Ketotic hyperglycemia is a condition where you have high blood sugars (usually 250 mg/dL or above) plus the presence of ketones in your blood and urine. People with type 1 diabetes are most likely to experience this condition.

People with diabetes often experience episodes of high blood sugar (hyperglycemia) because they aren’t getting enough insulin in their bodies.

However, ketotic hyperglycemia is a more severe and acute condition. It happens when your cells aren’t getting enough glucose for energy because of a lack of insulin, and your body starts to break down fat for energy. This process produces ketones, which are acids that can build up in your blood and urine over time. At certain levels, it can become dangerous or even fatal.

This article will explore what you need to know about ketotic hyperglycemia and how you can help prevent this condition.

Ketotic hyperglycemia is the condition of high blood sugar (usually 250md/dL or higher) plus the presence of ketones.

Ketotic hyperglycemia often arises from a combination of high blood sugar and a complete lack of insulin in the body. When the body’s cells are starved of energy from glucose, they start burning fat, resulting in acidic ketones that spill over into your blood and urine.

This condition can be dangerous if you live with diabetes.

When these ketones become abundant, it can lead to diabetic ketoacidosis (DKA), which is a severe and potentially life threatening medical emergency. It requires immediate attention, including IV insulin at a hospital and the replenishment of fluids. Without that prompt treatment, DKA can quickly lead to a coma.

DKA usually only affects people with type 1 diabetes (T1D). About 25% of people are in DKA when they’re diagnosed T1D. You can read more here about T1D and the early signs.

The following are the symptoms of ketotic hyperglycemia:

  • high blood sugar
  • ketones in the urine
  • extreme thirst
  • frequent urination
  • rapid heart rate
  • fruity smelling breath
  • headache
  • blurry vision or eyesight changes, or both
  • nausea
  • vomiting
  • lethargy
  • confusion
  • rapid weight loss

If you’re experiencing any of the symptoms along with high blood sugar and moderate to high ketones that are resistant to insulin, you may need to contact your doctor or seek immediate medical help.

Most people who experience ketotic hyperglycemia have been diagnosed with diabetes, and many with T1D are first diagnosed with ketotic hyperglycemia, which sometimes develops into DKA.

Ketotic hyperglycemia may have a sudden onset due to an insulin pump or continuous glucose monitoring (CGM) failure for people with diabetes. It can also happen to people with diabetes due to illness, infection, or even taking expired insulin.

Some people with diabetes will experience ketotic hyperglycemia if they’ve missed an insulin dose or are rationing their insulin.

Ketotic hyperglycemia can also sometimes happen in people without diabetes due to hyperthyroidism.

People with diabetes will likely experience high blood sugar from time to time. This more typical occurrence is called nonketotic hyperglycemia, and it doesn’t cause ketones in the body. If these episodes are addressed quickly, they’re generally not life threatening.

Ketotic hyperglycemia is more dangerous because it can be more difficult to rid the body of ketones and bring blood sugars down quickly before the condition progresses to DKA.

Unlike nonketotic hyperglycemia, ketotic hyperglycemia can cause acute complications, such as dehydration. And as mentioned previously, it can result in DKA, a coma, or death.

You can have ketosis without high blood sugar. This is a harmless biological condition that occurs when the body starts to rely on fat for energy instead of glucose.

Once the body burns this fat, it creates ketones that the body can then use for fuel. This can cause rapid and sustained weight loss and usually only occurs when people eat an extremely low carbohydrate diet, such as the ketogenic diet, or do intermittent fasting.

Ketosis without the presence of high blood sugars can also be caused by alcohol use disorder, hyperthyroidism, and starvation.

Nonketotic hyperglycemia associated with hemichorea-hemiballismus (NKHCHB) is a rare complication of nonketotic hyperglycemia in people with uncontrolled diabetes. It presents as continuous, irregular, and involuntary movements on one side of the body, resulting from a focal lesion of the contralateral basal ganglia.

This is an exceedingly rare complication, and studies show that it affects mostly older adults and those with HbA1cs of 13% and higher.

While not directly related to ketotic hyperglycemia, it’s crucial to keep your blood sugars in a healthy range over the long term to delay or prevent most diabetes complications.

Hyperglycemic ketosis is usually initially treated with subcutaneous insulin injections. If you’re already on insulin, these can be given at home along with drinking plenty of water to help flush the ketones from your system.

Diabetes guidelines recommended avoiding exercise during hyperglycemic ketosis.

Checking your blood sugar every few hours while giving additional insulin and rehydrating is also key.

If your blood sugars are not dropping after several hours and you still have ketones even after rehydrating, call your doctor for additional help. They may recommend an increased insulin dosage or recommend that you go to the hospital for IV fluids to hydrate, correct electrolyte imbalances, and deliver insulin.

Ketotic hyperglycemia is a condition that many people with diabetes experience. It’s high blood sugar levels, usually 250 mg/dL or higher, with the presence of ketones in the blood and urine.

This can be a dangerous condition if not treated promptly and can quickly develop into diabetic ketoacidosis (DKA), which can be fatal if not addressed by medical professionals.

Symptoms of ketotic hyperglycemia include thirst, frequent urination, weight loss, and fatigue. Immediate intervention is necessary if you have diabetes, are experiencing high blood sugar levels with ketones, and are experiencing the symptoms of ketotic hyperglycemia.

Treatment includes subcutaneous insulin injections, hydration, and correcting electrolyte imbalances.