Difference between Ketoacidosis and Ketosis: Symptoms, Trigger, Diagnosis and Treatment

Ketoacidosis refers to diabetic ketoacidosis (DKA) which is a serious complication of type 1 diabetes mellitus. This is a life-threatening condition and occurs when levels of ketones and blood sugar are very high. When the levels of ketone and sugar are too high, ketones are build up in your blood making your blood too acidic, which may impact on normal functioning of internal organs like your liver and kidneys.
DKA may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. DKA can occur due to illness, improper diet or not taking an adequate dose of insulin.
Ketosis is the presence of ketones which is not harmful. You will develop ketosis if you are on a low-carbohydrate diet or fasting, or if you have consumed too much alcohol. When your body burns stored fat instead of sugar, it produces the chemical called ketone. If a higher than normal level of ketones are found in your blood or urine which is not high enough to cause acid, then you are in ketosis.

Symptoms of Ketosis and Ketoacidosis:

When ketones broken down for use as a fuel source, acetone is excreted from the body in the urine and breath. This may smell fruity, a bad breath.
On the other hand, the symptoms of ketoacidosis are:

  • extreme thirst
  • dehydration
  • frequent urination
  • nausea
  • vomiting
  • stomach pain
  • tiredness
  • shortness of breath
  • breath that smells fruity
  • feelings of confusion

Symptoms of DKA can also be the first sign that you have diabetes.

Triggers for Ketosis and Ketoacidosis:

Triggers for Ketosis:

A low carbohydrate diet can trigger ketosis. That is because a low carb diet will produce less glucose in your blood, which will, in turn, cause your body to burn fat for energy instead of sugars. This will build up ketones in your blood.

Triggers for Ketoacidosis:

Poor diabetes management is one of the trigger for DKA. Missing one or more insulin dose, or not using the right amount of insulin can lead to DKA in people with diabetes. An illness or infection such as pneumonia and urinary tract infections or certain drugs can also prevent your body from using insulin properly which can lead to DKA.
Other possible triggers include:

  • stress
  • a heart attack
  • severe dehydration
  • misusing alcohol
  • fasting and malnutrition in people with a history of excessive alcohol consumption
  • certain medications
  • misusing drugs, especially cocaine
  • acute major illnesses, such as sepsis, pancreatitis, or myocardial infarction

Diagnosis of Ketosis and Ketoacidosis:

Diabetics who are losing weight will have often have low to moderate levels of ketones. But if your blood sugar is managed well and are within normal ranges, your risk for diabetic ketoacidosis will not increase. Your risk for DKA increases as your ketone levels rise and your blood sugar is above 250mg/dL.
Either a blood test is done to detect the level of ketones in your blood or a a urine test can also help determining the level of ketones. Diagnosis of ketosis or DKA is confirmed using level of ketones.
If the levels of ketone is less then 0.6 mmol/L in urine, it is considered as normal. If the level is  greater then 0.6 mmol/L, it is the beginning ketosis. Nutritional ketosis if the range is 0.6 to 3 mmol/ and Starvation ketosis if it is greater then 3 to 5 mmol/L. You are at high risk for ketoacidosis if blood sugar is greater than 250 mg/dL and ketone level is greater then 5mmol/L in your urine. You are diagnosed with DKA if the level is greater then 10 mmol/L and seek medical attention immediately.
If the ketone level is less then 0.6 mmol/L in your blood, it is considered as normal to low. If the level is  greater then 0.6 mmol/L, it is the beginning ketosis. If the level is between 0.6 to 1.5 mmol/L, you are at moderate risk of developing DKA. 1.5 to 3.0 mmol/L is considered as high risk for DKA and you are diagnosed with DKA if the level is greater then 3 mmol/L and seek medical attention immediately.
You can test your blood sugar and ketones with over-the-counter test kits at home. Your blood sugar can be tested using a blood test strip, and you can test for ketones using a urine test strip. When you place a dipstick into a clean catch of your urine, it will change colors based on the level of ketones in your urine.
Your doctor will perform a physical exam. Based on your symptoms and blood test result DKA or other complications of diabetes can be confirmed. Blood test is done to check your electrolytes, glucose, and acidity. A urine analysis for ketones, a chest X-ray, an electrocardiogram and other tests can be a part of the diagnosis.

Treatment of ketosis and ketoacidosis:

Treatment is not required if you have ketosis. But if you have DKA, treatment usually involves:

  • providing fluids by mouth or through a vein
  • replacement of electrolytes, such as chloride, sodium, or potassium
  • intravenous insulin until your blood sugar level is below 240 mg/dL
  • screening for other problems you may have, such as infection

DKA can improve within 48 hours of treatment. Keeping a log of medications, meals, snacks, blood sugar and ketones, can help you monitor your diabetes and prevent any possiblity of DKA in the future. Be especially alert for any possible symptoms of DKA if you are sick with a cold, the flu, or an infection.