The Ketogenic Diet: A Detailed Beginner's Guide to Keto - Healthline
The ketogenic diet involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy.
ketoacidosis
People often confuse ketosis with <anchor>ketoacidosis</anchor>. Ketoacidosis is dangerous, but ketosis on a ketogenic diet is usually fine for healthy people. Speak to your doctor before starting any new diet.
Ketosis vs. Ketoacidosis: What’s the Difference?
Ketosis vs. Ketoacidosis: What’s the Difference?

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# Ketosis vs. Ketoacidosis: What You Should Know

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Medically reviewed by Kelly Wood, MD — Written by Marjorie Hecht —  Updated on April 19, 2023

- [Ketosis](#ketosis)
- [Ketoacidosis](#ketoacidosis)
- [Symptoms](#symptoms)
- [Causes](#causes)
- [Diagnosis](#diagnosis)
- [Treatment](#treatment)
- [FAQs](#fa-qs)
- [Outlook](#outlook)

Ketosis is when ketones are produced in the body from the breakdown of fat for energy. Only if too many ketones accumulate in the body may ketosis progress to diabetic ketoacidosis (DKA), a life threatening condition.

[Ketosis](https://www.healthline.com/health/diabetes/ketosis-symptoms) is a natural metabolic process in which your blood develops a high concentration of [ketones](https://www.healthline.com/health/serum-ketones-test) when the body converts fat into energy. On the other hand, DKA is a serious complication of [type 1 diabetes mellitus](https://www.healthline.com/health/type-1-diabetes).

Learn about both conditions and the differences between them in this article.

## What is ketosis?

Ketones are a chemical your body produces when it burns stored fat. When you’re fasting, for example, or if you are following a low carb diet, your body doesn’t have enough glucose to use for energy. Instead, it uses your stored fat as a fuel source and converts it into ketones.

This is called ketosis. Many people choose a low carb diet to enter ketosis purposefully to support weight loss. Low carb diets like the [ketogenic diet](https://www.healthline.com/health/type-2-diabetes-ketogenic-diet) are common, but [more research is needed](https://pubmed.ncbi.nlm.nih.gov/31825066/) to determine their safety and long-term sustainability. Talk with a healthcare professional before starting any extreme diet plan.

[Learn more about ketosis.](https://www.healthline.com/nutrition/what-is-ketosis)

## What is ketoacidosis?

While ketosis is a typical metabolic process, DKA is not. DKA is a diabetes complication in which the glucose and ketone blood levels get too high. The cause is an extreme lack of insulin.

DKA also makes your blood too acidic, which can change how your internal organs like your liver and kidneys function.

People with [type 1 diabetes](https://www.healthline.com/health/type-1-diabetes-causes-symtoms-treatments), which means their bodies do not produce [insulin](https://www.healthline.com/health/type-2-diabetes/insulin), are most often diagnosed with the DKA. More rarely, it may also occur in people with type 2 diabetes, which means their bodies either do not make enough insulin or make insulin that does not work properly.

People with diabetes can get DKA for various reasons, such as becoming ill with a [triggering virus](https://pubmed.ncbi.nlm.nih.gov/34332112/) such as COVID-19.

Other reasons can include:

- not taking an adequate dose of insulin
- experiencing a stroke or heart attack
- going through physical or emotional trauma

DKA often develops slowly. However, if you’re vomiting, it [may progress](https://www.diabetes.org/diabetes/dka-ketoacidosis-ketones) in just a few hours. It’s critical that you get prompt treatment.

[Learn more about diabetic ketoacidosis.](https://www.healthline.com/health/type-2-diabetes/ketoacidosis#What-is-diabetic-ketoacidosis?)

## How do ketosis and ketoacidosis feel?

Ketosis may cause [bad breath](https://www.healthline.com/nutrition/10-signs-and-symptoms-of-ketosis). Ketones are broken down for use as a fuel source, and acetone is one of the byproducts the body excretes in the urine and breath. This may smell fruity but not in a good way.

On the other hand, the [symptoms of ketoacidosis](https://www.ncbi.nlm.nih.gov/books/NBK534848/) are:

- extreme thirst
- frequent urination
- dehydration
- nausea
- vomiting
- stomach pain
- tiredness
- breath that smells fruity
- shortness of breath
- feelings of confusion

DKA symptoms can also be the first sign that you have diabetes.

