How to Measure Ketosis in 5 Unique Ways

by Olivia Carleton - August 13, 2018

During the first 1-2 weeks of your ketogenic diet, your body will be in mid-transition from relying on blood glucose for energy to relying on ketones. Once your body has fully transitioned, you will be in the state of ketosis.

The question is: how do you know you’re in ketosis? There are multiple methods for how to measure ketosis, and this guide will help you understand when to use each technique and how they all work.

If you are on the ketogenic diet to lose weight and improve your overall health, read on to understand your state of ketosis further. If you are on the ketogenic diet to maintain your type 1 or type 2 diabetes, read on to learn the symptoms of health risks and how to interpret your blood meter readings!

How to Measure Ketosis

How to measure ketosis can be achieved in a few different ways. Before the methods for measuring ketosis can be described, you should understand the different ways ketones take form in the body.

Ketones are what the body produces instead of blood glucose, which aids in increased energy and focus, a healthy appetite, and natural weight loss (1).

Ketones are measurable in three ways within the body:

Acetate:

Ketones are measured on the breath via a breath meter. Without a meter, you may notice a strong acetate smell on the breath, which has been described as smelling like fruit or alcohol.

Acetoacetate:

Ketones are excreted in urine and are tested with urine test strips. Acetoacetate contains excess ketones, which will be at an intense level during the beginning stages of your ketosis.

As your body becomes adjusted to a higher ketone level and lower blood glucose level, fewer ketones will be excreted through the urine.

Beta-Hydroxybutyrate:

Also known as BHB, these ketones are measured directly from the blood. This is the most accurate form of your current ketone level (5).

Each type of ketone body is measured through a different kind of meter.

Each meter has its benefits and drawbacks, and they are all most beneficial if they are used through different phases of your ketosis.

Breathe Meter:

These meters are reasonably inexpensive, and they can be used repeatedly without spending money on test strips or other equipment. However, measuring acetone with a breath meter is not the most accurate method.

These are best used for confirming your body is in ketosis after you’ve checked the physical symptoms, which are described further in the next section.

Urine Strips:

Urine test strips are one of the most popular methods of how to measure ketosis. Test strips are low cost and can be purchased over the counter.

Similar to breathe meters, urine strips are not 100% accurate, and other factors can alter the results. These are best for understanding how your ketone level is affected by when and what you eat or drink.

Those who have transitioned into ketosis should use this method for regular ketone measurements as well as diagnosed diabetics (2).

Blood Meters:

This type of meter is the most accurate method for reflecting a direct count of your ketones in your blood. Blood meters are also the most expensive measurement tool, but your results won’t be altered by other factors

While all three types of meters help you measure ketosis, one method may work better for some than others. Depending on your keto diet and lifestyle, you may learn that you prefer a specific approach.

Nutritional Ketosis vs. Ketoacidosis

When learning how to measure ketosis, there is a lot of information available about the physical symptoms you should look for. It’s important to know that there are two different types of ketosis: nutritional ketosis and ketoacidosis.

Those on the mainstream keto diet are looking to achieve nutritional ketosis, which has a variety of symptoms that are typically labeled as “keto flu.”

Ketoacidosis is something you want to avoid, and it has its traits that require medical attention. During nutritional ketosis, your body produces far fewer ketones than those experiencing ketoacidosis.

There are also a few short-term symptoms that may not be desirable but will digress as you continue your healthy keto diet:

Staying fuller for longer
Temporary fatigue
Bad breath
Constipation or diarrhea (4)

Ketoacidosis is a more serious condition that indicates your body has a high blood glucose level and a high ketone level. In most cases, ketoacidosis occurs in people with diabetes and more typically in those with type 1 diabetes.

Signs of Ketoacidosis:

Unusually frequent urination
High level of ketones
Dry mouth
Nausea and vomiting
High blood glucose
Long-term fatigue
Inability to focus
Trouble breathing

If you feel you have experienced any of these symptoms of ketoacidosis while learning how to measure ketosis, you should contact your doctor immediately.

If you have type 1 or type 2 diabetes, always consult with your doctor before beginning the keto diet as well as how to measure your ketones and blood glucose level.

