Ketosis vs. Ketoacidosis

Ketosis and ketoacidosis both affect the production of ketones in the body. However, while ketosis is commonly safe, ketoacidosis can be life-threatening.

Nutritional ketosis happens when the body starts burning fat instead of glucose. Producing ketones is the aim of a ketogenic diet or “keto” diet, a high-fat, very-low-carb diet that can help people reduce weight.

Ketosis may be a normal, safe body response to low-carbohydrate diets or not eating for a certain period (fasting). On the other hand, ketoacidosis can be a severe and life-threatening problem where too many ketones will make your blood acidic.

Ketoacidosis occurs when the body creates remarkably high ketones levels, and it is often a complication of type 1 diabetes.

In this article, we’ll explain the difference between ketosis and ketoacidosis. This includes their symptoms, when to consult a doctor, and how to handle and prevent ketoacidosis.

What is Ketosis?

Ketosis is when ketones accumulate in your blood. It may be a typical process that happens when your body doesn’t have enough carbohydrates, breaking down fat into ketones for energy.

The word “ketosis” relates to the presence of ketones in the blood. This is usually not problematic.

Ketosis can happen when a person is fasting or doing a very low-carbohydrate diet, sometimes called a ketogenic diet. It’s normal to be in a low-level ketosis state when waking up in the morning, as the body was “fasting” during the night.

Low-carbohydrate intakes can help achieve ketosis. Decreasing carbohydrates to fewer than 50 grams per day have resulted in weight loss and A1C reduction. This is one component of Virta Health’s indirect medical care program to put type 2 diabetes into remission.

If you have type 1 diabetes, there is no way to distinguish if ketosis is affected just by fasting or by an insufficient amount of insulin. It is safest to consider any ketosis greater than 0.5 mmol/L is too much if you have type 1 diabetes.

Try to have ketone levels undetectable or at least less than 0.5 mmol/L.

What are Ketones?

Ketones are created from fat and can be used as an alternative energy source for the body when its cells are low on glucose (sugar) for some time. This is commonly a result of deficient insulin (the “key” needed for sugar to enter most cells). 

In response, the body releases fat deposited in fat cells. The fat then moves to the liver, where it is broken down into ketones, which are used as one source of alternative energy instead of glucose.

Symptoms of ketosis

For most people, ketosis is a short-lived metabolic condition that occurs when the body switches from burning glucose to burning fat.

During this time, the level of ketones in the blood increases. People on ketogenic diets aim to consume more extensive periods in ketosis. Some people also enter a condition of ketosis through fasting.

Ketosis can direct to bad breath and weight loss. It may also cause headaches, thirst, and stomach ailments in some people.

Although producing ketones is generally safe, it can lead to nutritional irregularities in some people. To some, producing ketones could mean not getting enough calories. Malnutrition can generate:

  • fatigue
  • weakness
  • low concentration or memory problems
  • changes in mood
  • anemia
  • feeling cold
  • getting ill more frequently

What Triggers Ketosis?

A low-carbohydrate diet can start ketosis. That is because a low-carb diet will induce you to have less glucose in your blood. In turn, this will cause your body to burn fat for energy instead of relying on sugars.

Risk factors for ketosis

Having a food consumption low in carbohydrates is a risk factor for ketosis. This may be purposeful, for example, as a weight-loss strategy. People on restrictive diets or people with an eating dysfunction may be at a higher risk for ketosis.

What is Ketoacidosis?

Ketoacidosis, or diabetic ketoacidosis (DKA) in people with diabetes, is a complication of diabetes. It happens when a person does not have sufficient insulin.

The body reacts by tearing down fat into ketones too quickly. This results in high levels of ketones in the blood (far more than the usual amount in people without type 1 diabetes).

Ketones are acidic molecules. So an expanded level of ketones can cause the blood to become more acidic, which blocks the body’s processes from working usually.

