Difference between Ketosis and Diabetic Ketoacidosis

Medically Reviewed By: Dr. Surajeet Kumar Patra, MBBS, MD, FDIAB, MBA & APMP January 6, 2022

Last updated on April 8th, 2022

Ketosis is a state in which people push themselves to reap the benefits such as reduced body weight plus enhanced energy levels. At the same time, diabetic ketoacidosis is a health issue and occurs when the body produces more ketones in people with diabetes type-1. In this article we will be explaining the difference between ketosis and diabetic ketoacidosis and what are the symptoms and treatment for duo.

Difference between Ketosis and Diabetic Ketoacidosis

A ketogenic diet has gained a lot of popularity in recent times because it offers multiple health benefits. It greatly helps in weight loss and increases energy levels. To get the health benefits, people usually push themselves to a ketosis state. Therefore, they do not develop metabolic complications. A similar term, “Ketoacidosis” is the scary side effect of some drugs for treating diabetes. Well, ketosis and ketoacidosis are different from each other.

Ketones – Basic of Ketosis and Ketoacidosis

Both ketosis and ketoacidosis involve the production of ketones in the body. In ketosis, ketones are produced intentionally, while in ketoacidosis they are produced unintentionally. Before starting with the difference between ketosis and ketoacidosis, you need to know what ketones are. Ketones are the molecules that the body releases when the fats from the liver break down. Ketones are transported to the blood to provide energy to the body cells.

Difference between Ketosis and Diabetic Ketoacidosis

Ketosis is a natural state when the body metabolizes fat from the liver instead of blood glucose. It is a short-lived metabolic state whereas, Ketoacidosis or diabetic ketoacidosis is a health complication.

what is ketosis

Here we will discuss some more difference between ketosis and diabetic ketoacidosis on the basis of:


People who aim to have a healthy weight loss prefer to enter into ketosis through fasting and the ketogenic diet. Although it is safe, it may lead to nutritional imbalances in the body. However, they do not develop metabolic complications.

Diabetic ketoacidosis occurs when a person’s body does not produce enough insulin for managing blood sugar levels. Without enough insulin, your body begins to break down the stored body fat to get energy. Consequently, the ketones are released into the bloodstream and cause a chemical imbalance in the blood. It results in metabolic acidosis. It is a rare side effect of anti-diabetes drugs like Metformin but may occur if a diabetes patient starves for a longer time.



Keep an eye on the symptoms of diabetic ketoacidosis in your body. Identifying the symptoms without delay enable the diabetes patients to immediately get the medical help. It prevent the worsening of the condition.

Ketosis gives the health benefits like weight loss. However, there are some uncomfortable symptoms of ketosis. These include:

  1. Nausea
  2. Fatigue
  3. Headache
  4. Insomnia
  5. Dizziness

The symptoms of ketosis do not cause severe health complications like in diabetic ketoacidosis. Ketosis occur due to a lack of nutrition as you have been on a strict diet. To avoid the uncomfortable symptoms of ketosis, follow the diet instructions that your dietician gives. It will help your body into a ketosis state safely and without trouble.

On the other hand, diabetic ketoacidosis can develop quickly, sometimes within 24-hours. Therefore, it is a must for people with diabetes and others to know the symptoms of diabetic ketoacidosis. Some of the symptoms of diabetic ketoacidosis are:

  1. Frequent urination
  2. Excessive thirst
  3. Dizziness
  4. Nausea
  5. Stomach pain
  6. Feeling of confusion
  7. Vomiting

High blood glucose levels and ketones in your body are the symptoms that accompany the above-mentioned symptoms of diabetic ketoacidosis. The combination of high blood glucose and dangerous ketone levels makes your blood acidic and affects the functioning of the internal organs. In some cases, patients may need immediate hospitalization. Otherwise, it can be fatal for them.

Risk Factors

Well, people with or without diabetes are willing to switch their bodies to ketosis as a weight-loss strategy. However, people on a strict diet or who have an eating disorder are at the risk of being on ketosis without intention. Also, people who take a low amount of carbohydrates can unwillingly turn their bodies into a ketosis state.

The risk factors of diabetic ketoacidosis include:

  1. Insufficient intake of nutrition can take you in the state of starvation that leads to ketoacidosis
  2. Poor diabetes management
  3. People who have had heart attack or stroke
  4. Not taking insulin as prescribed or not taking at all
  5. Antipsychotic drugs, steroids, and some diabetes medicines like Metformin
  6. Type-1 diabetes that has not been diagnosed

People who are at risk of developing diabetic ketoacidosis should take care of their blood sugar levels. They also need to consult with doctors regularly to avoid developing diabetic ketoacidosis.

Number of Ketones

The number of ketones present in the body while being on ketosis is lower than the number of ketones during diabetic ketoacidosis.