Drawbacks of Urine Ketone Testing

One of the most popular and convenient ways for how to measure ketosis is through the use of urine strips. Urine test strips are affordable, easily accessible without requiring a prescription or doctor visit, and they don’t need any invasive maneuvers for testing.

The drawbacks of testing for ketones through urine include it not being the most accurate method.

Urine strips test for acetoacetate only, which is one of the three body types of ketones, and it is excreted through the urine when your body begins to produce ketones instead of blood glucose.

To put it simply: urine strips are measuring the waste, and it may not always be an accurate illustration of your current ketone level.

The other drawback of urine test strips is your results can be affected by your hydration level. The more water you drink, the more diluted your urine becomes and it may not accurately depict your acetoacetate.

Staying hydrated is an integral part of the keto diet and your overall health, so keep this in mind when using urine strips.

Urine test strips indeed serve a purpose, but they are best for those who are in the first few weeks of their keto diet. When transitioning to nutritional ketosis, you will want to keep track of your physical symptoms.

You can use urine test strips to confirm that your body is producing ketones at a regulated and healthy rate.

Once you believe you are in ketosis, you will want to upgrade to a more accurate method for measuring your ketone level.

Blood Test for BHB Measurement

Another ketone body type, aside from acetoacetate, is beta-hydroxybutyrate (BHB). Measuring your BHB level via a blood test is the most accurate way to measure ketosis (6).

To measure your BHB, you will need to purchase a blood meter, which will also accurately measure your blood glucose level. This is a beneficial tool for anyone trying to achieve ketosis, but it is also a necessary tool for people with diabetes.

Blood meters require more attention and financial investment than urine test strips, but they are far more accurate since they measure the real-time level of ketones in your body instead of the waste ketones. Blood meter results are also not affected by your hydration level or any other factors.

Aside from the blood measuring device, you will also need test strips, a lancet device with lancets, alcohol for sanitizing, and alcohol swabs. These requirements are further explained below.

Blood Ketone Meters for Testing at Home

You can purchase a blood meter for testing your BHB at home. You will also need to buy a kit that includes lancet pens and test strips for ketones.

If you want to monitor your blood glucose level as well, you will need to buy separate strips for measuring that.

Today’s technology also allows you to upload your blood meter results to a computer. This is an effective way to observe your progress and recognize any positive or negative patterns in your ketone levels.

There are three brands of blood ketone meters that are popular to measure ketosis. Both meters have pros and cons:

Precision Xtra:

This blood meter seems to be the more popular choice among users on the keto diet. It includes a backlit display and stores 450 readings.

This way, you can compare your average glucose or ketone readings. Each testing strip requires 1.5 microliters of blood, and users have to manually enter a code to switch from blood glucose to ketone measurements.

Nova Max Plus:

This meter is sometimes offered for free when two boxes of test strips are purchased. That’s a big money saver! Each strip also requires a significantly less amount of blood than the Precision Xtra meter.

While the test strips are less expensive to purchase, they give more frequent error messages, so you’ll tend to go through a lot.

Keto Mojo:

This blood meter is offered to people who wish to test their ketones and blood sugar levels. You will need two different test strips, but you can use one meter to check both of these stats.

Keto Mojo regularly offers coupons, so it’s worth looking out for these to save a few pennies.

It’s clear you may need to weigh your pros and cons when choosing the right blood meter for you. You may also want to check with your insurance company because some insurers will cover some of the cost of a blood meter.

Ketone Test Strips

As mentioned previously, you need specific types of strips if you want to know how to measure ketosis through a blood meter. If you use your blood meter frequently, then test strips may add up in cost.

Your insurance provider may cover some costs, but it’s essential to follow a few simple tips for the best results and avoid losing money:

Always use blood meter test strips on your fingers instead of an alternate site, unless directed otherwise.
Only purchase test strips that have been cleared by the FDA for sale in the United States.
Purchase brand new test strips that have never been opened or used. You may find some used test strips for sale at a cheaper cost on bidding websites, but this is highly advised against by the FDA.
Make sure you know the difference between blood glucose strips and ketone strips. Use the correct ones for measuring your ketosis.
Always check the expiration date on your ketone test strips. Expired strips will not give accurate results (3).