By definition, ketone levels in DKA are too high, causing the blood to become severely acidic. If left unattended, even for a few hours, this decreases the brain’s function and other organs and can be life-threatening.

Symptoms of ketoacidosis

Diabetic ketoacidosis is a potential difficulty of type 1 diabetes. And it can happen if a person does not administer sufficient insulin at the right times.

Not eating adequate food can also sometimes trigger diabetic ketoacidosis. The symptoms of diabetic ketoacidosis incorporate:

  • high blood glucose levels
  • rising levels of ketones in the urine
  • thirst and frequent urination
  • exhaustion
  • dry or flushed skin

As ketoacidosis progresses, symptoms can involve:

  • nausea and vomiting
  • stomach pain
  • trouble breathing
  • a fruity odor in the breath
  • confusion and difficulty paying attention
  • loss of consciousness

What Triggers Ketoacidosis

Inadequate diabetes management is a leading trigger for DKA. In people with diabetes, missing one or more insulin shots or not using the correct amount of insulin can lead to DKA.

An illness or infection, as well as some drugs, can also stop your body from using insulin properly. This leads to DKA. For example, pneumonia and urinary tract infections are popular DKA triggers.

Other possible triggers incorporate:

  • stress
  • a heart attack
  • misusing alcohol
  • fasting and malnutrition in people with a history of excessive alcohol intake
  • misusing of drugs, especially cocaine
  • some medications
  • severe dehydration
  • acute major ailments, such as sepsis, pancreatitis, or myocardial infarction

Risk factors for ketoacidosis

Type 1 diabetes is the main hazard for DKA. In one of the people with DKA, researchers found that 47 percent had type 1 diabetes, 26 percent had type 2 diabetes, and 27 percent were newly diagnosed.

If you have diabetes, DKA’s main risk circumstance is not following the routine for blood sugar management that your doctor suggests.

Researchers looked at diabetes in children and teenagers. They discovered that one in four participants had DKA when their doctor first diagnosed them with diabetes. Additional risk factors include:

  • having alcohol use disorder
  • misusing drugs
  • skipping meals
  • not eating enough

The Difference Between Ketosis to ketoacidosis

Nutritional ketosis happens when the body uses fat instead of glucose as fuel. The liver tears down this fat into chemicals called ketones and discharges them into the bloodstream. The body is then capable of using ketones as an energy source.

The ketogenic diet aims to produce nutritional ketosis. People achieve this by eating foods that are high in fat but very low in carbohydrates. Using this diet has become a popular way to burn fat and lose weight.

Doctors first developed the ketogenic diet to treat children with epilepsy. The “classic” ketogenic diet includes eating 3–4 grams (g) of fat for every 1 g of carbohydrate and protein.

According to the Epilepsy Foundation, researches show that more than 50 percent of children who undertake this diet decrease their seizures by at least half. Meanwhile, 10–15 percent become seizure-free.

Doctors do not know why the ketogenic diet decreases some symptoms of epilepsy. The study recommends that this diet may also help with other neurological disorders, such as Parkinson’s disease and Alzheimer’s disease.

In opposite C, ketoacidosis happens when the body feels starving and starts breaking down fats and proteins too quickly. It is a possible complication of type 1 diabetes.

If a person does not have sufficient insulin, the body cannot move glucose from the blood into cells, where it is necessary for energy. 

As a result, critical levels of both glucose and ketones can accumulate in the blood. Doctors refer to this situation as diabetic ketoacidosis(DKA).

Doctors can use blood and urine tests to distinguish whether a person is in ketosis or ketoacidosis.

During nutritional ketosis, it is common to have blood ketone levels of 0.5–3.0 millimoles per liter (mmol/L). According to the American Diabetes Association, a person should monitor their ketone levels if their blood glucose levels are higher than 240 milligrams per deciliter (mg/dl).

People with diabetes whose blood ketone levels are high have a more significant chance of having diabetic ketoacidosis.

