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Ketosis vs. ketoacidosis: Compare causes, symptoms, treatments & more
Health Education

Ketosis vs. ketoacidosis: Compare causes, symptoms, treatments & more

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. Let’s take a more in-depth look at the difference between ketosis and ketoacidosis.  

Causes

Ketosis

Ketosis is a natural state the body goes into when it uses fats instead of carbohydrates for energy. When the body is burning fat instead of carbohydrates the liver will turn fats into ketones, or ketone bodies, which then enter the bloodstream and serve as an energy source for cells. Any excess ketones that don’t get used by cells will leave the body via the kidneys and urine. Ketosis happens when someone fasts, follows a low-carbohydrate diet, or follows the ketogenic diet.  

Ketoacidosis

Ketoacidosis, or diabetic ketoacidosis (DKA), is a serious condition that can lead to a diabetic coma and potentially be life-threatening. It mainly affects people with Type 1 diabetes, but can also affect people with Type 2 diabetes. Ketoacidosis happens when ketone and blood sugar levels get dangerously high. For people with diabetes, ketoacidosis is typically caused by not having enough insulin, thereby circulating sugar cannot be used by the body for energy. It can be triggered by not following a diabetes management plan properly, from illness or infections like urinary tract infections, or from pregnancy.    

Ketosis vs. ketoacidosis causes
Ketosis Ketoacidosis
  • Low-carb diet
  • Keto diet
  • Fasting
  • Intermittent fasting 
  • Not enough insulin
  • Insulin reaction 
  • Illness
  • Infection
  • Pregnancy
  • Missing doses of insulin
  • Not following your diabetes treatment plan
  • Alcohol or drug abuse
  • Physical or emotional trauma

Prevalence

Ketosis

Measuring the prevalence of ketosis is difficult because it’s hard to track how many people are fasting or on low-carb diets at any given time. There’s been much more research done on how effective ketogenic and low-carb diets are for weight loss. Some studies suggest that ketogenic diets may be more helpful for weight loss than low-fat diets, and people may feel less hungry on a ketogenic diet. One study by Epilepsy & Behavior showed that the ketogenic diet has significant potential to help treat epilepsy.  

Ketoacidosis

Ketoacidosis is a fairly common complication of Type 1 diabetes. It’s the leading cause of death in persons younger than 24 who have diabetes and may be present in 25%-30% of newly diagnosed Type 1 diabetes cases. Anyone can get diabetic ketoacidosis, but it may be more common among those aged 30 or younger. Thirty-six percent of cases occur among people 30 or younger, 27% among people 30-50, and 23% among people 51-70. Some studies show that it’s also more prevalent among women and patients who’re treated with insulin injections.   

Ketosis vs. ketoacidosis prevalence
Ketosis Ketoacidosis
  • Difficult to accurately say how many people may be in a state of ketosis
  • State of ketosis may be helpful for weight loss
  • Ketogenic diets may help treat epilepsy 
  • Leading cause of death in persons 24 and younger who have diabetes
  • Present in 25%–30% of newly diagnosed Type 1 diabetes cases
  • More common among younger adults
  • More common in women

Symptoms

Ketosis

Many people will intermittently fast or go on low-carb, high-fat diets to try and lose weight, and even though being in a state of ketosis may have some health benefits like weight loss, it can also cause uncomfortable side effects. Ketosis could cause nausea, fatigue, dizziness, headaches, or insomnia. The long-term health implications of a ketogenic diet aren’t well known.  

Ketoacidosis

Being aware of the symptoms of ketoacidosis is very important for people with diabetes. Being able to recognize if you or a loved one is going into ketoacidosis could save a life. If you have diabetes and start to experience fatigue, confusion, abdominal pain, vomiting, extreme thirst, fruity-smelling breath, or frequent urination, you should seek medical attention as soon as possible. 

Ketosis vs. ketoacidosis symptoms
Ketosis Ketoacidosis
  • Nausea
  • Fatigue
  • Weight loss
  • Bad breath
  • Dizziness
  • Headache
  • Insomnia
  • Less energy for exercise
  • Reduced appetite 
  • High blood glucose levels
  • High levels of ketones in the urine 
  • Fatigue
  • Confusion
  • Dry mouth 
  • Frequent urination
  • Being thirsty
  • Passing out
  • Fruity-smelling breath
  • Abdominal pain
  • Nausea
  • Fast breathing 

Diagnosis

Ketosis

Diagnosing ketosis is usually done with either a urine test or blood test. These tests can tell you what your blood-ketone levels are and whether or not your body is in a natural state of ketosis. Urine tests are easy to do at home and will change colors based on how many ketones are in your urine. Ketone levels that are equal to or less than 0.5 mmol/L are considered low or normal. Ketone levels that are between 0.5-3 mmol/L indicate that the body is in nutritional ketosis.  

Ketoacidosis

People with diabetes can tell whether or not they have ketoacidosis by measuring their ketone levels at home with urine tests. They can also have a doctor do blood ketone tests to check their ketone levels. According to the American Academy of Family Physicians, a diagnosis of diabetic ketoacidosis requires plasma glucose concentrations to be 250 mg per dL or higher, along with pH level less than7.3 and bicarbonate level 18 mEq/L or less. A urine test that reads >10 mmol/L means you have a very high risk of going into diabetic ketoacidosis, and if your test shows this you should seek medical attention immediately.   

