Ketosis versus Ketoacidosis

Courtesy of Master Isolated Images

Courtesy of Master Isolated Images


I hear over and over again that low carb dieting can lead to ketoacidosis.  It’s confusing to me because of the people out there who thrive on very little carbohydrates.  How do they avoid diabetic ketoacidosis?  How have I in the past?  I looked it up and learned that: (and correct me if I’m wrong)

Ketones are organic compounds that result when body fat is broken down for energy.  If you lose, say, a pound of fat you will make ketones.

Ketosis is the presence of excess ketones in the body.  It is the continuous state of fat metabolism.

Diabetic Ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism.  The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes.

Ketones resulting from low carb dieting or from fat loss measure around 5 to 20 mg/dl while the quantity of ketones associated with DKA is quite higher.  The warning to diabetics is if one low carb diets and then has elevated blood sugars, they are perhaps more likely to reach a point of ketoacidosis sooner than if they had no trace or small amount of ketones in their system to begin with.

What I’m understanding is that low carb dieting in diabetics should only be done with very tightly managed blood sugars. 

I could be wrong.  But it seems people might confuse the two because I’ve heard people say that they wouldn’t limit carbs because they don’t want to go into DKA.  These people I’m referring to don’t have diabetes of any kind so that is where my confusion stemmed.  If you don’t have diabetes and you limit carbs for some reason, then the ketosis in the body is not going to lead you to DKA-it just means you’re a constant fat burning machine?

Any thoughts on this?

4 thoughts on “Ketosis versus Ketoacidosis

  1. Scott K. Johnson

    I think you’ve got it, although I’m no expert. From my layman’s understanding, the non-diabetic body automatically starts increasing insulin output to compensate for the insensitivity the ketones cause.

    I don’t think anyone without diabetes could ever go into DKA and end up in the hospital like we do.

  2. Trev

    Nicely summarized explanation on DKA, Ketosis, and its metabolism.

    I eat low carb, less the 40 gms a day. I have Type 1 DM, and I think you are completely accurate in thinking if our glucose is well controlled our risk is less. It makes sense to me, if we are producing small amount of ketones, then it would take less time to enter DKA as opposed to having none.

    People just get scared because they link DKA with Harmless ketonetic diet and fat burning.

    What can you do.


  3. Michael Barker

    Wow! Sysy, I’ve never heard of people believing that low carb causes DKA. If anything quite the opposite is the case. DKA, as you said, is caused by the absolute or relative lack of insulin and the metabolic cascade that occurs because of it.

    Insulin seems to have quite a bit of uses in the human body but its primary function is the control of blood sugar. What food has the greatest capability of raising blood sugar: refined carbohydrates. These tend to be flours based on wheat. (Okay, I won’t get started on wheat.) My point is that a lot of these foods have a higher glycemic index than sugar.

    What does this mean? It means that they will tend to invoke a high insulin response. Insulin has another quality to it. It has the capability of shutting down fat metabolism in the body. High insulin essentially tells the fats cell to store fat and not release it for energy use by the body. This makes sense, a hyperglycemic blood sugar is harmful to the body and the body has a very limited ability to store glucose. It, however, can store fat till hell freezes over. This is because the primary energy for the body is fat.

    The body, in an effort to reduce blood sugar will recruit all the body systems to use this sugar and thus bring down the bodies blood sugar, thus the use of fats becomes secondary in a high glucose environment. This will mean that the formation of ketones will be reduced. This reduced ketone production then is a sign of metabolic derangement. The primary source of energy for the body is not being used. A healthy body should show some amount of ketosis.

    Ketoacidosis is another beast altogether. With no insulin, the body must burn fats to survive whilst at the same time enduring a hyperglycemic environment. The burning of fats isn’t the issue. The high glucose environment is. It essentially sets up a situation of body wide inflammation that disrupts the signaling of all systems involved in the control of blood sugar. Without insulin to modify this process, the body will convert excessive amounts of fats and make the blood more and more acidic.

    A diabetic needs to stay away from these sorts of problems and the best way to do this is to limit carbs. Tightly controlled or loosely controlled makes little difference. The lowering of carbs is the best way to handle diet and diabetes.

  4. Sysy Post author

    Thanks Michael! I appreciate your explanation. I couldn’t believe it either and that is why I decided to write a post about it. I must say, the number one food which makes it harder for me to manage my blood sugars and which increases my insulin resistance the most-is refined flour, wheat to be exact. I wish I had been told years ago to try to cut it out. Instead I had to learn the hard way. People ask me how on earth a type 1 gets an A1c as low as 4 or 5% and honestly I have to credit that mostly to avoiding any refined wheat. And yes that sucks, but it works for me.

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