Ketosis is a metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead. This results in a buildup of acids called ketones. Some people encourage ketosis by following the ketogenic, or keto, diet.

This diet, which is very low in carbohydrates, aims to burn unwanted fat by forcing the body to rely on fat for energy, rather than carbs.

Ketosis also commonly occurs in people with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly.

Health problems associated with extreme ketosis, such as diabetic ketoacidosis (DKA), are more likely to develop in people with type 1 diabetes than people with type 2 diabetes.

This article explains how ketosis works, what the keto diet is, and the possible effects of ketosis in people with diabetes. Read on to learn more.

a woman eating a keto meal to help her achieve KetosisShare on Pinterest
A person may follow a keto diet to help encourage ketosis.

In normal circumstances, the body’s cells use glucose as their primary form of energy. People can typically obtain glucose from dietary carbs, including sugars and starchy foods.

The body breaks these down into simple sugars. Afterward, it either uses glucose as fuel or stores it in the liver and muscles as glycogen.

If there is not enough glucose available to provide enough energy, the body will adopt an alternative strategy to meet those needs. Specifically, it begins to break down fat stores and use glucose from triglycerides.

Ketones are a byproduct of this process. These are acids that build up in the blood and leave the body in the urine. In small amounts, they indicate that the body is breaking down fat. However, high levels of ketones can poison the body, leading to a condition called ketoacidosis.

Ketosis refers to the metabolic state in which the body converts fat stores into energy, releasing ketones in the process.

As ketosis breaks down fat stores in the body, some keto diets aim to facilitate weight loss by creating this metabolic state.

Keto diets are usually high in fat. For example, 20% of the calories may be protein, 10% may be carbs, and 70% may come from fat.

However, there are different versions. The nutrient proportions will depend on the version of the diet a person follows.

Adhering to the keto diet can lead to short-term weight loss. This is partly because people are usually able to consume fewer calories without feeling hungry.

Nutrition resources

For more science-backed resources on nutrition, visit our dedicated hub.

Was this helpful?

The keto diet could reduce a person’s risk of developing several health conditions, including:

  • cardiovascular disease
  • diabetes
  • metabolic syndrome

It may also improve levels of high-density lipoprotein, or “good,” cholesterol more effectively than other moderate-carb diets.

These health benefits may occur due to the loss of excess weight and the inclusion of more healthful foods in the diet, rather than the reduction in carbs.

Doctors have also prescribed the keto diet to reduce the number of seizures in children with epilepsy who do not respond to other forms of treatment.

Some studies have suggested that the diet could also benefit adults with epilepsy, though more research is necessary to confirm these findings.

However, sticking to the keto diet on a long-term basis does not appear to provide many benefits.

Researchers are now studying other conditions to see if a keto diet might be beneficial, including:

In people with diabetes, ketosis can occur due to a person not having enough insulin to process glucose in the body. The presence of ketones in the urine indicates that a person needs to work on better controlling their diabetes.

Some dietitians recommend a keto diet for people with type 2 diabetes. With this condition, the body still produces some insulin, but it does not work as effectively.

The keto diet focuses on reducing a person’s intake of dietary carbs. Those with type 2 diabetes should aim to consume fewer carbs, as these convert to glucose and increase blood sugar levels.

People with diabetes who follow a keto diet need to monitor their ketone levels carefully. If levels get too high, ketoacidosis can occur.

DKA is a condition wherein the levels of ketones become extremely high, poisoning the body. It is a severe and dangerous condition that can develop rapidly, sometimes within the space of 24 hours.

There are several potential triggers for ketoacidosis. However, it most often occurs due to illnesses that cause higher levels of hormones that work against insulin.

It can also result from problems with insulin therapy, either through missing scheduled treatments or not receiving enough insulin.

Some less common triggers of ketoacidosis include:

  • drug misuse
  • emotional trauma
  • physical trauma
  • stress
  • surgery

Ketoacidosis most commonly occurs in people with type 1 diabetes. It can also occur in people with type 2 diabetes, though this is much less common.

High levels of ketones in the urine and high blood sugar levels are both signs of ketoacidosis. A person can test for ketoacidosis using a kit at home.

Some early symptoms of ketoacidosis include:

  • abdominal pain
  • confusion and difficulty concentrating
  • dry or flushed skin
  • excessive thirst and a dry mouth
  • fruity breath
  • frequent urination
  • nausea and vomiting
  • shortness of breath or rapid breathing

Ketosis does not usually occur in people who eat balanced diets and regular meals. Drastically reducing calorie and carb intake, exercising for extended periods, or being pregnant may trigger ketosis.

Although some people choose to put the body through ketosis, the risk of increased acid levels can be dangerous in those who are not controlling it.

In people with diabetes, ketosis and eventually DKA can occur if they do not use enough insulin, if they skip meals, or if an insulin reaction occurs. An insulin reaction usually happens while asleep.

Doctors consider DKA an emergency, as it can lead to a diabetic coma and even death. Emergency healthcare workers will usually administer treatment followed by hospitalization in an intensive care unit.

For those with diabetes, the emergency team will commonly take the following measures:

  • Fluid replacement: Doctors use this treatment to rehydrate the body and dilute the excess sugar in the blood.
  • Electrolyte replacement: This helps a person maintain heart, muscle, and nerve cell function. Levels in the blood often drop in the absence of insulin.
  • Insulin therapy: This can help doctors reverse the processes that led to ketoacidosis.

In otherwise healthy people, following a healthful, balanced diet and exercising regularly can help prevent ketosis.


There are several ways a person with diabetes can prevent ketoacidosis, including:

  • carefully monitoring their blood sugar levels at least three to four times per day
  • discussing insulin dosage with a specialist
  • following a diabetes treatment plan

People with diabetes should keep an eye on their ketone levels with a test kit, particularly when ill or under stress.

Ketosis occurs when the body starts to obtain energy from stored fat instead of glucose.

Many studies have demonstrated the powerful weight loss effects of a low carb, or keto, diet. However, this diet can be difficult to maintain and may cause health problems in people with certain conditions, such as type 1 diabetes.

DKA is a particularly dangerous complication of ketosis that can occur when ketosis makes the blood too acidic. Emergency treatment is necessary for people experiencing DKA.

Most people can try the keto diet safely. However, it is best to discuss any significant changes to diet with a dietitian or doctor. This is especially the case in those with underlying conditions.


I’ve heard that exercising too much with diabetes can lead to DKA. How can I manage weight and stay active without increasing acid levels too far?


As with any medical condition, a person should only begin an exercise program in consultation with their primary healthcare provider. Depending on the person’s age, type of diabetes, and the presence of other health issues, the American Diabetes Association recommend various types and amounts of both aerobic and strength training exercises.

In addition to an exercise program, a healthful diet will help a person manage weight. In general, to maintain their current weight, a person should consume and expend an equal number of calories. In order to effect weight loss, a person must be in a caloric deficit — that is, they must expend more calories than they take in.

As always, plan any weight loss strategies with a primary healthcare provider and a registered dietitian.

Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Was this helpful?