Ketosis Versus Ketoacidosis

By now, if you have been following me, you know that I try to follow a ketogenic diet in order to maintain good blood glucose control.  I am not sure I am in what you wold call true nutritional ketosis, but I am certainly in ketosis at times.  I am not sure my carbohydrate intake is low enough to put me into true nutritional ketosis.

You may have been told by well-meaning people and even some doctors that ketosis is dangerous.  If they have told you this, it is because they are confusing ketosis and ketoacidosis.  Ketosis is not dangerous.  Ketoacidosis is a life-threatening condition that requires IMMEDIATE MEDICAL ATTENTION.

Fortunately, Diabetic Ketoacidosis is a state that most Type 2 diabetics could not ever fall into.  Unless you are a very late-stage and insulin-dependent Type 2.

Basically, your body usually functions on glucose for fuel.  However, our bodies can also function on ketones.  What are ketones?  Kentones are made by our liver out of fat cells and selected amino acids.  IT is a major evolutionary advantage for us that we can function on ketones as well as glucose…because we cannot store more glucose than would get us through about 24 hours.  So if we were in a situation where food was not available for more than 24 hours…and we could not make ketones to provide fuel for our brains and our bodies, we would be in real trouble!

When your body is being fueled by ketones instead of glucose, you are in ketosis.  Nutritional ketosis is a prolonged state of ketosis.  This is usually achieved when your carbohydrate intake is under 30 grams a day.  Also, when you are engaged in Intermittent Fasting, as I have discussed in other articles, you are probably, at some point during the fasting period, switching over to ketones to fuel your body and your brain.

Insulin in your body serves as a feedback loop to prevent too many ketones from being produced.  This is why Type 2’s generally do not end up in a state of ketoacidosis.

Basically, ketoacidosis happens when you have little or no insulin at all running around in your body.  You could have all the glucose you wanted in your bloodstream, but, since you have no insulin, your body can’t use it for fuel…and so it begins to produce ketones.  The problem is…without insulin, you have no “feedback loop” to stop the production of ketones, and they build up in your system.  Eventually, they build up so high that they throw off the pH balance of your blood, and you are in ketoacidosis.

One of the most common signs of ketoacidosis is a “fruity” odor to the breath and/or urine.  Usually, if you are in ketoacidosis you will also have a very high blood glucose level.  IF this happens, you need medical attention fast!  The way in which ketoacidosis is normally treated is to administer insulin, which helps to stop the body’s production of even more ketones.

Think of it this way:  Nutrtitional ketosis is like a flame under the frying pan on your stove.  It is controlled and contained.  Ketoacidosis is like when your kitchen is burning down.  Of course, one should always make their healthcare team aware of any changes they intend to make to their diet…or before starting a ketogenic diet.  There are some people…and some conditions…for which it may not be a very good idea.

Some medications, including insulin, can cause you to experiences “hypos” – or episodes of low blood sugar.  Some oral diabetes medications that work by directly lowering your blood sugar, like sulfonylureas can also have this effect.  So, if you are on medication like that, you will want to very carefully monitor your blood sugar levels to avoid hypos.  A hypo can be as life-threatening as diabetic ketoacidosis.

I hope that this explains the basic difference between ketosis and diabetic ketoacidosis in a way the average layperson can understand.


Until next time!