Quick Facts
- Sample: Blood draw from arm
- Fasting: 8 hours recommended
- Turn-around: 3–10 business days. May take longer based on weather, holiday, or lab delays.
Benefits
- Superior accuracy - 98.1% sensitivity for detecting diabetic ketoacidosis
- Direct measurement - Tests the primary ketone body, not secondary effects
- Immediate access - No physician referral required for critical health insights
- Better monitoring - More precise than urine ketone tests for treatment tracking
- Early detection - Identifies potentially life-threatening metabolic conditions before crisis
- Convenient results - Clear numerical values for easy interpretation and monitoring
Who Is This Test For?
- Diabetics experiencing symptoms like frequent urination, extreme thirst, or nausea
- Type 1 diabetics at higher risk for diabetic ketoacidosis complications
- Ketogenic dieters monitoring therapeutic ketosis levels and metabolic status
- Fasting enthusiasts tracking controlled fasting protocols and ketone production
- High-risk individuals with blood glucose levels consistently above 250 mg/dL
- Anyone experiencing unexplained metabolic acidosis or fruity breath odor
How It Works – Just 3 Steps
- Order online - Select your test and schedule appointment at convenient location
- Quick blood draw - Trained phlebotomist collects sample in just minutes
- Get results - Secure online results with clear interpretation in 3-10 days
FAQ
What does this test measure? This test measures beta-hydroxybutyrate, the most abundant ketone in your blood, to diagnose diabetic ketoacidosis and monitor ketosis levels.
How accurate is this test compared to urine ketone strips? Blood ketone testing maintains 98.1% sensitivity while offering significantly better specificity (78.6% vs. 35.1%) than urine testing (American Diabetes Association 2022).
When should I be concerned about my results? Results above 1.5 mmol/L require immediate medical attention, especially if you have diabetes, as this indicates high risk for ketoacidosis.
Can I take this test if I'm on a ketogenic diet? Yes, this test helps monitor therapeutic ketosis levels, though dietary ketosis typically produces lower levels than diabetic ketoacidosis.
Do I need to fast before this test? An 8-hour fast is recommended for most accurate baseline results, though emergency situations may not require fasting.
How often should diabetics get this test? During illness, when blood glucose exceeds 250 mg/dL, or when experiencing DKA symptoms; frequency depends on individual risk factors.
More Details
What is the purpose of this test?
The Beta-Hydroxybutyrate (BHB) blood test measures the concentration of BHB, which represents 78% of total ketones in your blood. When your body cannot use glucose for energy due to insulin deficiency or low blood sugar, it breaks down fat for fuel, producing ketones as byproducts. This quantitative test provides direct measurement of ketonemia, offering superior diagnostic accuracy for ketoacidosis compared to traditional methods (Mayo Clinic 2019).
The 2024 consensus guidelines now recommend BHB as the primary marker for diabetic ketoacidosis diagnosis, severity assessment, and resolution monitoring (Cleveland Clinic Journal of Medicine 2025). This makes BHB testing essential for proactive health management, especially for those with diabetes who need timely, accurate assessment of their metabolic status.
Who would benefit from this test?
People with diabetes, particularly Type 1 diabetes, benefit most from this test as they face higher risk of diabetic ketoacidosis. The American Diabetes Association specifically recommends blood ketone testing over urine testing for DKA management. Individuals experiencing symptoms of DKA such as frequent urination, extreme thirst, nausea, confusion, or fruity breath should consider testing.
Additionally, patients following ketogenic diets for therapeutic purposes and those undergoing supervised fasting protocols can use this test to monitor ketosis safely. Anyone with unexplained metabolic acidosis or those needing differential diagnosis of hyperglycemic conditions would also benefit from BHB testing.
When should I order a Beta-Hydroxybutyrate Blood Test?
Consider ordering this test if you have diabetes and experience illness, dehydration, or unusually high blood glucose levels above 250 mg/dL. If you're following a ketogenic diet and experiencing concerning symptoms, this test can help distinguish between normal dietary ketosis and problematic ketoacidosis.
The International Society for Pediatric and Adolescent Diabetes recommends BHB testing "whenever possible" for diagnosing DKA. You should also consider testing during sick days, when managing diabetes becomes challenging, or when you need to monitor ketosis during therapeutic fasting protocols.
How do I interpret the results?
BHB <0.4–0.6 mmol/L
- Meaning: Normal range
- Action: Continue routine monitoring
BHB 0.6–1.5 mmol/L
- Meaning: Borderline elevation
- Action: Consult healthcare provider
BHB 1.5–3.0 mmol/L
- Meaning: High risk for diabetic ketoacidosis (DKA)
- Action: Seek immediate medical attention
BHB >3.0 mmol/L
- Meaning: Established diabetic ketoacidosis (DKA)
- Action: Emergency medical care required
Recent clinical guidelines use BHB levels below 1.5 mmol/L to define DKA resolution during treatment.
Disclaimer: Reference ranges may vary by laboratory. Listed ranges are general guidelines and may differ from those used by the performing lab. Always consult your healthcare provider for interpretation.
Values above 1.5 mmol/L indicate DKA risk requiring immediate medical evaluation, with optimal DKA prediction occurring at 5.3 mmol/L (90.6% accuracy). A BHB cutoff above 1.5 mmol/L provides 98.1% sensitivity and 78.6% specificity for DKA diagnosis (American Association for Clinical Chemistry 2021).
Pre-test preparation
Fast for at least 8 hours before testing for most accurate baseline results. Continue taking your regular medications unless specifically instructed otherwise by your healthcare provider. Note if you're following a ketogenic diet or fasting protocol, as these can affect your results.
Ensure proper hydration before the test unless medically contraindicated. The blood sample requires refrigeration after collection, but no special preparation is needed beyond standard blood collection procedures. Results typically take 3-10 business days depending on the laboratory.
How often should I get tested?
- Type 1 diabetes, stable – Test during illness or when symptoms appear
- High-risk diabetic – Test when glucose is over 250 mg/dL
- Ketogenic diet monitoring – Test monthly or as needed
- Therapeutic fasting – Test as recommended by healthcare provider
- DKA recovery monitoring – Test as directed during treatment
For ongoing monitoring of known conditions, follow your physician-recommended testing intervals. Consider repeat testing if symptoms persist despite normal results, and always document results to track patterns for sharing with healthcare providers.
Why early detection matters
In 2017, there were 220,340 hospital admissions with primary DKA diagnosis in the United States, with total charges of $6.76 billion and mean cost of $30,836 per hospitalization (CDC 2020). Early detection through BHB testing can prevent costly hospitalizations and potentially life-threatening complications.
DKA hospitalizations increased significantly from 2003 to 2014, though mortality decreased from 0.51% to 0.3% with improved detection and management. The superior accuracy of BHB testing, with a negative predictive value of 99.7%, helps eliminate unnecessary DKA workups while ensuring true cases receive prompt treatment.
Related tests you may consider
Comprehensive Metabolic Panel - provides broader context by measuring glucose, electrolytes, and kidney function to better assess overall metabolic status and identify ketoacidosis complications.
Hemoglobin A1c (HbA1c) - offers insight into long-term glucose control over 2-3 months, helping differentiate between acute metabolic crisis and chronic poor diabetes management.
C-peptide Serum - help distinguish between Type 1 and Type 2 diabetes while evaluating insulin production capacity, which affects DKA risk and management strategies.
