Ketones can be a safe outcome of a strict, low-carb diet. But ketones due to lack of insulin, intense exercise or hunger can be fatal. What is the difference and how to proceed?
Materials from the author’s workshop Diabeton
What is the difference between diabetic ketoacidosis (DKA) and nutritional ketosis ? To put it very simply: one is life-threatening, and the other is not.
Since ketones are becoming a very buzzword in the diet media, this is a little confusing. One often comes across the question: is the ketogenic diet safe for a person with diabetes, if diabetic ketoacidosis is extremely dangerous?
Let’s take a closer look.
What are ketones?
In short, ketones are compounds that are produced when the body burns adipose tissue and breaks it down into fatty acids and amino acids to use for energy.
How to measure your ketone levels
Ketones can be measured with visual test strips (urine ketone measurements) or a special blood ketone meter. There are glucometers with the function of measuring ketones. These devices require special test strips. Measuring blood ketones is of course a more accurate method because it measures your ketones in real time. Urinary ketone strips give a vague idea of what levels of ketones you had 2 or 3 hours ago, because that’s about the same delay they are excreted through the urine. In addition, visual test strips are a semi-quantitative measurement method in which you see compliance with the range, not an exact result.
Situations in which the body produces ketones
There are actually four circumstances under which the human body will produce ketones.
Nutritional ketosis : A diet that consumes less than 20 grams of “net” carbs per day can cause your body to start burning fat, primarily for energy, resulting in the production of ketone bodies.
Diabetic ketoacidosis (DKA): When there is too little insulin in the body ( primarily in those with type 1 diabetes), it is forced to burn body fat for energy because it cannot use glucose in the bloodstream for energy.
Fasting Ketones: If you haven’t eaten for a significant amount of time – about 10-12 hours for most people – your body may produce a small amount of ketones because it has started to extract energy from fat tissue. This process is often referred to as “starved ketones”. This often happens with intermittent fasting and is generally as safe as nutritional ketosis , provided you end up eating on time.
Illness-induced ketones: If you have a bad cold, a stomach virus, an infection, or the flu, your ketones may be high. People with diabetes in this case should discuss the situation with their endocrinologist. Often, on the background of the disease, blood sugars are elevated. Increasing the dose of insulin can solve both the problem of hyperglycemia and the problem of ketones.
Diabetic Ketoacidosis vs Nutritional Ketosis
The biggest difference between healthy ketones and dangerous ketones is the amount of ketones in your blood or urine.
Ketones themselves are not dangerous, but in a healthy body, the role of insulin and glucose is to prevent their accumulation.
On a ketogenic diet (less than 20 grams of carbs per day), ketone levels typically rise in the range of 1 to 2.9 mmol/L. The less carbohydrates consumed, the higher the risk of approaching a concentration of 3 mmol / l. But simply eating carbohydrates will help you get out of this state.
It should be noted that at a ketone level of 3 mmol / l there is a dangerous risk of developing ketoacidosis , so diabetics on a keto diet should carefully monitor this indicator and always keep test strips with them.
Yes, a person with type 1 or type 2 diabetes can follow a ketogenic diet. However, as always, it is important to make sure that you are receiving adequate treatment (enough insulin or a normal dose of antidiabetic agents) and achieving normal blood sugar levels. In the event that you often experience hypoglycemia on a ketogenic diet, it is worth reviewing the therapy for your diet and normalizing your carbohydrate intake.
In diabetic ketoacidosis , ketone levels usually rise rapidly.
Symptoms of diabetic ketoacidosis include:
- nausea and vomiting;
Treatment of DKA
As ketone levels build up, there are a number of rules on how to recognize the source (lack of insulin or starved ketones) and act on it.
But if your ketone levels are extreme and you’re experiencing nausea and vomiting, the only way to treat full-blown diabetic ketoacidosis is to go to the emergency room right away. There, they will give an intravenous injection and select doses of insulin to stabilize the condition.
The usual treatment plan for the early stages of rising ketones is to drink plenty of fluids and take extra insulin or food (depending on the cause of the ketones). With an increase in ketones during the inflammatory process – drinking + increased doses of insulin.
People with type 1 diabetes who participate in marathons and triathlons may experience elevated ketone states similar to stressful (high emotional stress) or starvation ketone situations. In the case of long-term sports, a strategy to increase insulin supply during intense exercise usually works well to eliminate ketones without lowering blood sugar.
Be sure to discuss any changes in insulin dosage with your doctor, especially if you are experiencing symptoms of DKA or symptoms caused by an illness.