Ketosis And Ketoacidosis

ketosis and ketacidosis

Both ketosis and ketoacidosis involve the production of ketone bodies in the body. However, while ketosis is usually safe, ketoacidosis can be life-threatening. Ketosis may be the body’s normal, safe response to a low-carbohydrate diet or to not eating for a certain period of time (fasting). On the other hand, ketoacidosis can be a dangerous, life-threatening complication where excess ketones make your blood acidic.

What are Ketones?

Ketone bodies are produced from fat and serve as an alternative source of energy for the body when body cells are low on glucose (sugar) for a period of time. This is usually the result of very low levels of insulin (the “key” needed for sugar to enter most cells). In response, the body releases fat stored in fat cells. The fat then enters the liver, where it is broken down into ketone bodies, which serve as a source of alternative energy instead of glucose.

What is Ketosis?

Ketone bodies are a chemical that your body produces when it burns stored fat. For example, when you fast, or if you follow a low-carb diet, your body doesn’t have enough glucose to use for energy. Instead, it uses your stored fat as a fuel source and converts it into ketone bodies.

This is known as ketosis. Many people choose low-carb diets that purposefully go into ketosis to support weight loss. Low-carb diets like the ketogenic diet are common, but more research is needed to determine their safety and long-term sustainability. Talk to a healthcare professional before embarking on any extreme diet plan.

What is Ketoacidosis?

Ketoacidosis, or Diabetic Ketoacidosis (DKA), is a complication of diabetes that occurs when a person does not have enough insulin. The body responds by breaking down fat into ketone bodies too quickly, resulting in high levels of ketone bodies in the blood (well above the normal levels for people who do not have type 1 diabetes).

Ketone bodies are acidic molecules, so increased levels of ketone bodies cause the blood to become more acidic, which hinders the body’s normal work processes. By definition, high levels of ketone bodies in DKA cause the blood to become dangerously acidic. If left untreated, even for a few hours, this can impair the function of the brain and other organs and can be life-threatening.

How to Tell the Difference?

You can do a simple urine test at home. In this test, you will put a dipstick into clean urine. It will change color based on the level of ketone bodies in your urine.

Urine Ketone Levels<20 mg/dL30–40 mg/dL>80 mg/dl
What do my ketone levels mean?SmallModerateLarge
Blood Ketone Levels<0.5 mmol/L0.3–21–2 mmol/L5–7 mmol/L0.5–5 mmol/L3–25 mmol/L
What do my ketone levels mean?NormalAfter prolonged exerciseAfter two days of fastingAfter three weeks of fastingAfter three weeks on ketogenic dietDKA (seek medical attention immediately)

Who is at Risk for DKA?

Patients with type 1 diabetes experience DKA most often, as patients with type 2 diabetes usually have some insulin secretion. Patients with type 2 diabetes may also experience DKA, but the risk is much lower – although when it does occur, the complications can be just as severe. Type 1 patients taking SGLT-2 inhibitors are at higher risk of ketoacidosis; However, it is generally accepted that DKA caused by SGLT-2 inhibitors may be preventable if appropriate measures are taken quickly.

Treatment of Ketoacidosis

Diabetic ketoacidosis is a medical emergency that can progress rapidly, but is also highly treatable.

Doctors usually treat patients with diabetic ketoacidosis in the hospital or emergency room. Treatment usually includes insulin therapy and fluid and electrolyte replacement.

Most patients with diabetic ketoacidosis will need to stay in the hospital for monitoring. When ketone levels in the blood return to normal, the doctor may recommend additional testing to determine if a person has other risk factors for ketoacidosis.

Prevention of Ketoacidosis

People with diabetes can reduce their risk of ketoacidosis by:

  • monitoring blood glucose levels regularly and notifying a doctor if they are not under control
  • testing 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 high
  • taking insulin according to the doctor’s treatment plan
  • eating a healthful and balanced diet
  • avoiding skipping meals


Although both ketosis and ketoacidosis result in increased levels of ketone bodies in the body, they are not the same. Nutritional ketosis is the purpose of the ketogenic diet and it is usually safe, while ketoacidosis is a potentially dangerous complication of type 1 diabetes.

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

A ketogenic diet can help people lose weight and may provide some health benefits. However, it is best to talk to your doctor before trying a new diet.

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