Understanding Ketones – Ketosis vs DKA!

As T1D’s, we are all programmed to think that ketones are a disaster in any amount or form and a sure fire sign that something is not right. This is, of course, quite often very accurate and the presence of any level of ketones in the blood can indicate dangerously high blood sugar levels.  I was therefore super confused and surprised when, a couple of years ago, when I went  to hospital with malnutrition and dehydration (that is a story for another time!), I had ketones despite the fact that my blood sugar was a respectable 5.4 and had not been above 7 for at least the past week if not longer.  At the time, I was feeling pretty rubbish so didn’t really question it and let the Dr’s hook me up to the relevant drips in order to fix the dehydration problem and provide me with the grossest of cheese sandwiches to combat the whole malnutrition issue.  It was only a few weeks later that I questioned this and started looking in to it.

I am going to say again what I have said many times before – I am no scientist, therefore, the following explanation is merely my understanding of how ketones work therefore feel free to shoot me down and please do not take it as gospel!


Ok so, here goes!

In order for the body to produce energy, it needs to burn fuel.  

This fuel can be either in the form of carbs or fats.

If the body burns carbs, they are digested and turned in to glucose which is then either transported to the cells to be used as energy OR is stored in the liver as glycogen to be used for energy on a later occasion.

If the body burns fats, these are digested and turned in to fatty acids which are then either broken down in order to be transported to the cells as energy OR stored in the body which is what we then see as fat (think that lovely little spare tyre!).

The body would always choose to use carbohydrates as a fuel source however, in the absence of these, it will resort to burning fats.  The by-product produced by the liver is KETONES.

Very simplistic I know, but this is how I understand it all in lay-mans terms, see below my lovely little hand drawn diagram to show the process!


Ok so, all of this is fine and explains why I had ketones when in fact I had a stable blood sugar but hadn’t really been able to eat anything for about a week – no carbs on board meant that my body was burning fat stores and therefore ketones were being produced.  That answered one question but then came my next question……what then, is the difference between this and the dreaded Diabetic Ketoacidosis (DKA) and why is it ok to have small levels of ketones in the blood when I have always thought they were poisonous to the body?


In a person with a fully functioning pancreas, the body produces its own insulin to ensure that the fat cells don’t continue to release too much fat in to the body’s circulation causing the liver to keep producing ketones HOWEVER, in someone with T1D, the ability to produce the insulin to stop this happening is not there and therefore the body just keeps merrily going about it’s business, making more and more ketones.  The danger of this is that ketones alter the body’s PH balance and make it more acidic – this constitutes an emergency medical situation as an acidic environment can cause all sorts of other issues and can be fatal if not rectified.


So that is my ‘Jenn’ understanding of the situation, basically, everyone will have a small level of ketones in their system following any sort of fasting or lack of carbohydrates and this is ok.  We, as T1D’s just need to be careful that we do not let our BG levels get too high and insulin levels therefore too low to avoid the body producing too many of the little blighters!

As seems to often be the case, since I became aware of the complexities of ketones and energy in the body, information seems to have increased on social media and I am aware that many people do actively aim to reach a state of nutritional ketosis through a low carb diet.  There are some fab insta accounts with lots of good info on if you are looking to learn more about this whole complicated process!

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