Ketones are not always something to be feared. You may have been told to test and watch out for ketones because they are a sign of impending DKA. But what you probably haven’t been told is they are actually an alternative form of fuel when your body isn’t using carbs.

Your body is able to get its energy from glucose or ketones, this is why when a person is diagnosed with Type 1 they will test very high for ketones. They do not make enough insulin to take the glucose in the blood, which is broken down from carbohydrates, into the cells where it is needed for energy. When the body is unable to get this glucose, it starts to use ketones, which are broken down from fat. This fat comes from the diet or from the bodies own fat stores. This is why people who are recently diagnosed with Type 1 diabetes are usually very slim, their body will have been breaking down fat stores for energy. Because a person who has Type 1 diabetes cannot make enough insulin to get this energy from the blood into the cells they will have high levels of both glucose and ketones in their blood. This combination of both glucose and ketones being very high creates a very acidic environment in the body and is what eventually results in DKA (diabetic ketoacidosis). It is very dangerous, and sometimes fatal state to be in and how many Type 1 diabetes learn they have the condition.

Its no wonder there is a lot of fear around ketones! But ketones themselves are actually not to be feared. Like glucose, they are an energy source. But unlike glucose, they come from fat, rather than carbohydrates. They also provide far more energy than glucose.

Ketones in and of themselves are not harmful, it is the acidic environment that develops when both glucose and ketones are extremely elevated that is harmful.

When a person has normal glucose levels, ketones in the blood will not result in an acidic environment and DKA. When a person eats low carb, and their blood sugar is well managed, their body will produce ketones as an alternative source of fuel. This is called being in a state of ketosis, and not the same as ketoacidosis…note the acidosis part of the word. This is something our bodies are designed to so, to be metabolically flexible. When there are carbs, we use glucose, when there aren’t carbs we use ketones. Even those who do not follow a low carb diet are likely to have some ketones first thing in the morning, its how people are able to fast for periods of time, and exclusively breastfed newborns are also said to be in ketosis most of the time.

So the take-home message is this. If you have ketones because you are eating low carb, and your blood glucose is in range, then you do not need to fear ketones.