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“Ketoacidosis” and “ketosis” are two words that sound strikingly similar but refer to two very different conditions — the first can be fatal, and the second is harmless.

Before we get into the other differences between them, it’s important to understand the one thing ketoacidosis and ketosis have in kommon: ketones.

Fat in your body — whether from food you’ve eaten or from your body’s stores — eventually breaks down into ketones in your liver. Ketones serve as energy sources for your organs, especially your brain.

When you’re healthy, you have ketones in your blood at very low levels. When your body enters ketosis — which we’ll get to in a minute — your ketone levels rise.

At slightly heightened ketone levels, people can experience weight loss; high ketone levels can also help with blood glucose control and, in children with epilepsy, seizure control.

But in ketoacidosis (DKA), ketones skyrocket past their normal levels, and the results can be fatal. Knowing the signs and symptoms can help you catch DKA early and get it treated by a doctor.

The first thing you need to know about ketosis (aka “nutritional ketosis”) is that most of the time, it isn’t harmful. It can actually be quite beneficial for some people.

Ketosis is a metabolic process that happens when there aren’t enough carbohydrates in your body to sustain the energy you need to function, so your body switches from burning sugar (carbs) to burning fat for fuel.

Simply put, this is why low-carb diets are a staple in weight loss and healthy eating. Carbohydrates raise blood sugar more than any other type of food, so lowering your intake will cut calories and send your body searching for alternative fat-fuel.

There are many low-carb diets out there, but the ketogenic diet has recently gained attention by promising to kick-start ketosis in your body, thus sending your body’s fat-burning into turbo mode.

For people simply concerned with weight loss, the dietary rules (what to eat, what to avoid) are pretty straightforward. But for people with serious health concerns, ketogenic diets should be monitored by a dietitian and/or doctor.

Zooming in on the keto diet

The ketogenic diet is a low-carb, high-fat diet meant to encourage your body to turn its fat stores into fuel.

It was originally developed to help children with epilepsy — the Epilepsy Foundation reports that more than 50 percent of children with epilepsy who try the keto diet have their seizures reduced by half, while “10 to 15 percent become seizure-free”). But it has proven to have many other benefits as well.

The keto diet has shown success in:

  • lowering blood sugar levels
  • encouraging weight loss
  • helping to curb appetite

Some research suggests nutritional ketosis may even help people with neurological disorders like Parkinson’s disease and Alzheimer’s disease.

The term “ketoacidosis” refers to diabetic ketoacidosis (DKA), which is a potentially fatal complication of type 1 diabetes.

It occurs when a person’s ketone levels and blood sugar (also called blood glucose) dramatically increase, making their blood too acidic, which in turn disrupts their organs’ ability to function.

DKA primarily happens to people who have type 1 diabetes when they don’t have enough insulin in their bodies.

With too little insulin, the body’s blood glucose can’t be absorbed, which makes the body go into “starvation mode.” As a result, the body begins to rapidly break down fat and protein into ketones, which sends the liver and kidneys into overdrive.

In most cases, ketoacidosis occurs when a person has high ketone levels and high blood glucose at the same time.

Ketoacidosis is usually brought on by:

  • illness
  • poor diet
  • insufficient insulin

One of the first signs that you may have ketosis is an increase in how many times a day someone offers you a breath mint.

Yep — bad breath caused by ketones is a sign your body is in ketosis. Acetone in the breath and urine is a byproduct of the process, and it tends to smell fruity, though not in a pleasant way.

Other symptoms of ketosis include:

  • weight loss
  • headaches
  • thirst
  • stomach complaints

Symptoms of diabetic ketoacidosis include:

  • excessive thirst and dry mouth
  • frequent urination
  • nausea and vomiting
  • abdominal pain
  • weakness or fatigue
  • shortness of breath
  • fruity-scented breath
  • confusion
  • high blood glucose levels
  • rising levels of ketones in the urine and blood
  • dry or flushed skin

These symptoms can develop quickly, sometimes within 24 hours, and can be the first signs that a person has developed diabetes.

Ketosis triggers

A low-carbohydrate/ketogenic diet is meant to trigger ketosis, so no harm, no foul there.

