This is directly from Allison Herschende - Diaverge Diabetes Facebook page. FOLLOW HER to learn more about managing diabetes safely, logically and peacefully.

"What about Ketones?"
I see this question so frequently from those new to low-carb. Most people's experience with ketones is a scary life-altering event which included a very sick individual, ICU time, and maybe even almost losing that person, so of course most people freak when they see them.

Most doctors are not familiar with nutritional ketosis, which is truly unfortunate. The emergency room doctor or endocrinologist frequently sees patients in DKA and that is what they associate with when they see ketones. They forget that info they learned way back in biochemistry about nutritional ketosis.

If you just started a low-carb diet, you may be seeing ketones. There is no reason to panic! Nutritional ketosis is a natural, healthy state in which the body is using ketones for fuel instead of glucose (some glucose is required but the body can use ketones to a great extent). They are simply a byproduct of burned fat.

So what is the difference between DKA and nutritional ketosis? Insulin. Insulin regulates ketones and prevents them from spiraling out of control. In DKA there is an insulin deficiency whether it be a new onset-type1 diabetic (or possibly type 2) who is making little to no insulin, a diabetic who forgot to take their basal insulin, a result of an insulin pump failure or as a result of dehydrating illness. During illness, insulin needs are increased and if they aren't matched with a proper increase of insulin, the combo of low insulin (which results in high blood sugar) and dehydration equal DKA.

There has been a lot of talk lately about euglycemic DKA (DKA with normal blood sugar) due to the increased popularity of SGLT-2 inhibitors. These medications cause a person to urinate their glucose out, thereby lowering blood sugar without insulin. There is still an insulin deficiency however, and combined with dehydration from the increased urination, there is DKA with normal blood sugars. This is pretty rare though.

When SGLT-2's are NOT a factor, it is even MORE rare. The VERY few cases I have seen always included prolonged fasting (which I do not recommend for an insulin dependent diabetic), and usually dehydrating illness or other dehydrating factor such as nursing a baby. When one fasts for a long period of time, they become much more insulin sensitive and either make or need less insulin (t1's will see blood sugars plummet and will accordingly lower their insulin). Again we have insulin deficiency. Insulin has many functions, not just transporting glucose into the cell.

Did you know that newborn babies have ketones in their umbilical cord blood and ketones are found in the placenta? Babies who are breast fed tend to be in ketosis as well. Pregnant women easily fall into ketosis and women who have morning sickness have them almost definitely!

The point to take home here is that a low carb diet is NEVER the cause of DKA. If you are told by a doctor that you are in DKA based only on the presence of ketones, this is incorrect! The diagnostic criteria for DKA includes an arterial blood pH of less than 7.3, a bicarbonate level of less than 18, an anion gap of more than 10, and blood sugar greater than 250mg/dL. If the doctor did not check arterial blood gases or the other things mentioned, he cannot diagnose you as being in DKA!

Again, DKA is NEVER CAUSED BY A LOW CARB DIET!!! "