(melissa brunker) #1

I recall hearing something about Keto Acidosis on one of the earlier podcasts (im currently up to podcast 74 as im a newbie and just started listening right from the start a few weeks back). A friend of mine whose husband is T2DM and she is a nurse (or studying to become one) and she claims that a Keto diet is not good for T2DM due to keto acidosis and said her husband is now in renal failure due to keto acidosis. Does anyone know where I can find any info on this please? I tried searching but couldnt find anything.
TIA Mel.

(Karim Wassef) #2

That’s terrible coming from a nurse…

Ketosis is a natural state where the body supports energy from fat instead of carbs. Glucagon release ketones when glucose and insulin are low. So glucose is low and ketones are high.

Keto acidosis is a medical issue where both ketones and glucose are high. Basically, this is an abnormal condition due to a hormonal failure. This makes the blood very acidic and is life threatening.


ketoacidosis is where ketone levels are excessively high, at a level that most researchers consider difficult to impossible to achieve unless you have some other specific medical problem like Type 1 Diabetes specifically (Type 1 is far rarer than Type 2, but people with it do need to address it).

From Dr. Phinney with some additional citations:
Ketosis vs ketoacidosis: What is the difference?

Ketoacidosis: In stark contrast to this normal physiology of ketosis, pathologic ketoacidosis manifests with serum levels ketone levels of 15-25 mM (i.e., three- to ten-fold higher than in nutritional ketosis). Lipolysis is exquisitely regulated, so it is exceedingly rare for a patient with normal pancreatic beta cell function to enter ketoacidosis.

(Jacqueline Porter) #4

Dr Eric Westman talks about this common misconception on Diet Dr site. Dr Ken Berry had a good You Tube video I think its called ’ can Keto cause kidney damage.

(Scott) #5

This is what I know is next after someone says to me Keto is dangerous.

(Khara) #6

Stumbling into a similar message way back in about 2005 is what scared me off of the ketogenic diet for a full decade. At the time there was just so little info out there. I couldn’t find much support for ketosis and got scared by a very limited amount of information on ketoacidosis and so gave up the diet for a decade - and I’m not even diabetic, either type. I’m glad that so much information is finally available to us. But, it’s extremely frustrating that the medical community has not caught on.

There are so many success stories here from T2D reversing their disease. As with any disease, monitoring by a doctor (who understands) is advised with T2D. My understanding is that the monitoring is needed because the diabetic will likely need to lower and go off of medications quite quickly.

(Jody) #7

insert shaking head… I can’t believe this came from a soon to be medical professional.

(Karim Wassef) #9

I hover between 6 and 7.

Highest was 9.3 while deep fasting.

But my glucose has also dipped as low as 33…

(It's all about the bacon, baby) #10

The main risk of ketoacidosis is in Type I diabetics who fail to take their insulin, or who have badly mismanaged their dosing. Ketone production gets out of control and glucose skyrockets, and the pH of the blood tips into acidic territory. This is a potentially fatal condition, and doctors are rightly concerned about it. It is not a risk if the patient is diligent about proper insulin dosing.

In Type II diabetics, the problem is not lack of insulin, but too much of it, so their risk of ketoacidosis is, in general, no greater than that of a normal person. The only circumstance in which a Type II diabetic would realistically need to worry is when he or she has failed for years to submit to treatment for the disease, and is getting close to death from failure of the pancreas.

Anyone whose pancreas is producing any insulin at all is safe from ketoacidosis, except under certain weird and very rare conditions, or when taking certain specific drugs (in which case your doctor will let you know what to look out for). The risk of non-diabetic ketoacidosis is so low as to be practically non-existent.

(Ethan) #11

How about an overload of exogenous ketones?

(Karim Wassef) #12

high ketones alone without glucose is not ketoacidosis… if you have a functioning pancreas, your insulin will control your glucose… and it would take a massive overdose of exogenous ketones to make any difference.

(Full Metal Keto) #13

Ignant :grin::joy: But the tradition of misinformation must be passed to the new blood. :cowboy_hat_face:


Alright? 6.2 isn’t Ketoacidosis as far as I’m aware. I usually hear it starting around 10 mmol/L, though the article I linked cites serum levels of 15-24 mmol/L (perhaps the older 10 number was being extra cautious, which probably isn’t a bad idea).

Type 1 diabetes, while itself rare, seems to be the most common situation for ketoacidosis that I’ve heard of (other than actual and complete starvation, I’d guess), but certainly isn’t the only. Even the quote I gave says rather carefully that:

it is exceedingly rare for a patient with normal pancreatic beta cell function to enter ketoacidosis.
Which one addresses the usual mechanism rather than a diagnosis, and two does leave room for the “exceedingly rare” situation where that’s working but something else has caused ketoacidosis.

Ketoacidosis is defined by high ketone levels in the blood leading to metabolic acidosis.
Metabolic acidosis is defined as

a pH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize the effects of the acid.

While I’m sure glucose levels have some effect on this, by definition high ketones alone without glucose can indeed be ketoacidosis.

Yes, if you have a functioning pancreas you will likely not go into ketoacidosis, but ketone levels are indeed what define ketoacidosis, not ketones with glucose.

(Karim Wassef) #15

I got over 9 ketones with no ill effects.

So while it’s possible to have high ketones without high glucose, that’s rarely how it happens and Ketoacidosis already happens so rarely that the exceptionally rare to the exceptionally rare is very highly unlikely…

So … unless you’re getting struck by lightning every day, you can’t go from not having type 1 diabetes to Ketoacidosis through diet.


9 isn’t ketoacidosis either.

Ketoacidosis is still defined by high ketones, not high ketones and high glucose (glucose isn’t acidic as far as I can find).

But yea, it’s all rare, and even type 1 diabetes is rare. “Rare to happen” and “Can’t happen” are very different though.

(Karim Wassef) #17

hence the “struck by lightning” comparison.

and I know that 9 is not ketoacidosis. I said I was fine. :smiley:

It was over 9… 9.3 and I had fasted for 19 days to get there, so not eating for a couple of weeks won’t get you there unless you’re ill.


I don’t see how that connects to ketoacidosis requiring high glucose, or any direct connection to glucose per se.

(Karim Wassef) #19

likelihood of occurring outside of type 1 diabetics (where it would happen together with high glucose) ~ as rare as getting struck by lightning.


Perhaps, but hundreds (some say hundreds of thousands, worldwide) do get struck by lightning every year. As a percentage of the population, it’s pretty low, but it’s again the difference between “rare to happen” and “can’t happen” that is key, and we certainly have gone to great lengths in my country at least to prevent getting struck by lightning (injury and death rates were orders of magnitude higher a century ago from the numbers I can find).

Even with Type 1 diabetes though, it’s the ketone levels that defines ketoacidosis, not the glucose.

(Karim Wassef) #21

you’re right… it is much rarer than getting struck by lightning for it to happen outside type1 diabetes = occurring with high glucose.

so much fun…