Treatment of ketosis and ketoacidosis

If you have ketosis, you’ll not require to undergo treatment.

You may only require to go to the emergency room or stay in the hospital if you have DKA. Treatment usually includes:

  • fluids by mouth or through a vein
  • replacement of electrolytes, such as chloride, sodium, or potassium
  • intravenous insulin until your blood sugar level is below 240 mg/dL
  • screening for other problems you may have, such as infection

Diabetic ketoacidosis is a medical crisis that can progress quickly, but it is also highly treatable.

Doctors typically treat people with diabetic ketoacidosis in a hospital or emergency room. Treatment typically includes insulin therapy together with fluid and electrolyte replacement.

Most people with diabetic ketoacidosis will need to stay at the hospital for monitoring. As blood ketone levels recover to normal, the doctor may suggest additional testing to determine whether a person has other risk factors for ketoacidosis.

Prevention of ketoacidosis

People with diabetes can decrease their risk of ketoacidosis by:

  • watching blood glucose levels regularly and notifying a doctor if they are not under the control
  • examining the urine for ketones if blood glucose levels are above 240 mg/dl
  • avoiding exercise if ketones are present in the urine and blood glucose levels are raised
  • taking insulin according to the doctor’s prescription plan
  • having a healthful and balanced diet
  • evading skipping meals

When to see a doctor

A doctor can use blood or urine tests to conclude whether a person is in ketosis or ketoacidosis. These tests will determine the levels of ketones, glucose, and acidity in the body.

Nutritional ketosis is not a medical disease and does not require a diagnosis. However, ketoacidosis is a life-threatening condition, and anyone with symptoms should seek urgent medical attention. People with signs of malnutrition should also consult a doctor.

Doctors often provide urine test strips to people with type 1 diabetes to check their ketone levels.

Outlook for people with ketosis and ketoacidosis

Ketosis usually isn’t dangerous. It’s usually linked to a planned, low-carbohydrate diet or a transient condition related to diet.

DKA can develop with treatment within 48 hours. After improving from DKA, the first step is to review your prescribed diet and insulin management program with your doctor.

Make sure you understand what you have to do to keep diabetes under limitation. Discuss with your doctor if you’re unclear about anything.

You may want to keep a regular log to track your:

  • medications
  • meals
  • snacks
  • blood sugar
  • ketones, if your doctor suggests it

Keeping a log can help you observe your diabetes and flag any possible DKA warning signs in the future.

If you’re sick with a cold, the flu, or an infection, be particularly alert for any possible symptoms of DKA.

Final Thoughts

Both include fatty acid substances called ketones. But ketoacidosis is a dangerous state when your body doesn’t have sufficient insulin, and ketones build up too much.

Ketosis occurs with much lower, safer levels of ketones than ketoacidosis. This process occurs in everyday life, depending on the amount of protein and carbs you consume. It’s a situation that can lead to weight loss and lower A1c for many people with diabetes.

Although ketosis and ketoacidosis generate ketone levels in the body to rise, they are not the same.

Nutritional ketosis is the aim of the ketogenic diet, and it is commonly safe. In contrast, ketoacidosis is a potentially dangerous complication of type 1 diabetes.

Ketones are, at physiological levels, up to around 3.0 mmol/L, which is adequate energy sources for the body that may contribute a metabolic benefit in many situations.

These ketones are produced while in nutritional ketosis, which usually happens when reducing carbohydrates down to around 20-50g per day.

DKA happens in people with type 1 diabetes with a relative lack of insulin. It creates a condition of internal starvation and much higher levels of ketones damaging to the body. This life-threatening state should not be confused with nutritional ketosis.

People with diabetes should avoid ketogenic diets and follow their doctor’s recommendations to prevent ketoacidosis.

Ketogenic diets can support people to lose weight and may offer some health benefits. However, it is always best to discuss it with a doctor before trying a new diet.