Effect on your health

Being in the state of Ketosis gives several health benefits to people with or without diabetes. Some of the health benefits of Ketosis are:

  1. Weight loss
  2. Improved blood sugar and insulin levels
  3. Lower risk of developing heart and kidney problems
  4. Improved insulin sensitivity
  5. Improved energy levels and better mental health
  6. Reduced inflammation
  7. Reduce the chances of developing PCOS in women

If diabetic ketoacidosis remains untreated for a long time, it can cause several health complications that can potentially be fatal. Ketoacidosis can cause the following complications:

  1. Swelling in brain
  2. Kidney damage
  3. Low potassium level
  4. The body fluid may enter the lungs
  5. Heart attack

Diabetes management is crucial to avoid such severe health complications due to diabetic ketoacidosis. Also, diabetes patients should not neglect the symptoms of diabetic ketoacidosis.


When your body enters the ketosis state, you may feel a fruity and metallic taste in your mouth when you wake up in the morning. It is a sign that your body is making enough ketones. To ensure your body is in a ketosis state, you can take blood tests, urine tests, and a breathalyzer to test the level of ketones in your body.

To diagnose diabetic ketoacidosis, you can measure the ketone levels with a urine test. Ketone levels of more than 3 mmol/L in urine show that a person has diabetic ketoacidosis. Amount of acid in your blood also determines the severity of diabetic ketoacidosis. When the plasma glucose is 11 mmol/L or higher with a pH level less than 7.3 and bicarbonate level is 15 mmol/L or less, it indicates that you have diabetic ketoacidosis.


People in ketosis state do not need any medical help. They can get out of the state of ketosis when they start eating carbs. Diabetic ketoacidosis patients need immediate medical attention to lower high blood sugar and ketone levels in the body. Treatment of diabetic ketoacidosis includes taking intravenous fluids and intravenous nutrients to replace lost electrolytes. In some cases, intravenous insulin also helps to treat diabetic ketoacidosis. Insulin helps the body to use glucose again as a fuel for energy. Therefore, the body will get rid of extra ketones.

Also Read: Fasting Blood Sugar Normal Range

Ways to Test Your Ketone Levels

There are three ways to test your ketone levels:

Urine test: The body expels excess ketones through urine. Urine strips are available in the market. You can test ketone levels at home. The number of ketones in urine for ketosis is lower than the levels of ketones for ketoacidosis.

Blood test: It is an accurate method to test ketone levels in your body. Similar to the blood glucose test meter, there is a ketone test meter. You need to prick your fingertip and take out a drop of blood on the testing strips to test ketone levels. Nowadays, some blood glucose monitors are integrated with ketone level test features.

Breath test: You can test the level of ketone in your body through your breath. Use a breath meter to measure the ketone level in your body. You have to exhale close to the meter to know the ketone level. Well, it is the most unreliable method to test the ketone levels.

Difference between Ketosis and Diabetic Ketoacidosis

Steps to Get into Ketosis

If you are starting with the keto diet for the first time, you need to follow the below steps to enter into the state of ketosis:

Step 1: Cut down the intake of carbohydrates-When you limit the intake of carbohydrates, your body starts to burn natural fat. Consult your dietician to know your net carb count in a day.

Step 2:  Increase the intake of healthy fats- Keto diet includes more intake of high-fat food with a moderate amount of protein in your diet. However, many people underestimate the need to eat fat while on Ketosis. They can consult a dietician to know more about fat intake. In a keto diet plan, around 60% of calories come from fat. Well, not all types of fats are healthy. Unsaturated fat is the healthy fat that supports a person to get into the state of ketosis.

Step 3: Exercise regularly- When you exercise, the body uses glycogen or stored glucose for energy. Therefore, athletes often take a high-carb diet so that their bodies do not burn glycogen. However, those who want to experience Ketosis should avoid eating carbs before hitting the gym.

Step 4: Intermittent fasting- Fasting for more than 10 hours in a day is called Intermittent Fasting. It helps your body switch in the metabolic state where fat is burnt to provide energy to the body.

Step 5: Take ketone supplement- It is not always necessary for a person to take ketone supplement to get into Ketosis. However, taking ketone supplement becomes necessary.

It will help your body to get into ketosis and lose weight in a healthy manner.

Prevention of Diabetic Ketoacidosis


 People with diabetes type-1 are often at the risk of developing diabetic ketoacidosis. It can cause health problems to them that can be fatal. Hence, it is better to look for the preventive measures to avoid developing diabetic ketoacidosis. Make sure that you do not skip your meals and take insulin on time. You should also avoid exercising when your ketone levels are high. Stick to a healthy diet option to avoid diabetic ketoacidosis.

People with diabetes can reduce the risk of developing diabetic ketoacidosis by following the preventive measures:

Do not skip your meals: When you skip meals, your body does not get enough carbs to break down into glucose for energy. Hence, your body starts burning stored fats and release ketones that lead to diabetic ketoacidosis.

Take insulin as prescribed: Doctors prescribe insulin injections to diabetes type-1 patients. When they skip taking insulin injections according to the treatment plan. It helps the patients to control blood sugar levels and avoid diabetic ketoacidosis.

Avoid exercising if ketone levels are high: Exercising increases blood sugar levels and leads to high ketone levels in urine. Thus, those who have high levels of ketones in urine should avoid exercising. It will lead to diabetic ketoacidosis.

