Ketosis vs. Ketoacidosis: What You Should Know

 What is ketoacidosis?

Despite the similarity in name, ketosis and ketoacidosis are two different things.

Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from 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. It’s critical that you get prompt treatment.

DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin.

Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production.

Ketosis is the presence of ketones. It’s not harmful.

You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol.

If you’re in ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat.

Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety and long-term sustainability, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan.

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

Ketosis may cause bad breath. Ketones are broken down for use as a fuel source, and acetone is one of the byproducts that is excreted from the body in the urine and breath. This may smell fruity, but not in a good way.

On the other hand, the symptoms of ketoacidosis are:

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

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

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 your body to burn fat for energy instead of relying on sugars.

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, as well as some drugs, can also prevent your body from using insulin properly. This can lead to DKA. For example, pneumonia and urinary tract infections are common DKA triggers.

Other possible triggers include:

Risk factors for ketosis

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

Risk factors for ketoacidosis

Type 1 diabetes is the main risk factor for DKA. In one studyTrusted Source 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.

Researchers looked at diabetes in children and teenagers. They found 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

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.

Urine Ketone Levels<0.5 mmol/L>0.5 mmol/L0.5-3 mmol/L>3–5 mmol/L>5mmol/L>10 mmol/LU
What do my ketone levels mean?Normal to lowBeginning ketosisNutritional ketosis (ideal for purposeful ketosis)Starvation ketosisHigh risk for ketoacidosis (if blood sugar is greater than 250 mg/dL, call your doctor)DKA (seek medical attention immediately)
Blood Ketone Levels<0.5 mmol/L0.5 mmol/L0.5–1.5 mmol/L1.5–3.0 mmol/L3 mmol/L
What do my ketone levels mean?Normal to lowBeginning ketosisModerate levelHigh level, may be at risk for DKADKA (seek medical attention immediately)

Diabetics who are losing weight will have often have low to moderate levels of ketones, which doesn’t increase your risk for diabetic ketoacidosis if your blood sugar is managed and within normal ranges.

Your risk for DKA increases as your ketone levels rise and your blood sugar is above 250mg/dL (14 mmol/L).

Blood ketone tests are the ideal method for diabetics to check ketone levels because they measure the levels of beta-hydroxybutyric acid, the primary ketone involved in ketoacidosis.

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 you or your loved one’s 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.

Some blood glucose meters also have the ability to check for blood ketones like Nova Max Plus and Abbott Precision Xtra.

If you have ketosis, you’ll not need to receive treatment.

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

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

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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