You may be tempted to purchase suspiciously low-cost test strips, but it’s best to look for name brand strips that have been approved by the FDA.

Not only is using expired or “used” test strips unsafe, but you are unlikely to get an accurate reading on your blood meter.

This defeats the purpose of measuring your ketosis all together!

Ketone Testing in Diabetes

For those with type 1 or type 2 diabetes, it’s necessary to test for ketones in addition to your blood glucose level.

Those with diabetes are at risk for developing ketoacidosis, which is when both your blood glucose level and ketone level is too high (6).

This can result in serious health risks. Testing for ketones in people with diabetes at home is believed to be a helpful factor in decreasing emergency hospital visits as well as recovery time.

There are a few signs to look for that may indicate you should know how to measure ketosis with a blood meter:

Your blood glucose level is over 250.
Your blood glucose level dipped severely overnight, increasing ketones.
You feel sick or are showing symptoms of ketoacidosis (described earlier in this guide).
You are showing symptoms of dehydration.

Anyone with diabetes should consult with their doctor on when and how to measure for ketosis. Those with type 1 diabetes are typically the most susceptible to developing ketoacidosis, so regularly testing blood glucose and ketone levels are highly advised.

How to Measure Ketosis on a Ketogenic Diet

If you do not have diabetes, and you are on the keto diet to lose weight, or for other health reasons, it is still important to know how to measure ketosis.

Knowing your accurate ketone measurement can aid you in learning what foods are affecting your ketosis, when you have the most and least energy during the day, as well as confirming if you are actually in ketosis or not.

The best way to get comparable ketone readings with any meter is to test for ketosis at the same time every day (7).

For those with normal blood glucose levels, you are likely to read a high level of ketones first thing in the morning, since your body has fasted overnight.

However, many users on the keto diet have experienced an increase in ketones throughout the day, since their bodies require more energy as the day goes on.

One of the most important guidelines to remember when learning how to measure ketosis in your body is that you can gravely affect your ketone level with your diet. If you are using a breath meter or urine test strip, your hydration level may change your reading.

Exercise can also affect your ketone measurement since your body needs to replenish your energy level by producing more ketones. The most altering factor, though, is eating food that is high in carbohydrates.

Once your body is re-introduced to an influx of sugar, your blood glucose level will increase, taking you out of ketosis.

While measuring your ketosis on a ketogenic diet, always make sure the food you are consuming is low-carb. Never assume that a typically “healthy” food is low in carbs!

You may be surprised to learn what foods are hurting your ketosis instead of supporting it.

How to Interpret the Results for Keto Diets

Nutritional ketosis is not difficult to measure. For anyone who is on the ketogenic diet and does not have diabetes, you want your meters to read your ketone level between 0.5 and 3.0 mmol/L (7).

It may take time to interpret your results accurately during the first two weeks of your ketogenic diet since your body is probably not yet in ketosis. Three to four weeks into your diet, you can regularly test to see at what ketone level you feel your best at and experience the most positive symptoms of ketosis.

You can also monitor your blood glucose level, but it’s not required if you are only trying to achieve nutritional ketosis.

For people with diabetes, interpreting your results requires more astute monitoring, and different levels of ketones indicate what type of medical attention you need if any:

Normal Level - 0.6 to 1.0 mmol/L
Call Your Doctor - 1.1 - 1.5 mmol/L
At Risk For Ketoacidosis - 1.6 - 3.0 mmol/L
Call 911 - any level over 3.0 mmol/L

This is only a guideline for interpreting your ketosis measurement on the ketogenic diet. You should consult with your doctor before beginning the diet and discussing what ketone levels are most appropriate for your body and health.

Knowing how to measure for ketosis, whether you are trying to achieve nutritional ketosis or avoid risking ketoacidosis, is very important while on the keto diet.

Whichever style of ketone meter you choose, knowing your average ketone level will clue you in on when you feel the healthiest and what you can do to improve your ketosis.

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