## Why do ketosis and ketoacidosis happen?

Ketosis happens when you have less [glucose](https://www.healthline.com/health/glucose) in your blood. This causes your body to burn fat for energy instead of relying on sugars. A common cause is eating a low carb diet.

Ketosis is a typical metabolic process that’s usually harmless. In most cases, a person can continue getting adequate nutrition from sources like fats and proteins. If fasting is the cause, ending the fast will usually occur within a reasonable time.

However, people with an [eating disorder](https://www.healthline.com/health/eating-disorders) may be at a higher risk of ketosis. Mild ketosis generally develops after a [12- to 14-hour fast](https://www.ncbi.nlm.nih.gov/books/NBK534848/).

Going a long time without eating can cause ketosis to become ketoacidosis. But this is rare and usually happens if a person’s body requires a lot of glucose, as is the case for newborns or for pregnant or nursing people. This process [may also](https://www.renalfellow.org/2018/02/12/starvation-ketosis-rare-cause-of/) happen with starvation.

### Triggers for ketoacidosis

In most cases, poor diabetes management is a leading trigger for DKA. In people with diabetes, missing one or more insulin doses or not receiving the right amount of insulin can lead to DKA.

An illness or infection and some drugs can also prevent your body from using insulin properly, which can lead to DKA. For example, pneumonia and urinary tract infections are [common DKA triggers](https://www.ncbi.nlm.nih.gov/books/NBK560723/).

Other possible triggers include:

- [stress](https://www.healthline.com/health/stress)
- [heart attack](https://www.healthline.com/health/heart-attack)
- [alcohol misuse](https://www.healthline.com/health/alcohol-use-and-abuse)
- [fasting](https://www.healthline.com/health/diet-and-weight-loss/intermittent-fasting) and [malnutrition](https://www.healthline.com/health/malnutrition) in people with a history of excessive alcohol consumption
- [drug misuse](https://www.healthline.com/health/drug-abuse), especially involving cocaine
- some medications
- severe [dehydration](https://www.healthline.com/health/dehydration)
- acute major illnesses, such as [sepsis](https://www.healthline.com/health/sepsis), [pancreatitis](https://www.healthline.com/health/pancreatitis), or [myocardial infarction](https://www.healthline.com/health/acute-myocardial-infarction)
- COVID-19

Additional risk factors include:

- having alcohol use disorder
- drug misuse
- skipping meals
- not eating enough

## How to tell the difference?

You can take a simple urine test at home. For this test, you’ll place a dipstick into a clean catch of your urine. It will change colors based on the level of ketones in your urine.

**Urine Ketone Levels**[<20 mg/dL](https://www.ucsfhealth.org/medical-tests/ketones-urine-test)30–40 mg/dL>80 mg/dl**What do my ketone levels mean?**SmallModerateLarge

**Blood Ketone Levels**<0.5 mmol/L[0.3–2](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656040/)1–2 mmol/L5–7 mmol/L0.5–5 mmol/L3–25 mmol/L**What do my ketone levels mean?**NormalAfter prolonged exerciseAfter two days of fastingAfter three weeks of fastingAfter three weeks on ketogenic dietDKA (seek medical attention immediately)

People living with diabetes who are seeking to lose weight will often have low to moderate [ketones](https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes), which doesn’t increase the risk of diabetic ketoacidosis if blood sugar levels are well managed and within typical ranges.

For people living with diabetes, blood ketone tests are an ideal method to check ketone levels because they measure beta-hydroxybutyric acid, a primary ketone involved in ketoacidosis.

## Treatment

Ketosis does not require treatment. But if you develop ketoacidosis, you need to go to the emergency room.

[Ketoacidosis treatment](https://www.ncbi.nlm.nih.gov/books/NBK534848/) usually involves:

- fluids by mouth or through a vein
- replacement of electrolytes, such as chloride, sodium, or potassium
- intravenous insulin
- screening for other problems you may have, such as infection

## Frequently asked questions

The following are answers to commonly asked questions about ketosis and ketoacidosis.

### How common is ketoacidosis?

Based on a 2017 sample of about 220,340 patients, the overall incidence rate of DKA is [61.6 cases per 10,000 hospital admissions](https://diabetesjournals.org/care/article/43/12/e196/31050/An-Update-on-the-Incidence-and-Burden-of-Diabetic).

The incidence of admissions is higher in males than females and in children ages 1 to 17 years than in adults. The incidence and mortality rates are also higher among Black people than white people.