Triggers for ketoacidosis

Poor diabetes management (such as missing insulin doses or not taking enough insulin) can cause DKA.

Certain infections and illnesses, such as pneumonia and urinary tract infections, cause the body to produce heightened levels of hormones like adrenaline or cortisol, which trigger DKA as well.

Other possible ketoacidosis triggers include:

  • physical or emotional trauma
  • stress
  • heart attack
  • alcohol or drug abuse
  • certain medications, including corticosteroids and diuretics
  • dehydration
  • acute major illnesses such as sepsis, pancreatitis, and myocardial infarction

Risk factors for ketosis

Low-carbohydrate diets are risk factors for ketosis (but they are usually intentional).

Risk factors for ketoacidosis

Missing insulin doses and having type 1 diabetes are the most common risk factors for DKA, followed by skipping meals, not eating enough, and misusing alcohol.

Ketones are detectable in both blood and urine, and testing these can determine whether you have ketosis or DKA. Blood tests are the most efficient method, especially if you have diabetes, but urine tests are also widely used and are available over the counter.

The urine tests involve a dipstick that can be placed into a clean sample of urine and will change color based on the level of ketones detected.

The blood tests give more accurate readings. Unlike the urine tests, blood tests can measure your level of beta-hydroxybutyric acid, a prominent ketone in DKA.

Your doctor will also most likely give you a physical exam and check your blood’s glucose levels, acidity, and electrolyte levels.

Be prepared to answer these questions for your doctor:

  • What are your symptoms, and when did they start?
  • Have you been managing your diabetes as directed?
  • Do you have an infection or illness?
  • Are you under stress?
  • Are you using drugs or alcohol?
  • Have you checked your sugar and ketone levels?

It’s possible that your doctor might perform other tests such as a chest X-ray or an electrocardiogram.

There’s no place like home… monitoring

If you have diabetes, you know getting sick can increase your blood sugar, making it extra crucial to keep track of your glucose and ketone levels.

Luckily, over-the-counter blood and urine tests let you monitor your health from home so every cough doesn’t send you running to the doctor.

Some home blood glucose meters can also test blood ketones, such as the Nova Max Plus and Abbott Precision Xtra.

If your blood sugar gets higher than 240 milligrams per deciliter, or if you get a cold or the flu, check your ketones every four to six hours and go to the hospital if you start experiencing symptoms of DKA.

Ketosis doesn’t require treatment, so that’s one less thing to worry about.

Ketoacidosis, on the other hand, requires immediate medical attention. Once you’re at a medical facility, you may be given fluids, have your electrolytes replaced, and/or be put on intravenous insulin.

Being able to recognize symptoms of diabetes can help you know when to seek medical attention before you develop DKA.

The signs differ for every age group, and your doctor should be able to give you a thorough rundown of what to look out for.

These are some of the most important preventive measures you can take:

  • Always take your prescribed dose of insulin.
  • Eat healthy food and maintain an active lifestyle.
  • Know how to adjust your insulin during times of illness.
  • Know how to monitor and interpret your glucose levels.
  • Know how to check your ketone levels.
  • If you use an insulin pump, know its settings and have a prescription for basal insulin ready in case the pump ever fails.

Be prepared to get to a medical facility immediately if you think you may have DKA.

Ketosis is a temporary metabolic state, usually brought on by fasting or following a ketogenic diet. It generally poses no threat and can be turned around simply by getting off the diet and eating more carbohydrates.

Ketoacidosis (DKA) can improve with treatment within 48 hours.

Managing diabetes isn’t always easy, but staying on top of your diet and insulin will be one of the most important and beneficial things you can do for yourself.

Keep a close eye on:

Bottom line

Ketosis and ketoacidosis may have ketones in common, but they are two very different conditions.

If you’re interested in the keto diet, talk to your doctor to make sure it’s right for you. Sending your body into ketosis is generally harmless and can result in desired weight loss, among other benefits. It’s also almost immediately reversible.

DKA is the condition to look out for. If you have type 1 diabetes, make sure to always take the correct dose of insulin and memorize the signs and symptoms of ketoacidosis. Precaution is your best friend.