Can Keto Diet Cause Ketoacidosis? What You Need To Know 2023

Reviewed by Dr. Maya Frankfurt, PhD

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can keto diet cause ketoacidosis
Ketoacidosis can be a possible complication of the keto diet. Photo: Shutterstock

The popular, ketogenic diet promises many benefits including weight loss, increased energy, decreased inflammation, blood pressure and glucose levels. All of these can greatly improve your overall health.

However, it is also important to be aware of the potential side effects that may occur. Specifically, you need to avoid developing ketoacidosis. Can the keto diet cause ketoacidosis? In this article, we will learn about the potential signs to look out for while on a keto diet.

Can Keto Diet Cause Ketoacidosis?

Sometimes the keto diet can cause ketoacidosis. The basis of the keto diet is that your body breaks down fat, rather than glucose for energy. When carbohydrate intake is low, fats are broken down into  ketones for energy. Under certain conditions and in some people, the keto diet can lead to ketoacidosis because of an excess of ketones. Read on to see how to best avoid ketoacidosis on a keto diet and when to seek medical attention.

Can Keto Diet Cause Ketoacidosis?

The ketogenic diet limits the carbohydrate intake in a person’s diet. When a person consumes carbohydrates, they are broken down into glucose, which serves as the primary source of energy. For people with type two diabetes this helps control their blood sugars. But can the keto diet cause diabetic ketoacidosis?

When carbohydrates are limited, the body switches to ketosis, which is a process that uses fats instead of sugars for energy. Therefore, the keto diet focuses on maintaining the body in the ketosis state to help people lose weight and feel more energized throughout the day as it reduces the fat storage.

Ketosis relies on the body’s use of fats, rather than carbohydrates for energy This is a natural response to starvation and does not harm the body in any way. However, in individuals with certain blood glucose regulation disorders, ketosis may not be maintained in a healthy way.

One possible complication of the keto diet is ketoacidosis,[1] which is an extreme form of ketosis where the body burns fats too quickly and produces too many ketone bodies, a byproduct of the reaction. However, physicians have asserted that ketoacidosis mainly concerns individuals with type 1 diabetes.[2] 

What Is Ketoacidosis?  

Ketoacidosis is a metabolic condition that occurs when there is a decrease in the body’s normal insulin production resulting in an buildup of ketones in the blood. Ketones are produced by the liver from stored fat instead of the usual energy source of glucose (sugar) as a result of consuming carbohydrates.

Normally, insulin is responsible for the transport of glucose into the body’s cells to provide energy to muscles and other tissues. However, an individual adhering to a ketogenic diet limits carbohydrate intake and glucose and insulin production are drastically decreased.

Ketoacidosis is a medical emergency, and an individual experiencing this condition should seek medication attention immediately.

Ketoacidosis Symptoms 

can keto diet cause ketoacidosis
Am I experiencing symptoms of ketosis or ketoacidosis? Photo: Shutterstock

Initially, ketoacidosis often mimics the symptoms of diabetes. The three P’s of diagnosing diabetes include:

  • Polydipsia: Increased thirst.
  • Polyuria: Frequent urination.
  • Polyphagia: Increased appetite.

Additional symptoms of ketoacidosis include the following: 

  • Elevated ketone levels in urine.
  • Exhaustion.
  • Dry and/or flushed skin tone.
  • Nausea.
  • Vomiting.
  • Abdominal pain.
  • Shortness of breath.
  • Keto breath.
  • Mental status changes.
  • Confusion.

Ketosis Vs. Ketoacidosis

can keto diet cause ketoacidosis
How can I avoid ketoacidosis? Photo: Shutterstock

Ketosis and ketoacidosis are similar metabolic states since both conditions are defined by an elevation of ketones in the blood. However, the key difference between these conditions is the extent of ketone and glucose buildup and if it approaches an unhealthy and potentially dangerous level. Ketoacidosis[3] can be diagnosed by blood glucose levels and the degree of blood acidity. The following are clinical parameters that identify a state of ketoacidosis.

  • Ketone Levels: Ketoacidosis is defined by blood and urine ketones within the high range.
  • Blood Acidity: Ketoacidosis is defined by a pH level of less than 7.30 and a bicarbonate level of less than or equal to 18 mEq per L.
  • Blood Glucose: Ketoacidosis is defined by excessively high glucose levels in the blood.[4]

Tips To Avoid Ketoacidosis While On Keto

Individuals participating in a ketogenic diet must understand the risk of developing ketoacidosis for different conditions. Ketogenic diets work well for weight loss and type 2 diabetes which is due to insulin resistance. But, can a keto diet cause ketoacidosis in type 1 diabetes?

While these diets are appropriate for weight loss and type 2 diabetics, patients with type 1 diabetes are generally advised to avoid ketogenic diets because they use insulin with requires carbohydrates as an energy source. The following are ways to prevent ketoacidosis from occurring while on a ketogenic diet.

  • Monitoring.
    • Blood glucose.
    • Ketone levels.
  • Diet.
    • Avoid skipping meals.
  • Physical activity.
  • Medications.
  • Know when to seek help.

