Ketosis Versus Ketoacidosis

There are a LOT of misconceptions surrounding the Keto diet for dogs—one of them being that dogs going Keto will develop Ketoacidosis, a life-threatening condition. Although the words sound similar, Ketosis (Nutritional Ketosis) and Ketoacidosis (Diabetic Ketoacidosis or DKA) are very different things.

The two terms should not be confused.  

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Ketoacidosis (DKA) occurs in the body when there are extremely high levels of ketones and blood sugar at the same time. This condition is very serious and often life-threatening:   

“This combination [of high ketone levels and high blood sugar] makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys" (source

DKA occurs in individuals or dogs with uncontrolled Type 1 Diabetes. Individuals with uncontrolled insulin, who are sick, or who have an improper diet with Type 1 Diabetes are at a higher risk for developing DKA. DKA is far less likely to occur in individuals without Type 1 Diabetes (i.e. those with controlled insulin): 

“In normal individuals, or those with well controlled diabetes, insulin acts to cancel the feedback loop and slow and stop the overproduction of ketones. Without this feedback loop, dangerous levels of ketones build up, acidifying the body. This would register on a Ketone Meter at levels of 20 mmol/l. The levels can build up to a state that is highly toxic.” (source

So, without controlled insulin levels, blood sugar levels rise (and are unchecked by insulin) and ketone levels also rise unchecked. In this state of DKA, there will be warning signs like: 

  • Excessive urination and thirst 

  • Dehydration 

  • Nausea 

  • Pain 

  • Difficulty breathing 

  • Vomiting 

  • Exhaustion 



On the other hand, Ketosis is not harmful to the body like Ketoacidosis is.

Ketosis can occur in the body when a dog (or human) eats a high fat, adequate protein, and low carb diet. In this state, the body switches from using glucose for fuel to burning fat for fuel. Although ketone levels do rise during Ketosis, they don’t rise to dangerously high levels as they do in DKA.  

In nutritional Ketosis, ketone levels are moderate and blood glucose levels are generally low. For instance, in a state of Ketosis, ketone levels should be moderately high (between 0.3 - 5 mmol/L) and blood glucose moderately low (>75 mg/dL).  

In DKA, these values would read closer to a ketone level of 20.0 mmol/L and a blood glucose level of 220 mg/dL. Ketone values are very high and blood glucose levels are very high—this is the dangerous state. 

Here are a few charts to help out: 

Ketone Levels

Ketone Levels

Blood Glucose Levels

Blood Glucose Levels


As you can see, nutritional Ketosis and DKA are very different. In a healthy dog, blood sugar levels and ketone levels should not rise unchecked when eating Ketogenic food. 

Due to this, when your dog eats B&C’s Keto food, they are not at significant risk (or really, any risk) for developing DKA. 

Not sure what about the science behind Ketogenic food or why it’s optimal? Check out our article on that here:  



Most likely, no.  

When a dog is eating a properly balanced Ketogenic diet (like our patties or minis), that dog should be in Ketosis burning healthy fat for fuel. If that dog does not have Type 1 Diabetes or other insulin-related problems, there should be little-to-no risk of developing DKA or having unchecked levels of ketones and blood glucose rising in the body. 

In Ketosis, a dog should not have any of the problems that occur during DKA such as throwing up, nausea, excessive urination, and thirst. If you do notice these symptoms developing, this could be cause for concern in general. We always recommend consulting your holistic veterinarian when these types of issues arise (it could be related to DKA or not, you have to talk to your doc to know!).  


Type 1 Diabetes and Ketogenic food

Here’s the interesting thing: even in dogs with Type 1 or Type 2 diabetes should still be able to eating Ketogenic food as long as insulin levels are in check.

Doctors typically recommend that people (and dogs) with Type 1 Diabetes eat a high-carb, low-fat diet to keep “a healthy amount of blood sugar up” and to avoid fat as it could cause heart disease.  

This doesn’t really make sense: the more ideal thing is eating a diet that limits the amount of insulin needed by limiting the amount of blood sugar in the body. Lowering blood sugar comes from eating less sugar and less carbs:

“Switching to a low-carb, fat-burning ketogenic diet stops the blood sugar spike/crash cycle, because when carbohydrate intake is reduced, basal blood sugars stay normal and steady, and less insulin is needed at mealtime. Smaller doses of insulin mean there is less danger of driving blood sugar too low.” (source

Instead of having sugar spikes and crashes, in Ketosis the body uses fat for fuel, which is ideal and allows for ever better regulation of blood sugar. 

As we discussed before, if a dog or human does not have controlled levels of insulin, DKA or low blood sugar can be the result. Remember: the hormone insulin makes sure that, in Ketosis, ketone levels don’t rise unchecked. The way that low blood sugar or DKA would occur is if a human (or dog) doesn’t regular the proper amount of insulin: this should be avoided. 

There is nothing wrong with a dog who has T1D eating Ketogenic food. It takes monitoring blood sugar levels and having control of insulin injections to avoid complications. 


Type 2 Diabetes and Ketogenic food: 

As with T1D, it is usually recommended that those with T2D eat a high-carb, low-fat diet to avoid storing up excess fat. Again, this doesn’t make much sense because fat doesn’t make dogs fat...getting excess glucose from carbs and storing fat at the same time makes dogs fat. 

If a dog switches over their metabolic pathway from using glucose to burning fat-for-fuel, they can actually use their fat instead of store their fat. This helps tremendously with T2D by allowing blood sugar levels to remain low and fat storage to remain minimal:  

“Following a low carb, high fat ketogenic diet stops this blood sugar spike/crash cycle and in many cases, helps you reduce or even eliminate the necessity for medications such as metformin.  It can also greatly reduce insulin needs.” (source

Additionally, the reason why T2D develops in the first place in dogs is because dogs, who aren’t biologically supposed to eat carbs, eat high amount of carbs and sugars from kibble and develop insulin-resistance. This leads to unchecked levels of rising blood glucose and medical complications.  

If we stop fearing fat and start using fat-for-fuel:  

“Removing the barrier of concern about dietary fat makes carbohydrate restriction a reasonable, if not the preferred method for treating type 2 diabetes and metabolic syndrome. We emphasize the ability of low carbohydrate diets to improve glycemic control, hemoglobin A1C and to reduce medication.” (source

Dogs with T2D don’t have to worry about Diabetic Ketoacidosis as long as...again...their insulin levels are not in check. With insulin levels in check, Ketogenic food seems ideal to help with T1D and T2D without worrying about Diabetic Ketoacidosis. 



As you can see, there are a lot of fear tactics used to scare people away from feeding their dogs Ketogenic the “risk” of developing DKA. Together, we can move past misconceptions about fat and Ketogenic food in order to help dogs live healthier, more metabolically efficient lives (even those dogs with Type 1 or 2 Diabetes!).

We are on a fresh food mission to move beyond our old conceptions about fat and move toward a brighter, more fat-fueled future. 

WE NEED YOUR HELP FIGHTING FOR FAT. Together, we put pressure on the kibble industry to re-think how we are feeding our dogs. The more people that band together for the love of our dogs, the better. 

For The Love Of Fat, 

Your Devoted B&C Tribe 

Have specific questions about your dog’s health? While B&C cannot give medical advice, we recommend seeking advice from a Holistic Veterinarian for your best furry friend (BFF). B&C is here to be a resource for you while you learn more about raw food, Keto, and dog nutrition!

Bones & Co.