Diets such as very low carbohydrate diets (<50g carb/day), or fasting for long hours to manage weight and blood glucose levels, have gained popularity in recent years.
Ketosis, or the process of ketone formation by burning fats in place of glucose, is a term that goes hand in hand with these diets.
It’s vital to understand the types of ketosis one may encounter as a result of dietary manipulation called nutritional ketosis. More importantly, it’s important to learn how nutritional ketosis differs from the more serious and life threatening condition of diabetic ketoacidosis (DKA), a process that leads to ketone formation along with significantly high blood glucose levels in people with diabetes.
What is Nutritional Ketosis?
Nutritional ketosis is defined as the intentional restriction of dietary carbohydrate intake to accelerate the production of a certain amount of ketones. This form of diet, aims to reach a state of nutritional ketosis for effective fat burning. This state is achieved either by following a very low carbohydrate diet such as a ketogenic diet, or by going very long hours without eating as in intermittent fasting.
What is Starvation Ketosis?
Note: This segment is purely informational and NOT recommended. Do not confuse with intermittent fasting.
Starvation ketosis occurs during a complete absence of calories for many days, which leads to a significantly higher concentration of ketones. Much higher than what is considered safe as seen with nutritional ketosis. Whereas blood ketone levels are often between 0.5-3 mmol/L, with nutritional ketosis, levels can reach 3-5 mmol/L or higher with prolonged starvation.
What is Diabetic Ketoacidosis (DKA)?
DKA is a life-threatening condition that occurs when there is unintentional accumulation of ketones accompanied by significantly high blood glucose levels and inadequate insulin availability. When there is inadequate insulin to halt the production of ketones, it increases the risk of DKA due to an extremely high amount of ketones. People with type 1 diabetes with inadequate insulin are at greatest risk. During illness, people with both type 1 and type 2 diabetes are at risk.
How To Measure Ketones for Nutritional Ketosis
Ketones can be measured either by urine or blood. Urine ketone strips are not intended for monitoring nutritional ketosis. Ketometers measure one’s ketone levels by calculating the amount of beta-hydroxybutyrate in the blood, the primary type of ketone produced during ketosis. Below are examples of blood ketone meters.
Note: A Ketometer can be a better method to check for ketone production indicative of DKA as compared to urine ketones, as the beta-hydroxybutyrate levels are significantly higher than another type of ketone called acetoacetate in the presence of DKA.
For people with diabetes, do make sure to have either one of these methods for home ketone measurement.
The difference between Nutritional Ketosis & DKA ketone production
* For people taking insulin and/or other diabetes medication, please check in with your care team for possible adjustments to reduce the risk of hypoglycemia.
Although Nutritional Ketosis and DKA have stark differences, it can become tricky while taking care of your diabetes and trying a very low carb meal plan; all while walking the fine line of keeping ketone levels in check. If one chooses to try a ketogenic meal plan or intermittent fasting, proceed with caution and with these Steady Health recommended best practices:
- Watch for blood glucose trending >250 mg/dL
- Check ketone levels using ketostix (for urine levels) or ketometer (blood levels)
- Check for signs and symptoms (see above chart)
- When in doubt, reach out to your Steady Health care team
- Learn more about preventing and reducing the risk of DKA