When carbohydrate availability is reduced, the body increases its use of fat. The liver converts some fatty acids into ketone bodies, which can be used for energy by tissues including the muscles, heart and brain.

This is nutritional ketosis.

Ketone production is strongly influenced by insulin. Insulin suppresses fat release and ketone production; lower insulin permits more fat metabolism. In nutritional ketosis, insulin is still present and ketone production remains regulated.

DKA is very different.

In DKA there is insufficient insulin for the body’s needs. Glucose rises, fat metabolism becomes uncontrolled and ketones can accumulate to dangerous levels, producing acidosis, dehydration and potentially a life-threatening emergency.

So the presence of ketones alone doesn’t define DKA.

The metabolic context matters.

This is particularly important for someone encountering Type1Keto for the first time.

People with type 1 diabetes require insulin whether they eat 20 grams or 200 grams of carbohydrate.

A ketogenic diet doesn’t protect against DKA either. Illness, missed insulin, pump failure or another situation producing insufficient insulin can still cause DKA.

That means the familiar safety principles remain important: take your insulin, have access to blood ketone testing, know your sick-day plan and seek appropriate medical help when glucose, ketones or symptoms suggest that something is wrong.

Much of the confusion comes from the word ketone appearing in both conditions.

The important question for someone with type 1 diabetes is whether ketone production is occurring in a regulated environment with sufficient insulin, or because insulin has become dangerously deficient.

Understanding that distinction helps remove some of the fear surrounding nutritional ketosis without underestimating the seriousness of DKA.

The difference between ketosis and DKA is explored in more detail in Shifting Gears.