While following a ketogenic diet, there is a concern about potentially experiencing nutrient deficiencies. Since this dietary plan eliminates most vegetables, fruits, and grains, the body will not obtain several micronutrients and vitamins. Micronutrient deficiencies include selenium, magnesium, and phosphorus, while vitamin deficiencies seen are vitamins B and C.

As a result of these dietary restrictions, it is important to know what vitamin deficiency causes sugar cravings and can negatively impact the overall success of a ketogenic diet. Specifically, a deficit of vitamin B6 can result in depression, mood swings, and decreased energy. To offset these, the body will crave foods that are high in sugar content.

Adherence and engagement in a weight loss program are critical factors in achieving success and overall weight loss goals. While a personalized approach under the supervision of a trained professional is ideal, that may not be the most affordable and sustainable option for many.

Since the COVID-19 pandemic, there has been a significant increase in the number of people who utilize a digital approach to increase personal accountability in their weight loss plan.

  • Carb Manager.
  • Macro Tracker.
  • Keto Manager.
  • Total Keto Diet.
  • Senza.
  • Keto Diet Recipes.
  • PlateJoy.


Based on current research available and clinical studies, it cannot be determined if a ketogenic diet can cause the body to enter a state of ketoacidosis.

However, sufficient evidence supports that if an individual has a predisposition to experiencing ketoacidosis, such as diabetes, they may be at an increased risk. Individuals must realize that following a keto diet plan is not recommended for those with uncontrolled diabetes or those on insulin.

It is important for people with diabetes engaging in a keto diet meal plan know how to manage and monitor their blood glucose and ketone levels. Above all, an individual needs to be confident in their ability to identify symptoms of ketoacidosis to prevent fatal, life-threatening complications.

Frequently Asked Questions

Why are some individuals at an increased risk of experiencing ketoacidosis?

People with type one diabetes do not produce insulin and therefore need to inject it. With a ketogenic diet the carbohydrate level may be too low and patients run a greater risk of both hypoglycemia and ketoacidosis.  

Why is ketoacidosis so serious?

Ketoacidosis disrupts the normal function of the body because the increased acidity interferes with many bodily functions. Keeping the pH in a normal range is critical for the biochemical reactions that cells undergo.

How can diabetes and ketoacidosis be differentiated? 

Both diabetes and ketoacidosis present with increased thirst (polydipsia), increased urination (polyurea) and often increased appetite (polyphagia). Ketoacidosis is the result of untreated diabetes which occurs more often with Type 1 than Type 2 diabetes. High levels of glucose, and ketones in the blood and a low pH indicate ketoacidosis.

How can you avoid ketoacidosis on the keto diet?

Careful monitoring of blood glucose and ketone levels is important to avoid ketoacidosis. Also practice a healthy lifestyle by eating healthy meals, avoid skipping meals, maintain hydration and be physically active. Lastly, seek medical help if necessary.

+ 4 sources

MIDSS adheres to strict procurement guidelines and relies on peer-reviewed studies, academic research institutes, and medical associations. We work mainly with peer-reviewed studies to ensure the accuracy of the information. We avoid the use of tertiary references. You can read about how we ensure the accuracy and timeliness of our content in our editorial process.

  1. CDC (2021). Diabetic Ketoacidosis . [online] Centers for Disease Control and Prevention. Available at:,dangerous%20levels%20in%20your%20body.
  2. Mullins, G.R., Hallam, C. and Broom, I. (2011). Ketosis, ketoacidosis and very-low-calorie diets: putting the record straight. Nutrition Bulletin, [online] 36(3), pp.397–402. doi:
  3. Gosmanov, A.R., Gosmanova, E.O. and Kitabchi, A.E. (2021). Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. [online] Available at:
  4. Chukwuka Elendu, Judy Ann David, Abasi-O Udoyen, Egbunu, E.O., Ogbuiyi-Chima, I.C., Unakalamba, L.O., Temitope, A.I., Ibhiedu, J.O., Ibhiedu, A.O., Nwosu, P.U., Koroyin, M.O., Eze, C.A., Boluwatife, A.I., Alabi, O.T., Okabekwa, O.S., Fatoye, J.O. and Ramon-Yusuf, H.I. (2023). Comprehensive review of diabetic ketoacidosis: an update. Annals of medicine and surgery, [online] 85(6), pp.2802–2807. doi:



Dr. Maya Frankfurt received her Ph.D. in neuroscience and has been teaching and doing research for over 30 years. She has taught neuroscience and physiology to medical students and allied health students. Her research interests are primarily related to understanding how the brain responds to alterations in hormones, drugs, and aging. Of particular importance is the understanding of the mechanisms involved in short- and long-term memory. Although these studies are done in animals the goal is to understand the mechanisms underlying learning and memory in humans and to provide potential directions for therapy in patients with dementia. Related to this, is the attempt to understand potential sex differences and the effects of estrogen in learning and memory because women have a greater incidence of Alzheimer’s Disease than do men. The initial hormone studies led to an interest on the effects of Bisphenol A (BPA), a chemical used in plastics that has been shown to disrupt endocrine function, on both memory and brain structure. This research has been published in over 80 papers in peer referred journals.

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