What to know about ketosis

Ketosis is a metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead. This results in a buildup of acids called ketones.
Some people encourage ketosis by following the ketogenic, or keto, diet. This diet, which is very low in carbohydrates, aims to burn fat by forcing the body to rely on fat for energy, rather than carbohydrates.
Ketosis also commonly occurs in people with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly.
This article explains how ketosis works, what the keto diet is, and the possible effects of ketosis in people with diabetes. Read on to learn more.
What is ketosis?
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In typical circumstances, the body’s cells use glucose as their primary form of energy. People can usually obtain glucose from dietary carbohydrates, including sugars and starchy foods.
glucose
The body breaks these down into simple sugars. Afterward, it either uses glucose as fuel or stores it in the liver and muscles as glycogen.
If there is not enough glucose available to provide enough energy, the body will adopt an alternative strategy to meet those needs. Specifically, it begins to break down fat stores and use glucose from triglycerides.
triglycerides
Ketones are a byproduct of this process. These are acids that build up in the blood and leave the body in the urine. In small amounts, they indicate that the body is breaking down fat. However, high levels of ketones can poison the body, leading to a condition called ketoacidosis.
high levels
Ketosis refers to the metabolic state in which the body converts fat stores into energy, releasing ketones in the process.
The keto diet
As ketosis breaks down fat stores in the body, some keto diets aim to facilitate weight loss by creating this metabolic state.
Keto diets are usually high in fat. For example, 20% of the calories may be protein, 10% may be carbohydrates, and 70% may come from fat.
20%
calories
carbohydrates
However, there are different versions. The nutrient proportions will depend on the version of the diet a person follows.
For more science-backed resources on nutrition, visit our dedicated hub.
dedicated hub
Is the keto diet healthy?
A 2021 narrative review states that the keto diet could reduce a person’s risk of developing several health conditions, including metabolic syndrome, cardiovascular disease, and diabetes.
2021 narrative review
cardiovascular disease
These health benefits may occur due to the loss of excess weight and the inclusion of more nutritious foods in the diet, rather than the reduction in carbohydrates.
Doctors have also prescribed the keto diet to reduce the number of seizures in children with epilepsy who do not respond to other forms of treatment.
reduce the number of seizures
epilepsy
Some studies have suggested that the diet could also benefit adults with epilepsy, though more research is necessary to confirm these findings.
It is important to note that the keto diet can have side effects. The authors of a 2018 article state that there are several short-term adverse effects of following a keto diet, including:
2018 article
muscle cramps
bad breath
loss of energy
changes in bowel habits
keto flu, which refers to a group of symptoms people experience after beginning a keto diet
keto flu
Additionally, a 2022 review states that the long-term safety and health benefits of the keto diet have not yet been proven.
2022 review
The authors of the review note that various studies have found that adhering to a keto diet long-term can increase levels of LDL, or “bad,” cholesterol.
Ketosis and diabetes
In people with diabetes, ketosis can occur due to a person not having enough insulin to process glucose in the body.
Following a keto diet may be beneficial for people with type 2 diabetes. With this condition, the body still produces some insulin, but it does not work as effectively.
may be beneficial
The keto diet focuses on reducing a person’s intake of dietary carbohydrates. Those with type 2 diabetes can aim to consume fewer carbohydrates, as these convert to glucose and increase blood sugar levels.
However, everyone has different dietary needs. A person with diabetes can speak with a healthcare professional and registered dietician to come up with a diet plan that is suitable for them.
Learn more about the keto diet and type 2 diabetes.
keto diet and type 2 diabetes
Ketoacidosis
People with diabetes who follow a keto diet need to monitor their ketone levels carefully. If levels get too high, ketoacidosis can occur.
DKA is a condition wherein the levels of ketones become extremely high, poisoning the body. It is a severe and dangerous condition.
DKA
The Centers for Disease Control and Prevention (CDC) notes that there are several potential triggers for ketoacidosis. However, it most often occurs due to illnesses that cause higher levels of hormones that work against insulin.
Centers for Disease Control and Prevention (CDC)
It can also result from problems with insulin therapy, either through missing scheduled treatments or not receiving enough insulin.
Some less common triggers of ketoacidosis include:
drug misuse
emotional trauma
physical trauma
stress
stress
surgery
Ketoacidosis most commonly occurs in people with type 1 diabetes. It can also occur in people with type 2 diabetes, though this is much less common.
High levels of ketones in the urine and high blood sugar levels are both signs of ketoacidosis. A person can test for ketoacidosis using a kit at home.
Some early symptoms of ketoacidosis include:
abdominal pain
confusion and difficulty concentrating
dry or flushed skin
excessive thirst and a dry mouth
dry mouth
fruity breath
frequent urination
frequent urination
nausea and vomiting
shortness of breath or rapid breathing
Ketoacidosis treatment and prevention
Ketosis does not usually occur in people who eat balanced diets and regular meals. Drastically reducing calorie and carb intake, exercising for extended periods, or being pregnant may trigger ketosis.
Although some people choose to put the body through ketosis, the risk of increased acid levels can be dangerous in those who are not controlling it.
In people with diabetes, ketosis and eventually DKA can occur if they do not use enough insulin, if they skip meals, or if an insulin reaction occurs. An insulin reaction usually happens while asleep.
Doctors consider DKA an emergency, as it can lead to a diabetic coma and even death. Emergency healthcare workers will usually administer treatment followed by hospitalization in an intensive care unit.
diabetic coma
For those with diabetes, the emergency team will commonly take the following measures:
Fluid replacement: Doctors use this treatment to rehydrate the body and dilute the excess sugar in the blood.
Electrolyte replacement: This helps a person maintain heart, muscle, and nerve cell function. Levels in the blood often drop in the absence of insulin.
Insulin therapy: This can help doctors reverse the processes that led to ketoacidosis.
In otherwise healthy people, following a healthful, balanced diet and exercising regularly can help prevent ketosis.
exercising regularly
There are several ways a person with diabetes can prevent ketoacidosis, including:
carefully monitoring their blood sugar levels at least three to four times per day
discussing insulin dosage with a specialist
following a diabetes treatment plan
People with diabetes should keep an eye on their ketone levels with a test kit, particularly when ill or under stress.
Summary
Ketosis occurs when the body starts to obtain energy from stored fat instead of glucose.
Many studies have demonstrated the powerful weight loss effects of a keto, diet. However, this diet can be challenging to maintain and may cause health problems in people with certain conditions, such as type 1 diabetes.
DKA is a particularly dangerous complication of ketosis that can occur when ketosis makes the blood too acidic. Emergency treatment is necessary for people experiencing DKA.
Most people can try the keto diet safely. However, it is best to discuss any significant changes to diet with a dietitian or doctor. This is especially the case in those with underlying conditions.