Eat healthy diet: Your diet is an important factor in balancing the blood sugar levels in your body. People with diabetes should stick to their diabetic meal plan. Such type of diet plan includes high fiber, high fat, and low carb foods. If the ketone levels are higher than the normal levels in diabetes patients, they can switch to a diabetic ketoacidosis diet plan after consultation with their doctor.

Also Read: Hyperosmolar Hyperglycemic State 

Ketogenic Diet for Diabetes Type-2 Patients


The ketogenic diet plays a crucial role to prevent the risk of developing diabetic ketoacidosis. It also helps to avoid related complications.  Diabetes patients, who want to switch their body to the ketosis state can take help from a professional dietician to get the best ketogenic diet plan. The ketogenic diet is about high-fat and low-carb foods. The best ketogenic beverage is water because it contains zero calories.

It is interesting to know the ketogenic diet for diabetes patients is high in fat and low in carbs. Keto-diet, instead of blood glucose, converts the body fat into energy. Therefore, it helps in weight loss. It also helps reducing blood glucose levels and may reduce the need for insulin for managing blood sugar. Since the ketogenic diet includes high-fat foods, it doesn’t mean you need to load your body with unhealthy saturated fats. You should consume foods that contain heart-healthy fats to promote overall health.

Foods to include

Some healthy food options that are the part of ketogenic diet are:

  • Seeds like sunflower seeds, chia seeds, and flaxseeds.
  • Salmon
  • Olives and olive oil
  • Cottage cheese
  • Eggs
  • Full-fat dairy products
  • Non-starchy vegetables
  • Nuts

Switching to the ketogenic diet can be overwhelming but not impossible. Cut down the carb intake while increasing fat and protein content in your meals

Foods to avoid

Some foods that people with diabetes type-2 should avoid while on ketogenic diet are:

  • Sweets and sugary food items
  • Sweetened beverages like soda, canned juices, tea, and sports drinks
  • Starchy vegetables
  • Alcoholic beverages
  • Bread and bakery products
  • Grains and grain products like Wheat, rice, oatmeal, breakfast cereals, and tortillas
  • Beans
  • High carb sauces
  • Citrus fruits

Avoiding these high-carb food items help meeting your goal of weight loss through ketosis.

Also Read: Diabetes and Artificial Sweeteners


Ketosis and Ketoacidosis both involve the production of Ketones in the body. However, there are many differences between the two. Your body enters into Ketosis when you eat a low-carb diet. Ketosis aims to promote better health through weight loss. On the other hand, diabetic ketoacidosis causes the release of more ketones in your body that makes the blood acidic. Therefore, if untreated, it leads to fatal health complications. Diabetic Ketoacidosis is dangerous and occurs in people with diabetes type-1 as a rare complication.


How can my body get out of ketosis state and how can I get back into it?

When you consume a small to medium amount of carbohydrates, your body gets out of the ketosis state. It happens right after you eat your meal, and it can last up to few hours. It is normal and, your body can get back into the ketosis state as soon as it gets some glucose. If you want to keep your body in the ketosis state for longer, make sure to limit the intake of carbohydrates.

How can I avoid developing diabetic ketoacidosis?

People with diabetes can avoid developing ketoacidosis through maintaining their lifestyle. Following ketogenic diet plan along with some exercises is one of the ways to avoid developing diabetic ketoacidosis. Sugar patients should also discuss about their health history with their doctor before starting anti-diabetes drugs. It helps to avoid development of diabetic ketoacidosis as the side effect of anti-diabetes drugs.

What is keto-adaptation and how long does it take to become adapted to keto?

Keto-adaptation is the transition of your body from burning glucose for energy to being able to use ketones that are produced on burning of body fat. One may take few days to feel the effect of keto-adaptation. When you start with ketosis and become fat-adapted, you will crave fewer carbohydrates. Hence, it will help you to lose weight quickly.

What are the rules for starting with ketosis?

You can turn your body into a ketosis state with a ketogenic diet. It is a diet that contains very low carbohydrates, moderate protein, and high fat. The ketogenic diet contains around 20 to 50 grams of carbohydrates in a day. You should restrict the carbohydrates to continue to keep your body in a ketosis state. It surely helps in losing weight to stay healthy.

Can ketogenic diet cause ketoacidosis?

Yes, the ketogenic diet can lead to ketoacidosis. The ketogenic diet contains high fat and low carbohydrate. The ketogenic diet with or without fasting has the potential to cause weight loss. However, it can also induce ketoacidosis. People with diabetes should consult a doctor before starting a ketogenic diet. It helps them to avoid the potential danger of developing ketoacidosis.


  1. https://www.singlecare.com/blog/ketosis-vs-ketoacidosis/
  2. https://www.diabetes.co.uk/keto/ketogenic-diet-faqs.html
  3. https://wellversed.in/blogs/articles/can-a-ketogenic-diet-cause-ketoacidosis
  4. https://www.healthline.com/nutrition/keto-diet-meal-plan-and-menu#meal-plan
  5. https://www.medicalnewstoday.com/articles/324237

Last Updated on by Dr. Damanjit Duggal 


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