Ketoacidosis vs. Ketosis: What's the Difference?

By: Lainey Younkin, M.S., R.D., L.D.N.

Ketosis, ketogenic, ketoacidosis. Why are "keto" words popping up everywhere, and what do they mean? We break down these words and how they compare to one another.

You may have heard the term "keto" or ketogenic floating around. So what exactly is ketoacidosis, ketosis and ketones? Here, we break it down for you.

"Keto" is derived from the word ketone, a specific class of organic compounds in your body that are produced when your body burns fat instead of carbohydrates. Your body prefers to burn carbohydrates (glucose) for energy. However, if there is not enough glucose to burn, you will start burning fat instead. This process is called ketosis. Ketones circulate in the bloodstream and are used by tissues and muscles for fuel. You will excrete any ketones not used for energy in your urine.

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Ketosis vs. Ketoacidosis

"Ketosis is simply the presence of ketones in the blood," says Staci Freeworth, R.D., C.D.E., professor of nutrition at Bowling Green State University. "This can be caused by periods of energy imbalance, a change in diet, pregnancy or overconsumption of alcohol."

Ketosis is a normal response in the body when a healthy person with a balanced diet starts fasting or severely restricting calories or carbohydrates (e.g., the super low-carb ketogenic diet). Ketosis happens when the body senses a state of starvation.

Ketoacidosis is when blood levels of ketones are so high that your blood becomes too acidic.

"Ketoacidosis is short for diabetic ketoacidosis and occurs in diabetics who do not make insulin or stop taking their prescribed insulin, typically people with type 1 diabetes," Freeworth says. It can lead to a diabetic coma or even death, according to the American Diabetes Association.

Insulin helps transport your blood glucose (or blood sugar) to your cells and tissues. People with type 1 diabetes, and some people with type 2 diabetes, have to inject insulin because their bodies do not make enough. When the body does not have the amount of insulin it needs to take glucose to its cells, it starts breaking down fat for fuel, producing ketones.

"In ketoacidosis, the amount of ketones in the blood affects the blood pH level, increasing the acidity, which is a dangerous medical state," Freeworth says.

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Causes and Symptoms of Ketoacidosis

Diabetic ketoacidosis can be caused by uncontrolled diabetes (such as not taking insulin) or an acute illness, such as an infection or heart attack.

Ketoacidosis symptoms are similar to diabetes symptoms. You might feel thirsty, have a dry mouth, urinate frequently, have high-blood sugar levels, and have high levels of ketones in your urine. You can test ketone levels in your urine with a test strip.

"Symptoms also include fruity breath, nausea, vomiting, fatigue, flu-like symptoms, difficulty breathing and eventually coma," said Sylvia White, R.D., C.D.E., diabetes educator and owner of ParentingDiabetes.com.

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Diagnosis of Ketoacidosis

It is important to see a doctor and registered dietitian regularly if you have diabetes. "A dietitian can educate people with type 1 diabetes on the importance of checking for ketones when blood sugars are high, symptoms of diabetic ketoacidosis, and how to clear ketones to prevent an emergency room trip," White says.

If your blood glucose levels are higher than normal and you experience any of the symptoms above, call your doctor. If your symptoms worsen to include vomiting, extreme dehydration or flu-like symptoms, go to the emergency room. Diabetic ketoacidosis can be fatal if not treated.

Treatment of Ketoacidosis

Your health care providers can advise you on what you should do if ketone levels are high in your urine. "When ketones are present, extra insulin and adequate sugar-free liquids can flush the ketones," White says. "If the ketones cannot be cleared and dehydration is happening, an emergency room visit is needed."

How to Avoid Ketoacidosis

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If you have diabetes, especially type 1 diabetes, do the following to avoid diabetic ketoacidosis:

• Check your blood sugar regularly.

• Take your insulin as prescribed.

• See your doctor regularly.

• Meet with a registered dietitian.

• Go to the emergency room if your blood sugar is higher than normal and you have symptoms of diabetic ketoacidosis.

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