From the Guidelines
Diabetic ketoacidosis (DKA) is a life-threatening medical emergency that requires immediate hospital treatment, whereas ketosis is a normal metabolic state that can be beneficial for many people, but individuals with diabetes should monitor ketone levels carefully and consult healthcare providers before attempting ketogenic diets. DKA is characterized by high blood glucose, high ketone levels, dehydration, and symptoms like excessive thirst, frequent urination, nausea, vomiting, abdominal pain, confusion, and fruity-smelling breath 1. In contrast, ketosis is a normal metabolic state where the body produces moderate ketones when burning fat for fuel during carbohydrate restriction, fasting, or prolonged exercise. Nutritional ketosis, often deliberately achieved through ketogenic diets, typically maintains blood glucose within normal ranges and doesn't cause acidosis.
Key Differences Between DKA and Ketosis
- DKA is a medical emergency that requires immediate hospital treatment with IV fluids, insulin, and electrolyte replacement, whereas ketosis is generally safe and even beneficial for many people 1.
- DKA is characterized by high blood glucose, high ketone levels, and acidosis, whereas ketosis is characterized by moderate ketone levels and normal blood glucose levels 1.
- Individuals with diabetes should monitor ketone levels carefully and consult healthcare providers before attempting ketogenic diets, as the line between therapeutic ketosis and dangerous ketoacidosis can be narrow for those with insulin deficiency 1.
Diagnosis and Management of DKA
- Diagnosis of DKA should not rely on urine ketone determinations but requires the presence of hyperglycemia, increased blood ketone bodies or bOHB, and acidosis with increased anion gap 1.
- Specific measurement of b-hydroxybutyrate in blood should be used for diagnosis of DKA and may be used for monitoring during treatment of DKA 1.
- Individuals who are prone to ketosis (those with type 1 diabetes, history of DKA, or treated with SGLT2 inhibitors) should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis and implement sick-day rules and/or seek medical advice if urine or blood ketones are increased 1.
From the Research
Diabetic Ketoacidosis vs Ketosis
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body produces high levels of blood acids called ketones 2.
- Ketosis, on the other hand, is a metabolic state in which the body burns fat for fuel instead of carbohydrates, producing ketones in the process 3.
- The key difference between DKA and ketosis is the level of ketones in the blood and the presence of other symptoms such as high blood glucose levels, metabolic acidosis, and dehydration 4.
- DKA is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration 4.
- Ketosis, in contrast, can occur in people without diabetes and is often a result of fasting, prolonged exercise, or a low-carb diet 3.
Diagnosis and Treatment
- Diagnosis of DKA is confirmed when all three criteria are present: elevated blood glucose levels or a family history of diabetes mellitus, the presence of high urinary or blood ketoacids, and a high anion gap metabolic acidosis 2.
- Treatment of DKA includes restoration of circulating volume, insulin therapy, electrolyte replacement, and treatment of any underlying precipitating event 2.
- Ketosis, on the other hand, does not require medical treatment and can often be managed through dietary changes and monitoring of blood glucose and ketone levels 3.
- The urine ketone dip test (UKDT) can be used as a screen for ketonemia in patients with DKA and ketosis, with a sensitivity of 97% for the detection of ketonemia in all patients with DKA or DK 5.
Monitoring and Prevention
- Monitoring of blood glucose and ketone levels is crucial in preventing and managing DKA and ketosis 6, 3.
- Patient education on how to adjust insulin during times of illness and how to monitor glucose and ketone levels is essential in preventing DKA 4.
- Regular monitoring of blood glucose levels, careful attention to diet and exercise, and the use of medications can help prevent the complications of diabetes, including DKA and ketosis 6.