Ketosis vs. ketoacidosis diagnosis
Ketosis Ketoacidosis
Urine ketone levels

  • <0.5 mmol/L = low/normal
  • 0.5-3 mmol/L = nutritional ketosis
  • >10 mmol/L = diabetic ketoacidosis 

Blood ketone levels

  • <0.5 mmol/L = low/normal
  • 0.5 mmol/L = beginning ketosis
  • 3 mmol/L = diabetic ketoacidosis  
Urine ketone levels

  • <0.5 mmol/L = low/normal
  • >10 mmol/L = diabetic ketoacidosis

Blood ketone levels

  • <0.6 mmol/L = normal
  • 0.6-1.5 mmol/L = beginning ketosis
  • >3 mmol/L = diabetic ketoacidosis

Treatments

Ketosis

Most people with ketosis don’t need medical treatment because it’s one of the body’s natural states. If you’re consistently following a low-carb diet and practicing intermittent fasting, stopping these should reverse any adverse effects you might be experiencing. Increasing your carb intake and eating less fats will make the body burn carbohydrates instead of fats for fuel, and the body will produce fewer ketones. 

Ketoacidosis

People with ketoacidosis will need medical attention to safely reverse high blood sugar levels and high levels of ketones in the body. Ketoacidosis is treated in a hospital by medical professionals who will give intravenous fluids, intravenous nutrients to replace lost electrolytes, and/or intravenous insulin.    

Ketosis vs. ketoacidosis treatments
Ketosis Ketoacidosis
  • Treated at home
  • Adding more carbohydrates into the diet
  • Stopping intermittent fasting
  • Stopping the ketogenic diet
  • Consuming less fat in comparison to carbohydrates 
  • Treated in a hospital
  • Intravenous insulin therapy 
  • Intravenous fluids
  • Intravenous nutrients  

Risk factors

Ketosis

Some people have a higher risk of experiencing ketosis than others. Here are the top risk factors of ketosis:

  • Being on a restrictive diet
  • Being on a low-carb diet
  • Having an eating disorder 

Ketoacidosis

The following factors may increase risk of developing ketoacidosis:

  • Type 1 diabetes, especially those with undiagnosed Type 1 diabetes
  • Heart disease
  • Pregnancy
  • Infections
  • Significant illness or trauma
  • Substance and/or alcohol abuse 
  • Missing or not correctly taking insulin doses 
Ketosis vs. ketoacidosis risk factors
Ketosis Ketoacidosis
  • Restrictive diet
  • Low-carb diet
  • Eating disorder
  • Type 1 diabetes
  • Heart disease
  • Pregnancy
  • Infection 
  • Illness or trauma
  • Alcohol or substance use disorder
  • Not following diabetes treatment plans properly 

Prevention

Ketosis

The best way to prevent ketosis is to eat a balanced diet that contains adequate amounts of carbohydrates, fats, and proteins. This will keep the body from relying on fats as a source of energy. There is much debate as to what the right diet should be, but many sources agree it’s one that contains a variety of fresh fruits and vegetables and that’s low in processed foods. 

Ketoacidosis

Preventing ketoacidosis involves doing several things on a regular basis. People with diabetes can lessen their chances of getting diabetic ketoacidosis if they follow their diabetes treatment plan given to them by their healthcare provider, take their insulin as recommended, check their blood glucose levels regularly, and check for the presence of ketones in their urine if their blood glucose levels are high.  

How to prevent ketosis vs. ketoacidosis causes
Ketosis Ketoacidosis
  • Keeping a well-balanced diet that contains carbohydrates, proteins, and fats
  • Limiting fasting or intermittent fasting
  • Following your diabetes treatment plan
  • Taking your insulin as recommended
  • Checking blood glucose levels regularly
  • Checking for ketones in your urine

When to see a doctor for ketosis or ketoacidosis 

Because ketosis is not a medical condition but a natural metabolic state of the body, it doesn’t require medical attention. It’s when ketone levels get too high and blood sugar levels rise that people should see a healthcare provider. If you have diabetes and your blood or ketone levels are high and getting higher, or if you don’t feel well even though your blood sugar and ketone levels are normal, you should seek medical advice as soon as possible.  

Frequently asked questions about ketosis and ketoacidosis

What are some of the complications that ketoacidosis can cause? 

Seeking treatment for ketoacidosis as soon as possible is important because if it goes untreated it can cause additional health problems and could potentially be fatal. Ketoacidosis has been known to cause swelling in the brain (cerebral edema), fluid to enter the lungs (pulmonary edema), kidney damage, comas, low potassium levels, and can even be fatal. 

Are people with Type 2 diabetes safe from getting ketoacidosis?  

Even though people with Type 2 diabetes are less likely to get ketoacidosis than people with Type 1 diabetes, anyone with diabetes can get the condition. This is why following your diabetes treatment plan is so important.  

How often should you check your ketone levels?  

People with insulin-dependent diabetes should check their ketone levels with test strips anytime their blood sugar levels are over 300 mg/dl, if their sugar levels have repeatedly been over 230 mg/dl, or if they are unwell and have any of the symptoms of ketoacidosis.