What’s the Difference Between Ketosis, Ketones + DKA?

Understanding the differences between ketones, ketosis and diabetic ketoacidosis (DKA) is important, especially for people living with type 1 diabetes (T1D). While ketones can be a natural part of energy production, high levels can lead to serious health risks like DKA, which requires immediate medical help.

Watching your ketone levels and knowing when to get help can help you stay healthy and avoid severe complications, especially if you’re following a ketogenic diet while living with any form of diabetes. For some people with diabetes (PWD), nutritional ketosis might actually be helpful. But remember, ketosis is very different from having ketones or DKA!

In this guide, we break down these differences to help you stay on top of your diabetes management and recognize dangerous symptoms.

What are ketones?

Ketones are a backup energy source for the body. Normally, cells use glucose (sugar) as fuel. But when glucose isn’t available, the body burns fat instead, producing ketones. 

There are three types:

• Acetoacetate and beta-hydroxybutyrate: These help transfer energy from the liver to the rest of the body.
• Acetone: This gives off a fruity breath smell, a sign of ketones in the blood.

People with type 1 and type 2 diabetes (T2D) may develop ketones, but it’s more common for those with T1D. The American Diabetes Association (ADA) explains that high levels of ketones can poison the body. If you have ketones, you need to take them seriously because they can cause a life-threatening condition called DKA.

What is DKA?

DKA is a serious condition that happens when someone with diabetes doesn’t have enough insulin. Without insulin, glucose stays in the blood instead of fueling the cells. The body then burns fat rapidly, producing high levels of ketones, which makes the blood too acidic.

Signs of DKA include:

• Moderate or large ketones
• Nausea
• Vomiting
• Stomach pain
• Fruity breath
• Breath that smells like nail polish remover
• Fast breathing
• Extreme fatigue or tiredness

DKA can lead to severe dehydration, confusion, coma and even death. If ketones are present and you are experiencing any of these symptoms, seek immediate medical attention. Don’t mess around with ketones or DKA! 

Stay on top of ketone levels. There are ways you can monitor at home regularly or when you suspect something’s off.

Ketone levels can be checked in the following ways:

• Blood ketone meter test: This is the most accurate method and uses a small blood sample, much like a blood glucose meter (BGM). Meter costs vary and test strips are usually affordable.
• Urine ketone test strips: This is a less accurate but inexpensive method. These test strips are available at most drug stores. Hydration levels can influence results.
• Breath ketone meter: This method measures acetone, the ketone that appears in your breath. It is easy to use and requires only a one-time purchase, but it can be a little more expensive as a result.

What is ketosis?

Ketosis happens when the body shifts to burning fat for fuel instead of carbs. This can occur naturally after fasting or following a low-carb, high-fat diet—often, less than 50g of carbs per day.

In nutritional ketosis, low levels of ketones are produced and used for energy. Ketosis is different from DKA because the body still maintains a healthy balance. Ketosis is most commonly associated with a ketogenic diet.

The benefits of a ketogenic diet have been well documented for those living with T2D. Some people with T1D opt for keto, too. Not only does the diet help manage blood sugar, but it also supports weight loss. 

Many people with T2D who follow a keto diet have found that they significantly reduce their use of insulin or other blood-sugar-lowering medications. A keto diet can also lower cholesterol and blood pressure.

Being aware makes a big difference

Knowing the differences between nutritional ketosis, DKA and ketones isn’t meant to be scary—it’s meant to empower you to make important medical decisions when something feels off with your health. Diabetes is complicated, but it doesn’t have to feel so burdensome.

The more aware you are of your body, the more proactive and on top of things you can be in managing your diabetes! Teach your friends and family about ketones, nutritional ketosis and DKA, too, so they can support you in case of emergency. Preparation is key in life with diabetes!

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This educational resource is made possible through the support of Abbott Diabetes Care. Beyond Type 1 retains complete, independent editorial control over all content.