If you live with diabetes, you are probably well aware of the dangers of letting your blood sugar go too high and slipping into diabetic ketoacidosis, or DKA. 

This dangerous condition can become fatal if left untreated. 

What a lot of people (with and without diabetes) may not be aware of, however, is that there is a similar biological condition known as ketosis, that has nothing to do with dangerously high blood sugars and generally feeling awful. 

This article will explain in greater depth what ketoacidosis is, what ketosis is, and how the two conditions are different. 

What is ketoacidosis? 

Diabetic ketoacidosis, or DKA, is a serious short-term complication of diabetes that develops when the blood turns acidic from too many ketones in the body, from extremely high blood sugar levels.

Ketoacidosis happens when the body cannot metabolize any glucose ingested because there is no insulin available in the body. This results in a rapid deterioration and requires immediate emergency medical attention.

Ketoacidosis can happen quickly from a complete lack of insulin (due to an insulin pump failure or forgetting to take an injection before a meal), or develop more slowly, due to regular sickness and stubborn high blood sugars over the course of several days. 

Ketoacidosis occurs in people with type 1 diabetes much more often than people living with type 2 diabetes. In fact, about 25% of patients are in DKA at diagnosis with type 1 diabetes. 

Although rare, some people who don’t have diabetes can get ketoacidosis too. It can be caused by chronic alcoholism, starvation, or an overactive thyroid. 

What are the symptoms of ketoacidosis? 

Some common symptoms of ketoacidosis are the following. Please seek immediate emergency medical attention if you suspect you have ketoacidosis.

  • Bodyache and headache 
  • Extreme thirst and dry mouth 
  • Frequent urination 
  • High blood sugar
  • Ketones in the urine 
  • Nausea 
  • Vomiting 
  • Blurry vision
  • Fruity-smelling breath
  • Extreme fatigue 
  • Confusion 
  • Weight loss (rapid and dangerous) 
  • Flushed face 

How dangerous is ketoacidosis? 

Ketoacidosis is extremely dangerous and must be addressed immediately by a medical professional. 

Call 911 or go to your local emergency department if you think you are in DKA and/or have a blood sugar of 250 mg/dL or higher and moderate to high ketones for several hours and cannot get your blood sugar down. 

If left untreated, ketoacidosis can lead to diabetic coma and death. 

Everyone with diabetes should have at-home ketone strips to test (via blood or urine) for ketones in their system and to help prevent the development of DKA. 

What is ketosis? 

Nutritional ketosis, on the other hand, is a 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 (similar to the weight loss seen at the diagnosis of diabetes, but this weight loss is harmless). 

This usually occurs when people eat an extremely low carbohydrate diet, such as the ketogenic diet, intermittent fasting, or (occasionally) the Paleo diet. 

Nutritional ketosis can be achieved after about 3-4 days of eating 50 or fewer carbohydrates per day. 

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 
  • Insomnia
  • Irritability 
  • Headache
  • Constipation (and sometimes diarrhea) 
  • Sugar cravings
  • Muscle aches
  • Elevated heart rate
  • Dehydration 
  • Nausea 
  • Cramping
  • 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. 

Is ketosis dangerous?

For people without any chronic conditions and who are not pregnant, nutritional ketosis is not dangerous, as long as you have sufficient insulin in the body. 

A person can be in ketosis and not have dangerously high blood sugars, nor be in any grave danger.

Ketosis is not recommended for women who are pregnant, are trying to become pregnant, and those who are breastfeeding, as ketosis can affect breast milk supply. 

Eating for a state of ketosis is also not recommended for people who are experiencing: 

  • Pancreatitis
  • Liver failure
  • Carnitine deficiency
  • Porphyria
  • Disorders that affect the metabolism of dietary fat 

Some people who stay in ketosis long-term may experience low blood sugar, fatigue, fatty liver, chronic constipation, raised cholesterol levels, and increased incidence of kidney stones, but this is not guaranteed. 

Always check with your doctor before beginning any new eating plan. 

Can someone with diabetes be in ketosis without being in ketoacidosis?

Yes! While you should always talk with your doctor before beginning any new eating regimen, there are plenty of people with diabetes who adhere to a ketogenic diet and stay in ketosis, while maintaining a normal blood sugar range. 

In fact, several studies attest to the health benefits of being on a ketogenic diet/staying in ketosis if you have diabetes. A two-year study found that people with diabetes following the ketogenic diet lost an average of 26 pounds.

A different study found that the ketogenic diet helped improve people’s insulin sensitivity by 75%.

If followed for 3 months or longer, staying in ketosis via an extremely low carbohydrate diet has even been found to lower hba1c levels in people with diabetes.

Be aware that being on a ketogenic diet and/or achieving ketosis will affect the amount of insulin and/or diabetes medication you require, so always check with your doctor before making any changes to your eating habits or medications. 

You can learn more about the ketogenic diet here: The Ketogenic Diet and Diabetes: The Definitive Guide

The key difference between ketosis and ketoacidosis 

While both conditions result in the development of ketones in the body, the difference between ketosis and ketoacidosis is the mechanism behind the development of ketones. 

Ketones along with insufficient insulin (ketoacidosis) is an extremely dangerous condition that can lead to diabetic coma or death if left untreated. 

It usually only happens to people with insulin-dependent diabetes, although people with other types of diabetes can develop the condition as well, along with people who are suffering from an overactive thyroid, starvation, or alcoholism. 

The ketones formed from the body being in a state of ketosis, on the other hand, result from the body using fat instead of carbohydrates for fuel, oftentimes from eating a very low carbohydrate diet or fasting. 

If you’re interested in exploring ways to achieve ketosis and you live with diabetes, check with your doctor first before making any changes to your dietary and/or medication regimens.