Ketoacidosis in patients with ketotic hypoglycemia
Statement from Henrik Thybo Christesen, MD, PhD., head of KHI scientific advisory board
“The ketosis in diabetic ketoacidosis (DK) and ketotic hypoglycemia (KH) are both similar and highly different. In both conditions, the cells cannot burn sugar and start to burn fat which produces ketones. In DK, there is excess glucose in the blood, but it cannot enter the cells because of a lack of insulin. In KH, the cells start to burn fat because of low blood sugar.
The ketosis typically reaches 6-7 mmol/L in DK and 1,5-3 mmol/L in KH, but sometimes also 5-6 mmol/L in KH. The difference is that DK develops over a longer period of time (although the time span is not well studied before the diagnosis). The longer time span allows for a much lower pH (a much stronger acidosis) down to e.g. pH 6.8, which is the critical thing for cell function. In KH, the time span is shorter, e.g. a night, and the ketosis can be corrected by drinks and food in a few hours, so the acidosis is not so pronounced. Drinks and food do not help in DK, so it continues for days or weeks until diagnosis and treatment”
“People have protested against the view that the ketosis in KH is milder than in DKA (diabetic ketoacidosis). Though this is correct for the general picture, more rare patients with severe KH can be difficult to treat. This is why Ketotic Hypoglycemia International was made.