Glucose & Ketone Reference Guide

A single elevated reading doesn't necessarily indicate a problem. Many factors can temporarily raise blood glucose, including:

• Recent meals (especially carbohydrate-heavy food)
• Stress or illness
• Certain medications (including some anti-seizure drugs)
• Lack of sleep

What to do: Don't panic. Recheck after fasting for 8+ hours. If fasting glucose is consistently above 100 mg/dL across several readings, talk to your doctor. They may recommend an HbA1c test for a more complete picture.

Remember: Only your doctor can diagnose or rule out conditions like prediabetes or diabetes.

Blood glucose below 70 mg/dL is considered low (hypoglycemia) and can cause symptoms like shakiness, sweating, confusion, irritability, and dizziness. If untreated, severe hypoglycemia can lead to seizures or loss of consciousness.

What to do immediately:

• Consume 15-20 grams of fast-acting carbohydrate (glucose tablets, fruit juice, regular soda, or honey)
• Wait 15 minutes and recheck your glucose
• If still below 70, repeat
• Once glucose is above 70, eat a small snack or meal

If glucose drops below 54 mg/dL or you feel very unwell, seek medical help immediately. Low blood glucose can also lower your seizure threshold, so it's especially important for people with epilepsy to address it promptly.

For therapeutic purposes (such as epilepsy management), the target is typically 1.5 to 3.0 mmol/L. This is considered "optimal nutritional ketosis" where the anti-seizure benefits are believed to be strongest.

However, your specific target may differ. Your neurologist and dietitian will set the right range for your situation. Some children and adults on strict medical ketogenic diets may have higher targets.

Important: Nutritional ketosis (0.5-3.0 mmol/L) is very different from diabetic ketoacidosis (usually above 10 mmol/L with high glucose). If you're following a supervised ketogenic diet and don't have diabetes, levels up to 3.0 mmol/L are generally considered safe.

Ketone levels below 0.5 mmol/L generally indicate you are not in nutritional ketosis. Common reasons include:

• Too many carbohydrates in your diet
• Not enough time since starting the diet (it can take 2-7 days to enter ketosis)
• Hidden carbs in processed foods
• Excessive protein intake (protein can be converted to glucose)

If you're following a ketogenic diet for seizure control, talk to your dietitian about adjusting your macronutrient ratios. Do not make drastic changes to your diet without medical guidance.

Ketone levels between 3.0 and 5.0 mmol/L can occur during prolonged fasting, very strict keto diets, or intense exercise. For most people without diabetes, this isn't immediately dangerous, but you should monitor more closely.

If your ketones go above 5.0 mmol/L, especially if your blood glucose is also high (above 250 mg/dL), this could indicate ketoacidosis — a medical emergency.

Watch for these symptoms:

• Nausea or vomiting
• Abdominal pain
• Fruity-smelling breath
• Confusion or difficulty concentrating
• Excessive thirst and frequent urination

If you experience any of these symptoms with high ketone levels, seek medical attention immediately.

Yes, both glucose and ketone levels can influence seizure activity:

• Low blood glucose (hypoglycemia) can lower your seizure threshold and may trigger seizures in some people
• Very high blood glucose may also affect brain function and seizure risk
• Ketone bodies may have a stabilizing effect on brain excitability, which is why the ketogenic diet can help reduce seizures
• Stable levels of both glucose and ketones are generally better than large fluctuations

Tracking both values in your diary and sharing the data with your neurologist can help identify patterns between your metabolic state and seizure occurrence.

For the most consistent and comparable readings:

• Glucose: First thing in the morning before eating (fasting), or 2 hours after a meal
• Ketones: Morning fasting readings are most reliable. Ketone levels tend to be lowest in the morning and highest in the late afternoon/evening

Try to measure at the same time each day for the most useful trend data. Record the values in your Epilog diary entry so the 30-day chart in Insights can show meaningful patterns.

Tip: If your doctor has asked for specific timing (e.g., pre-meal, post-meal, bedtime), follow their instructions instead.

Blood ketone meters are more accurate and are the recommended method for monitoring ketosis, especially for therapeutic purposes like epilepsy management.

Urine strips measure a different ketone (acetoacetate) and are affected by hydration levels. As your body becomes more efficient at using ketones, urine strips may show lower readings even though you're in deeper ketosis — which can be misleading.

If your healthcare team has recommended ketone monitoring, ask them which method they prefer. For tracking in Epilog, enter blood ketone values in mmol/L.

Yes, some anti-seizure medications can influence blood glucose and/or metabolism:

• Valproate (Depakote) may cause weight gain and metabolic changes that affect blood sugar
• Topiramate (Topamax) can sometimes cause metabolic acidosis, which may interact with ketone levels
• Some medications can affect appetite, which indirectly impacts glucose and ketone readings

If you notice unexpected changes in your glucose or ketone levels after starting or adjusting medication, tell your neurologist. They can assess whether the medication may be contributing and adjust your treatment plan accordingly.