Ketosis vs. Ketoacidosis: What You Should Know

What is ketoacidosis?

Ketoacidosis is a life-threatening condition in which your body doesn’t make enough insulin. This can cause you to have dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. If you don’t get prompt treatment for it, you could go into a coma or die.

What are ketones?
Your body produces ketones when it burns stored fat instead of sugar, or glucose, for energy. A German chemist in the mid-1800s first used the word “keton.” The word came from “aketon,” which is the German word for acetone.

Ketoacidosis is also known as diabetic ketoacidosis (DKA).

DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes. If you have type 1 diabetes, you’re more prone to quick changes in blood sugar levels. DKA symptoms often lead to an initial diagnosis of diabetes. DKA can also occur if you have type 2 diabetes and you aren’t managing your diet and insulin properly.



What is ketosis?

Ketosis is a mild form of ketoacidosis, and it’s not necessarily harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you have consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine. Ketones are a chemical your body produces when it burns stored fat.

Some people choose a low-carbohydrate diet to help with weight loss. While low-carbohydrate diets are generally safe, they can lead to ketoacidosis if you take them to the extreme. If you have diabetes, high levels of ketosis can lead to ketoacidosis.


Ketoacidosis statistics

DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent.

People under the age of thirty make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the age of 30 and 50, 23 percent are between the age of 51 and 70, and 14 percent are over the age of 70.



What are the symptoms of ketosis and ketoacidosis?

Ketosis doesn’t have symptoms. Once you begin to have symptoms, your body has entered ketoacidosis.

The symptoms of ketoacidosis are:

  • extreme thirst
  • frequent urination
  • dehydration
  • nausea
  • vomiting
  • stomach pain
  • tiredness
  • breath that smells fruity
  • shortness of breath
  • feeling confused

DKA symptoms can also be the first sign that you have diabetes. In one study of hospital admissions for DKA, 27 percent of people admitted for the condition had a new diagnosis of diabetes.

Read more: Ketosis: Symptoms, signs, and more »


What triggers ketosis and ketoacidosis?

Triggers for ketosis

A low carbohydrate diet can trigger ketosis. That is because a low-carb diet will cause you to have less glucose in your blood, which will, in turn, cause you to produce less insulin. Your body will begin to burn fat for energy instead of relying on sugars. A diet low in calories or nutrients can also trigger ketosis.

Triggers for ketoacidosis

Poor diabetes management is a leading trigger for DKA. In people with diabetes, missing one or more insulin dose or not using the right amount of insulin can lead to DKA. An illness or infection, and some drugs can also prevent your body from using insulin properly, which can lead to DKA. For example, pneumonia and urinary tract infections are common DKA triggers.

Other possible triggers include:

  • stress
  • a heart attack
  • alcohol abuse
  • fasting and malnutrition in people with a history of excessive alcohol consumption
  • drug abuse, especially cocaine abuse
  • some medications
  • severe dehydration
  • acute major illnesses, such as sepsis, pancreatitis, or myocardial infarction

Risk factors

What are the risk factors for ketosis and ketoacidosis?

Risk factors for ketosis

Having a diet low in carbohydrates, nutrients, or calories is a risk factor for ketosis. People on restrictive diets or people with an eating disorder may be at a higher risk for ketosis.

Risk factors for ketoacidosis

Diabetes is the main risk factor for DKA. In one study of people with DKA, researchers found that 47 percent had known type 1 diabetes, 26 percent had known type 2 diabetes, and 27 percent had newly diagnosed diabetes. If you have diabetes, a main risk factor for DKA is not following the routine for blood sugar management that your doctor recommends.

In one study, researchers looked at diabetes in children and teenagers. They found that 1 in 4 participants had DKA when their doctor first diagnosed them with diabetes. Additional risk factors include:

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


How are ketosis and ketoacidosis diagnosed?

You can get a simple blood test to detect the level of ketones in your blood. You can use the level of ketones to determine if you have ketosis or DKA.

You may also be able to take a urine test at home. For this test, you’ll place a dipstick into a clean catch of your urine. It will change colors based on the level of ketones in your urine.

Ketone levels >0.6 mmol/L 0.6-1.5 mmol/L >1.5 mmol/L
What do my ketone levels mean? Low-risk Medium-risk High-risk (call your doctor)

You should go to your doctor or the emergency room immediately for evaluation and treatment if you have diabetes or you take care of someone with diabetes and you notice any of the symptoms of DKA. Call 911 if the symptoms worsen quickly. Prompt treatment for DKA can save your life.

Your doctor will want to know the answers to these questions:

  • What are your symptoms?
  • When did your symptoms start?
  • Have you been managing your diabetes as directed?
  • Do you have an infection or illness?
  • Are you under stress?
  • Are you using drugs or alcohol?
  • Have you checked your sugar and ketone levels?

Your doctor will perform a physical exam. They’ll also do a blood test to check your electrolytes, glucose, and acidity. The results from your blood test can help your doctor determine if you have DKA or other complications of diabetes. Your doctor may also perform:

  • a urine analysis for ketones
  • a chest X-ray
  • an electrocardiogram
  • other tests 

Home monitoring

Illness can affect diabetes and increase your blood sugar level. The American Diabetes Association recommends that you check for ketones every four to six hours if you have a cold or the flu, or when your blood sugar is higher than 240 milligrams per deciliter (mg/dL).

You can monitor blood sugar and ketones with over-the-counter test kits. You can monitor your blood sugar using a blood test strip, and you can test for ketones using a urine test strip.



Treatment of ketosis and ketoacidosis

If you have ketosis, you’ll not need to receive treatment. You’ll only need treatment if it develops into DKA.

You may need to go to the emergency room or stay in the hospital if you have DKA. Treatment usually involves:

  • 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


Outlook for people with ketosis and ketoacidosis

Ketosis generally isn’t dangerous, but it can lead to DKA, which can be dangerous.

DKA can improve with treatment within 48 hours. The first step after recovery from DKA is to review your recommended diet and insulin management program with your doctor. Make sure you understand what you have to do to keep diabetes under control. Talk to your doctor if you’re unclear about anything.

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

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

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

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

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