Ketones vs Ketosis vs DKA


What are the differences between ketones, ketosis, and diabetic ketoacidosis (DKA)? These terms are commonly used in the type 1 community but what do they mean? Here is a breakdown of their definitions and differences.


Ketones are a source of energy for the cells in the body. Typically, glucose is used as fuel for cells. When the body is unable to access glucose for fuel, it uses fat stores as an alternative. The liver burns fatty acids and produces usable energy called ketones. There are three types of “ketone bodies”: acetoacetate, beta-hydroxybutyrate and acetone. Acetoacetate and beta-hydroxybutyrate transfer energy produced in the liver to the rest of the body. Acetone, also known as a “fruity breath smell” results from the breakdown of Acetoacetate.


Nutritional ketosis occurs when the body changes the way it gets energy over at least a few days. After the body burns through all of its glycogen stores, or cannot use glucose derived from carbohydrates for energy, it breaks down fat which produces ketones. In nutritional ketosis, small amounts of ketones are created and used as energy. The body will produce ketones until a more significant serving of carbohydrates is consumed. A diet that is high in fat, moderate in protein and extremely low in carbohydrates can result in nutritional ketosis. An extremely low carbohydrate diet consists of a 20-50g carbohydrate limit per day which varies based on body type and exercise.


Diabetic ketoacidosis or DKA is typically caused by a lack of insulin. Normally, insulin takes glucose out of the blood and allows cells to use glucose for energy. When insulin isn’t available, glucose remains in the blood causing hyperglycemia, and the body goes into starvation mode. Then, fat is burned as a source of energy resulting in ketone production. Very high levels of ketones lower the pH in the bloodstream leading to acidosis, or too much acid in the blood. These high levels of ketones are very dangerous and can be life-threatening.

This piece is part of Beyond Type 1’s resources on DKA + managing ketones—find the complete collection of resources here.

WRITTEN BY Julia Blanchette PhD(c), RN, CDE, POSTED 06/17/19, UPDATED 11/10/22

Julia has lived with type 1 diabetes for 20 years. She works as a certified diabetes educator and certified insulin pump and continuous glucose monitor (CGM) trainer. She is also finishing up her PhD in nursing science at Case Western Reserve University which is focused on financial stress, mental health and self-management in young adults with type 1 diabetes. In her spare time, she enjoys helping with Camp Ho Mita Koda where she is the healthcare director, exploring Cleveland and writing. You can follow her on Twitter @JBlanchetteCDE or on Instagram @nursejebcat.