Some people get confused between the difference between nutritional ketosis vs ketoacidosis which we see in diabetics. As a result, some people think that a ketogenic diet can be dangerous for the non-diabetic because they confuse being in nutritional ketosis vs being in diabetic ketoacidosis.

There’s a big difference between nutritional ketosis on a well-formulated ketogenic diet and the extreme high levels of blood ketone levels that happen with diabetic ketoacidosis. So let’s look at the difference between nutritional ketosis vs ketoacidosis.

Nutritional Ketosis vs Ketoacidosis

Ketone bodies are chemicals made by the liver in times of fasting or when the body is on a low-carbohydrate diet. These ketones or ketone bodies can be used for energy by most of the body when glucose (and glycogen) runs low. In an otherwise healthy person, ketone bodies are a natural response.

Ketones in a normal high carb diet

For people that are on a typical high carb diet, their blood ketone levels will usually be unmeasurable or below 0.1 mmol/l as the body uses blood glucose as the primary source of energy.

If someone on a high carb diet fasts for 18 to 24 hours, there may be a slight increase of blood ketones to 0.1 to 0.3 mmol/dl. But as soon as they eat any carbohydrates, they will see their blood ketone levels drop below 0.1 mmol/dl again because they are not fat adapted.

Nutritional Ketosis and Low Carb Diets

Nutritional ketosis usually will occur on a very low carbohydrate diet where daily c carbohydrate intake is limited to 50 grams a day or less. It can take several days to a week to attain true nutritional ketosis. A person in nutritional ketosis will typically have a blood ketone level of 0.5 to 3.0 mmol/l while maintaining normal blood glucose levels and a slightly lower insulin response.

Nutritional Ketosis and Ketone Levels with Exercise

For someone that is in nutritional ketosis, they can see their blood ketone levels increase to 1.0 to 5.0 mmol/l after exercise, especially if exercising fasted. This increase in ketone levels is usually temporary and the blood ketone levels will drop once you eat after your workout.

As you become more fat-adapted, you also may not see as much of an increase in your blood ketone levels with exercise since the muscles will rely on local triglyceride stores for energy instead of ketones.

Ketone Levels with Prolonged Fasting

Prolonged fasting (longer than 24 hours) will also increase blood ketone levels up to 5 to 7 mmol/l while maintaining blood glucose in low-normal ranges. People that are nutritionally fasting that are not type 1 diabetics will also have slight low to low-normal levels of insulin as well.

When they break their fast, they should see a drop in their blood ketone levels to a more moderate level of 0.5 to 1.5 for their blood ketones.

Diabetic Ketoacidosis and blood ketone levels

Diabetic ketoacidosis is primarily caused by low or no insulin in Type 1 diabetes. Insulin is required for glucose to enter into the body’s cells. When a diabetic is not taking their insulin, blood glucose levels rise, sometimes up to 600 to 700 mg/dL (or over 33 mmol/l). As the blood sugar levels climb and the body can not get glucose into the cells, the liver tries to make ketone bodies as a secondary fuel source.

In these ketoacidosis cases, the high level of blood glucose and ketones causes the blood to become extremely acidotic Diabetic ketoacidosis (DKA) is a life-threatening condition. Diabetics in DKA often need hospital admission, insulin and fluid replacement and close monitoring of their electrolyte levels in the intensive care unit.

So there is a big difference when comparing nutritional ketosis vs ketoacidosis. Nutritional ketosis can be a healthy way to lose weight and help your body to become better fat-adapted. Diabetic ketoacidosis is a life-threatening condition that occurs in insulin-dependent diabetics that have extremely high blood glucose and blood ketone levels.