Ketosis is perfectly normal - up to a point. Fundamentally, it's just an alternative way for your body to fuel itself. Rather than breaking down blood glucose, your cells rely on fats and free fatty acids for energy. But prolonged bouts of ketosis can result in a severe, and sometimes fatal, condition called ketoacidosis, in which the blood becomes far too acidic.
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Most of your body's energy comes from carbohydrates, molecules made up of carbon, hydrogen and oxygen that are plentiful in foods that look like this:
Sweet potatoes, oats, chickpeas and, of course, bread. After those foods are broken down, your cells take complex carbohydrates (which are basically long chains of sugar molecules) and break them down further, into a simpler form: glucose. Glucose is still a carbohydrate, because it's made up of carbon, hydrogen and oxygen, but it's small enough that your cells can use it effectively.
When you're eating a healthy amount of food, glucose is usually the only energy source your body needs. Another energy source, fatty acids, travel around the blood stream, too, usually packaged together in little bundles called triglycerides. While fats are made out of carbon, hydrogen and oxygen, just like carbohydrates, they're structured for more for long-term storage. Since carbohydrates can only hang around for one or two days, your body relies on them first.
All those fats, meanwhile, are packed away for later use. When you're not consuming enough complex carbohydrates, fat cells start releasing their trove of energy in the form of glycerol, a simple compound of sugar and alcohol, and free fatty acids.
Free fatty acids are a great source of fuel, and most of your body's cells are able to use them. Red blood cells, however, don't have mitochondria, the internal structure that other cells use to convert free fatty acids into energy. Cells in your central nervous system, although they have mitochondria, can't use fatty acids, either, because the molecules can't get through the blood-brain barrier.
Liver cells are presented with a similar problem. They don't have enough of a specific chemical, called oxaloacetate, which is key to converting fatty acids into energy, so instead cells in the liver break fatty acids down into three "ketone bodies": acetoacetate, beta-hydroxybutyrate and acetone. These are acids, and once produced, all three are released by your liver into the blood stream. Cells elsewhere are able to pick up the ketone bodies and transform them into a fuel source.
Ketones are also important because they can pass through the blood-brain barrier, unlike free fatty acids, and thus nourish the central nervous system in the absence of glucose. This whole process is called "ketosis."
A little ketosis is normal. The process is triggered after periods of prolonged exercise, and often between meals. But having diabetes changes the picture, especially for people with type 1 diabetes. In type 1, the body can't produce insulin, a hormone needed to get blood glucose sugars inside cells in the first place. Without sufficient insulin, the body turns to fatty acids, and ketosis, to create energy.
But it's the drop in insulin that triggers your liver's reaction, and the subsequent production of ketone bodies. Since people with type 2 diabetes produce insulin, their insulin levels usually don't get low enough to trigger ketosis, according to the Harvard Health Guide.
A little blip of ketosis probably isn't a problem, even for diabetics. But sudden sharp increases in ketone production, and prolonged moderate levels of ketone production, definitely are.
No, but it's really a matter of degree.
If your body relies on ketosis for its energy production too much, the blood eventually becomes acidic. Ketones are acids, after all. That's ketoacidosis, when the concentration of ketone bodies in the blood is so high that it becomes acidic. Diabetic ketoacidosis, or DKA, is just ketoacidosis in a diabetic patient.
This is a major shift in your blood's chemistry, and it can have a serious, potentially deadly, effect on multiple organs.
Vomiting and pain in the abdomen are usually the first signs of DKA. Fluid loss in general is a major problem during an episode of ketoacidosis. Having very high blood glucose levels, which often accompanies the condition in people with type 1 diabetes, increases the amount you urinate, resulting in a loss of electrolytes, too. Dehydration and dry mouth, accompanied by frequent urination, are often signs that your ketone levels are dangerously high. As the attack continues, your breathing may become labored, or very slow, and you might start to feel disoriented. Your breath might also start to smell fruity, since acetone, one of the three ketone bodies, smells like fruit (or nail polish remover, depending on who you ask).
Eventually, ketoacidosis can lead to coma or even death. It's a serious emergency, but with proper care, including rehydration and insulin therapy, the condition can be reversed.
Thanks to our friends at Glenn Stern Law, Glendor litigation and trial attorneys, for their contributions to this post.