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Ketosis vs Ketoacidosis Symptoms: What’s The Difference?

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Ever wondered about the differences between ketosis and ketoacidosis symptoms? Me too and I want to share what I learned.

When first venturing into the low-carb and keto diet world, it is common to confuse the (normal and healthy) process of ketosis with the (not normal, and dangerous) process of ketoacidosis.

While the state of diabetic ketoacidosis is a more extreme version of ketosis, it is not caused by ketosis or the ketosis diet.

There are many misconceptions both about ketosis and ketoacidosis. Today I’m going to go into detail about both, so you can get a better understanding of these two states.

What Is Nutritional Ketosis?

First, we need to understand the process of ketosis.

Ketosis is a normal metabolic process. It is something your body does to keep on working.

You can get into the state of ketosis after exercising for a long time, and during pregnancy. Ketosis can also occur in people with uncontrolled diabetes, and it is a sign of not using enough insulin.

Nutritional ketosis is induced when you change your diet in order to enter the state of ketosis. This is a deliberate process.

Nutritional ketosis occurs when your body adapts from burning carbohydrates (glucose) as its primary source of fuel to burning fat, instead.

When your carbohydrate consumption goes low enough (<50 grams per day), your liver then converts adipose tissue and dietary fats into a fatty acid that is known as ketones and then burns these ketones for energy.

Each person’s ability to reach nutritional ketosis is different. For some it will take a few days, for others it could take 1-2 weeks (especially for those taking medication for diabetes).

Is Ketosis Bad?

Ketosis itself is not harmful. In fact, being in ketosis can have many positive health benefits. If you have liver or kidney issues, however, approach the keto diet with caution and work in conjunction with a medical professional.

Symptoms Of Ketosis Flu

When you switch from burning carbohydrates to burning fat, you will most likely experience what is known as “keto flu”.

Don’t be alarmed – you aren’t sick. The keto flu – while annoying – is harmless.

The symptoms of the keto flu can include fatigue, headaches, dizziness, cravings for sugar and carbohydrates, nausea, and irritability.

These symptoms generally go away after a few days, but there are some steps you can take to reduce them (or eliminate them altogether).

Treatment Of Ketosis

Following these steps will reduce your symptoms of the keto flu:
Increase your salt and water intake.
Add more fat to your meals.
Slow your transition by first following a more moderate low-carb diet, then going low-carb.
Cut back on physical activity.
Don’t go hungry (but eat slowly to make sure you don’t over-eat).

Want to avoid the keto flu? Go read this post on the ways to minimize or avoid the keto flu.

What Is Ketoacidosis

So, we’ve determined that ketosis is a natural process that occurs when drastically reducing your carbohydrate intake.

Ketoacidosis, however, is a potential complication of Type 1 diabetes, and it is dangerous. It can also sometimes occur in people with type 2 diabetes if they aren’t managing their insulin and diet properly.

Ketoacidosis occurs when your body thinks it is starving and breaks down fats and proteins too quickly.

Your body uses insulin to move glucose from the blood into the cells. If it does not have enough insulin, this process cannot happen. This can lead to dangerous levels of glucose and ketones accumulating in the blood, and in turn, your blood becomes acidic.

It is this condition that is referred to as diabetic ketoacidosis. This can be triggered by not eating enough food, or not administering enough insulin at the right times.

Diabetic ketoacidosis can also be triggered by alcoholism, starvation combined with alcoholism, acute major diseases like pancreatitis, sepsis, or myocardial infarction, an overactive thyroid, heart attack, stress, drug abuse, illness or infections like urinary tract infections and pneumonia, or medications that may inhibit proper use of insulin.

The blood ketone level of a person in nutritional ketosis is normally between 0.5–3.0 millimoles per liter (mmol/L). Between 0.6 and 1.5 mmol counts as low to moderate ketone levels, and between 1.6 and 3.0 mmol counts as high ketone levels (*). Anything over 3.0 mmol counts as very high ketone levels.

If you have diabetes and your blood glucose levels are higher than 240 milligrams per deciliter (mg/dl), you should check your ketone levels to make sure they are not too high.

This is because diabetics with high ketone levels are more at risk of developing diabetic ketoacidosis.

Symptoms Of Ketoacidosis

The early symptoms of diabetic ketoacidosis can include:

  • Thirst and frequent urination
  • Flushed or dry skin
  • Exhaustion
  • High blood glucose levels
  • Rising ketone levels

As the diabetic ketoacidosis progresses, the symptoms can include:

  • Fruity breath odor
  • Stomach pain
  • Difficulty breathing
  • Nausea and vomiting
  • Confusion
  • Loss of consciousness

When You Should See A Doctor

Ketoacidosis is a life-threatening condition and should be treated as such. If you suspect you have the symptoms of ketoacidosis, seek medical treatment immediately. Without treatment, the chance of death within 24 hours is high.

You can keep track of your ketone levels at home using urine strips that can be provided by your doctor.

Treatment Of Ketoacidosis

Because ketoacidosis is a medical emergency, it will be treated in a hospital or an emergency room. The treatment will usually involve insulin therapy, combined with fluid replacement and electrolyte replacement.

Patients will need to stay in the hospital and be monitored while the blood ketone levels return to normal.

How To Prevent Ketoacidosis

If you have diabetes, it is important to take the necessary steps to prevent ketoacidosis from occurring.

You can reduce your risk by:

  • Monitoring your blood sugar regularly.
  • Taking insulin as per your doctor’s treatment plan.
  • Eating a healthy diet.
  • Avoiding skipping meals or eating too little.
  • Testing your urine for ketones if your blood glucose levels are higher than 240 mg/dl.
  • Avoiding exercise if your blood glucose levels are too high and ketones are present in your urine.

How To Achieve Ketosis

Getting into a state of ketosis can occur – as I mentioned above – by drastically cutting your carbohydrate intake to less than 50 grams per day.

In addition to cutting your carbs, there are also 6 steps that you can take that will help you get into ketosis quicker and more effectively:

  • Include coconut oil in your daily diet.
  • Increase your physical activity.
  • Increase the intake of healthy fats.
  • Fast – either a fat fast or short water fast.
  • Keep protein intake moderate.
  • Test ketone levels regularly, and adjust your diet as needed.

Learn how to start a keto diet or how to know if you're in ketosis after you've learned how to avoid ketoacidosis.

The Bottom Line

If you follow the keto diet, or are wanting to follow the keto diet, and are in good health overall, then you shouldn’t have anything to worry about. Ketoacidosis will almost certainly not be an issue for you.

However – if you are diabetic, or have liver or kidney issues – then you should ensure that you taking care of your health and following your doctor’s recommendations. Test your blood glucose regularly, eat healthily, and take the required medication. 


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