Ketosis and ketoacidosis are two conditions that can be easy to confuse with one another if you don’t know what their differences are. Ketosis is a metabolic state the body goes into when it doesn’t have enough glycogen from carbohydrates to burn for energy. Ketoacidosis is a complication of diabetes (typically Type 1) that causes the body to produce excess blood acids. In this article, we discuss the differences between ketosis and ketoacidosis, including their symptoms. We also explain when to see a doctor and how to treat and prevent ketoacidosis.
What are Ketones?
Ketones are produced from fat and can be used as an alternative source of energy for the body when its cells are low on glucose (sugar) for a period of time. This is generally a 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 travels to the liver, where it is broken down into ketones, which are used as one source of alternative energy instead of glucose.
What is ketosis?
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.
Symptoms of ketosis
Although the only way to be sure that the body is in ketosis is to take a ketone test, there are some symptoms that you may be experiencing the “keto flu”, or experiencing the initial side effects of sugar and carbohydrate withdrawal.
These will pass within a few days but include:
- Brain fog
- Constipation (and sometimes diarrhea)
- Sugar cravings
- Muscle aches
- Elevated heart rate
- Bad breath (known as “ketosis” breath)
Drinking plenty of water can help alleviate the symptoms of ketosis, and most of them should completely go away after a few days.
One severe side effect that some people see from long-term ketosis is the increased incidence of kidney stones. Supplementing your diet with a potassium citrate tablet can help prevent this.
What is Ketoacidosis?
Ketoacidosis, or diabetic ketoacidosis (DKA) in people with diabetes, is a complication of diabetes that occurs when a person does not have enough insulin. The body responds by breaking down fat into ketones too rapidly, resulting in high levels of ketones in the blood (far more than the normal amount in people without type 1 diabetes).
Ketones are acidic molecules, so an increased level of ketones can cause the blood to become more acidic which prevents the body’s processes from working normally. By definition, ketone levels in DKA are too high, causing the blood to become dangerously acidic. If left unaddressed, even for a few hours, this impairs the function of the brain and other organs and can be life-threatening.
Symptoms of Ketoacidosis
Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice:
- Excessive thirst
- Frequent urination
- Nausea and vomiting
- Stomach pain
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include:
- High blood sugar level
- High ketone levels in your urine
When to see a doctor
If you feel ill or stressed or you’ve had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit.
Contact your doctor immediately if:
- You’re vomiting and unable to tolerate food or liquid
- Your blood sugar level is higher than your target range and doesn’t respond to home treatment
- Your urine ketone level is moderate or high
Seek emergency care if:
- Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
- You have ketones in your urine and can’t reach your doctor for advice
- You have many signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion
Remember, untreated diabetic ketoacidosis can lead to death.
Prevention of Ketoacidosis
There’s much you can do to prevent diabetic ketoacidosis and other diabetes complications.
- Commit to managing your diabetes. Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
- Monitor your blood sugar level. You might need to check and record your blood sugar level at least three to four times a day, or more often if you’re ill or stressed. Careful monitoring is the only way to make sure that your blood sugar level stays within your target range.
- Adjust your insulin dosage as needed. Talk to your doctor or diabetes educator about how to adjust your insulin dosage in relation to factors such as your blood sugar level, what you eat, how active you are, and whether you’re ill. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.
- Check your ketone level. When you’re ill or stressed, test your urine for excess ketones with an over-the-counter urine ketones test kit. If your ketone level is moderate or high, contact your doctor right away or seek emergency care. If you have low levels of ketones, you may need to take more insulin.
- Be prepared to act quickly. If your blood sugar is high and you have excess ketones in your urine, and you think that you have diabetic ketoacidosis, seek emergency care.
Diabetes complications are scary. But don’t let fear keep you from taking good care of yourself. Follow your diabetes treatment plan carefully. Ask your diabetes treatment team for help when you need it.
Although ketosis and ketoacidosis both cause ketone levels in the body to rise, they are not the same. Nutritional ketosis is the aim of the ketogenic diet, and it is generally safe, whereas ketoacidosis is a potentially dangerous complication of type 1 diabetes.
People with diabetes should avoid ketogenic diets and follow their doctor’s treatment recommendations to prevent ketoacidosis. Ketogenic diets can help people lose weight and may offer some health benefits. However, it is always best to talk to a doctor before trying a new diet.