In higher-income countries, the risk of death from DKA is [less than 1%](https://pubmed.ncbi.nlm.nih.gov/32409703/). According to research, deaths occur more often in older adults or those who have illnesses that trigger the condition. In children, the trigger is often a brain injury or cerebral edema.

### How do I know if I am in ketoacidosis?

The Centers for Disease Control and Prevention (CDC) recommend that you check ketone levels if your blood sugar is higher than [240 milligrams per deciliter (mg/dL)](https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html).

You can monitor blood sugar and ketones with over-the-counter test kits. You can [monitor your blood sugar](https://www.healthline.com/health/blood-sugar-tests) using a blood test strip and test for ketones using a urine test strip.

Some blood glucose meters like Nova Max Plus and Abbott Precision Xtra also have the ability to check for blood ketones.

### When should I go to the emergency room?

You should see your doctor or go to the emergency room immediately for evaluation and treatment if you have diabetes or if you take care of someone with diabetes and notice any DKA symptoms. Call 911 if the symptoms worsen quickly. Prompt DKA treatment can save you or your loved one’s life.

Your doctor will perform a physical exam. They’ll also do a blood test to check your electrolytes, glucose, and acidity. The blood test results can help your doctor determine if you have DKA or other diabetes complications. Your doctor may also order:

- a [urine analysis (urinalysis)](https://www.healthline.com/health/urinalysis) to check for ketones
- a [chest X-ray](https://www.healthline.com/health/chest-x-ray)
- an [electrocardiogram](https://www.healthline.com/health/electrocardiogram)
- other tests

## Outlook

Ketosis is not harmful unless lack of nutrition is the cause. In most cases, it’s related to a planned, low carbohydrate diet or a transient diet-related condition.

DKA can improve with treatment within [24 to 36 hours](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085289/). The first step after DKA recovery is reviewing your recommended diet and insulin management program with your doctor.

Talk with your doctor to learn what you can do to keep your diabetes in a well-managed range. They can also answer questions about anything you may not be sure about.

You may want to consider keeping a daily log to track your:

- medications
- meals
- snacks
- blood sugar
- ketones, if your doctor suggests it

Keeping a log can help you monitor your diabetes and alert you to any warning signs of possible DKA in the future.

If you have a cold, the flu, or any other infection, be especially watchful for any possible DKA symptoms.

### How we reviewed this article:

Sources

History

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our [editorial policy](https://www.healthline.com/about/process).

- Dhatariya KK, et al. (2020). Diabetic ketoacidosis.

[https://pubmed.ncbi.nlm.nih.gov/32409703/](https://pubmed.ncbi.nlm.nih.gov/32409703/)
- Diabetes & DKA (ketoacidosis). (n.d.).

[https://www.diabetes.org/diabetes/dka-ketoacidosis-ketones](https://www.diabetes.org/diabetes/dka-ketoacidosis-ketones)
- Diabetic ketoacidosis. (2021).

[https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html](https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html)
- Ghimire P, et al. (2022). Ketoacidosis.

[https://www.ncbi.nlm.nih.gov/books/NBK534848/](https://www.ncbi.nlm.nih.gov/books/NBK534848/)
- Gosmanov AR, et al. (2014). Management of adult diabetic ketoacidosis.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085289/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085289/)
- Ketones and diabetes. (n.d.).

[https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes](https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes)
- Kolb H, et al. (2021). Ketone bodies: From enemy to friend and guardian angel.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656040/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656040/)
- Lizzo JM, et al. (2022). Adult diabetic ketoacidosis.

[https://www.ncbi.nlm.nih.gov/books/NBK560723/](https://www.ncbi.nlm.nih.gov/books/NBK560723/)
- Ludwig DS, et al. (2019). The ketogenic diet: Evidence for optimism but high-quality research needed.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269727/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269727/)
- Luethi N, et al. (2016). Prevalence of ketosis, ketonuria, and ketoacidosis during liberal glycemic control in critically ill patients with diabetes: An observational study.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025567/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025567/)
- Ramphul K, et al. (2020). An update on the incidence and burden of diabetic ketoacidosis in the U.S.

[https://diabetesjournals.org/care/article/43/12/e196/31050/An-Update-on-the-Incidence-and-Burden-of-Diabetic](https://diabetesjournals.org/care/article/43/12/e196/31050/An-Update-on-the-Incidence-and-Burden-of-Diabetic)
- Stevens JS, et al. (2021). Diabetic ketoacidosis and mortality in COVID-19 infection.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317499/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317499/)

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