For last week’s practice question, we quizzed participants on how to best detect euglycemic ketosis. 53% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question:

According to recent research by the ADA/EASD, about 10% of people admitted to the hospital in diabetes crisis have euglycemic diabetes ketoacidosis.  

Since blood sugars are at normal levels or only slightly elevated, which of the following lab tests most accurately evaluate for euglycemic ketosis?

Answer Choices:

1. Blood pH and arterial glucose.
2. Beta-hydroxybutyrate and bicarbonate levels.
3. Urine ketones and urine glucose.
4. Anion gap and glucose level measured in mmol/L.

---

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 15.60% chose this answer. “Blood pH and arterial glucose.” Since euglycemic ketosis is often associated with blood glucose levels less than 200 mg/dL, checking arterial glucose levels won’t provide additional clarity on diagnosis.  However, checking pH levels is recommended, since a pH less than 7.3 is a clear clinical indication of ketosis.

Answer 2 is correct. 53.20% of you chose this answer. “Beta-hydroxybutyrate and bicarbonate levels.” YES, this is the best answer.  Beta-hydroxybutyrate evaluation with a low cutoff equal to or greater than 3.0 mmol/L, whether by lab or point-of-care-testing, is one of the most accurate measurements to evaluate if a person is in ketosis.  Bicarbonate level concentration < 18 mmol/L also helps to provide confirmation of ketosis.  Ketoacidosis in diabetes is due to inadequate circulating insulin, so the body switches to burning fat for fuel (instead of glucose), which leads to a build up of ketones or ketosis.

Answer 3 is incorrect. About 20.68% of respondents chose this. “Urine ketones and urine glucose.” Urine ketone testing can be used if Beta-hydroxybutyrate evaluation is not available. A urine ketone strip value of 2+ or greater indicates ketosis. However, checking urine glucose levels won’t provide additional clarity on diagnosis, since euglycemic ketosis is often associated with blood glucose levels less than 200 mg/dL.

Finally, Answer 4 is incorrect. 10.53% chose this answer. “Anion gap and glucose level measured in mmol/L.” he anion gap has long been a clinical measure of acidosis; however it is not considered to be a key indicator in the new guidelines. Metabolic acidosis is now defined as a pH < 7.3 and a bicarbonate concentration < 18 mmol/L.  The anion gap can still be used in settings where ketone testing is unavailable. In addition, checking urine glucose levels won’t provide additional clarity on diagnosis, since euglycemic ketosis is often associated with blood glucose levels less than 200 mg/dL.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

---

Want to learn more about this question?

Join our Annual Webinar

Airs live February 1, 2024 at 11:30 am PT

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.