Ketosis vs Diabetic Ketoacidosis

Ketosis and diabetic ketoacidosis are two conditions that are often confused with one another. While ketosis is a metabolic state the body goes into when it begins to burn stored fat for energy, diabetic ketoacidosis is a complication of diabetes (typically type 1 diabetes) which causes the body to produce excess blood acids.

What is ketosis?

Ketosis is the natural state the body goes into when it uses stored fat instead of carbohydrates (sugar) for energy. When the body is burning fat instead of carbs, the liver will turn fats into “ketones”, a chemical produced, which then enter the bloodstream as energy. Ketones that aren’t used by cells will leave the body via the kidneys as urine. This ketosis process happens when someone fasts, follows a carbohydrate-restricted diet, or follows the ketogenic diet.

The prevalence of ketosis is difficult to determine as it would be near impossible to quantify how many people are fasting or following low-carb or ketogenic diets. However, extensive research has been conducted on how effective low-carb and keto diets are for weight loss. Studies suggest that ketogenic diets may be more effective for weight loss than low-fat diets since people may feel fuller for longer on a ketogenic diet. Some research even suggests that a ketogenic diet has the potential to help treat epilepsy.

Ketosis causes

• Low-carb diet
• Keto diet
• Fasting and intermittent fasting

Symptoms and/or side effects

Many people have opted for a low-carb or keto diet to try and lose weight and for overall health, and although being in a state of ketosis may offer some health benefits like weight loss, it can also cause uncomfortable side effects. Mismanaged ketosis could cause nausea, reduced appetite, fatigue, dizziness, and headaches.

Diagnosis

Diagnosing ketosis can be done with either a urine or blood test. These tests can tell you what your blood-ketone levels are to determine whether or not your body is in a natural state of ketosis. Ketone levels that are 0.5 mmol/L or less are considered low or normal. Ketone levels that are between 0.5-3 mmol/L suggest that the body is in nutritional ketosis.

Treatments

There’s rarely any need for medical treatment for ketosis because it’s a body’s natural state. Consistently following a low-carb or keto diet, or practising intermittent fasting may require you to stop should any adverse effects arise. Increasing your carb intake and eating fewer fats will make the body burn carbohydrates again instead of fats for fuel and produce fewer ketones.

What is ketoacidosis?

Ketoacidosis, or diabetic ketoacidosis (DKA), is a very serious condition that can lead to a diabetic coma and potentially be fatal. Although it mainly affects people with type 1 diabetes, it can also affect people with type 2 diabetes. Ketoacidosis happens when the body’s ketone and blood sugar levels get significantly and dangerously high. For people with diabetes, ketoacidosis is typically caused by not having enough insulin and sugar cannot be used by the body for energy effectively. It can be triggered by not controlling diabetes properly, either from illness, infections, pregnancy, or mismanagement.

Ketoacidosis is a fairly common complication of type 1 diabetes. It’s the leading cause of death in individuals younger than 24 years who have diabetes. Although anyone can get diabetic ketoacidosis, it’s more common among those aged 30 or younger. Thirty-six percent of cases occur among people who are 30 years old or younger, 27% among people aged 30 to 50, and 23% among people who are between 51 and 70 years old. Some studies show that it’s also more prevalent among women and patients who’re treated with insulin injections.

Ketoacidosis causes

• Insufficient insulin circulating throughout the body
• Insulin reaction
• Illness or infection
• Pregnancy
• Missing insulin shots
• Mismanagement of diabetes treatment plan
• Consuming alcohol or drugs in excess
• Physical or emotional trauma

Symptoms

Watching out for the symptoms of ketoacidosis is extremely important for people with diabetes. Being able to recognise these symptoms could save a life. If you have diabetes and begin to experience fatigue, confusion, abdominal pain, vomiting, extreme thirst, or frequent urination, seek medical attention immediately.

Symptoms to watch out for:

• Fatigue
• Confusion
• Dry mouth and/or fruity-smelling breath
• Frequent urination
• Excessive thirst
• Feeling faint or passing out
• Abdominal pain
• Nausea
• Rapid breathing
• High blood glucose levels
• High levels of ketones in the urine

Diagnosis

Much like ketosis, people with diabetes can confirm ketoacidosis by measuring ketone levels with urine and blood tests. Urine tests can be conducted at home with the appropriate tools, while a doctor can do blood ketone tests to check ketone levels. Typically, diagnosing DKA requires plasma glucose concentrations to be 250 mg per dL or higher and a pH level less than 7.3 and a bicarbonate level of 18 mEq/L or less. With a urine test, readings >10 mmol/L show a very high risk of going into diabetic ketoacidosis, and medical attention should be sought immediately.

Treatments

People with DKA will need medical attention as soon as possible to safely reverse high blood sugar levels and high levels of ketones in the body. Ultimately, it needs to be treated in a hospital by medical professionals with intravenous fluids, intravenous nutrients to replace lost electrolytes, and/or intravenous insulin.

Conclusion

Ketosis and diabetic ketoacidosis (DKA) both involve the production of ketones in the body, however they can have very different outcomes on an individual’s health. While ketosis is a generally safe and natural body state, diabetic ketoacidosis can be life-threatening to someone with type 1 diabetes.

For more information please contact Dr O Naidoo, General Practitioner at Lenmed Shifa Private Hospital.

Email: [email protected]

Contact details: 087 265 6364 or 087 284 0124

The Lenmed Group is a world-class group of Private Hospitals that brings quality healthcare to communities across Southern Africa.