at about $10 per 100 strips, the annual cost of urine testing is about $40. At $4 per test for blood ketone testing, if you test 10 times a year, the annual cost is also about $40 per year. If you check for ketones more often, then urine testing might be more economical, but the clinical benefits described in recent studies still argue for using blood ketone testing.
Of course, the benefits of feedback on what’s happening in your body at that instant, not having to force toddlers to pee on demand, not having to drag a sick teenager out of bed to the bathroom, and not having to go into a public bathroom when you’re out and not feeling well are — as the advertisement says — priceless.
- Blood beta-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review.
- Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial.
- Early detection of insulin deprivation in continuous subcutaneous insulin infusion-treated patients with type 1 diabetes.
- Impaired endothelial antithrombotic activity following short-term interruption of continuous subcutaneous insulin infusion in type 1 diabetic patients.
- Review of the Precision Xtra blood glucose meter, which can also also measure blood ketones.
- Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial. (Diabetic Medicine 23 (3), 278-284)
- Early detection of insulin deprivation in continuous subcutaneous insulin infusion-treated patients with type 1 diabetes. (Diabetes Technol Ther. 2006 Feb;8(1):67-75)
- Accuracy of an Electrochemical Sensor for Measuring Capillary Blood Ketones by Fingerstick Samples During Metabolic Deterioration After Continuous Subcutaneous Insulin Infusion Interruption in Type 1 Diabetic Patients [Diabetes Care 26:1137-1141, 2003]. Full text available as HTML or PDF.
- The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment. [Diabetes Nutr Metab. 2003 Oct-Dec;16(5-6):312-6].
- The hospital and home use of a 30-second hand-held blood ketone meter: guidelines for clinical practice [Diabet Med. 2001 Aug;18(8):640-5].