What to do if ketones are too high? A guide to balancing your body's energy

October 14, 2025 •

5 min read

According to the Centers for Disease Control and Prevention (CDC), high ketones can be an early sign of a life-threatening medical emergency known as diabetic ketoacidosis (DKA). Knowing what to do if ketones are too high is critical for both individuals with diabetes and those on low-carb diets, as the appropriate response can differ significantly depending on the underlying cause.

Quick Summary

High ketone levels demand a swift response, whether due to a health condition or dietary changes. This guide outlines the immediate steps to take, from rehydration and dietary adjustments to distinguishing safe nutritional ketosis from dangerous ketoacidosis (DKA), which requires urgent medical attention.

Key Points

Identify the cause: High ketones can be from nutritional ketosis (often safe) or diabetic ketoacidosis (DKA), a life-threatening emergency.
Recognize DKA symptoms: Watch for extreme thirst, frequent urination, fruity breath, nausea, and confusion, especially with high blood sugar.
Seek emergency care for DKA: If you suspect DKA, go to the nearest emergency room or call for immediate medical help; this is not a condition to manage at home.
Drink plenty of fluids: Hydrate with water or sugar-free beverages to help flush ketones from your body, especially if you have diabetes.
Reintroduce carbohydrates (non-diabetics): If you are on a keto diet and want to lower ketones, gradually increase your intake of healthy carbs.
Administer insulin (diabetics): If you have type 1 diabetes and high ketones, follow your doctor's instructions for a corrective insulin dose.
Replenish electrolytes: Consume electrolyte-rich foods or sugar-free drinks to restore minerals lost during ketosis or illness.
Do not exercise if ill: Avoid strenuous physical activity when your blood sugar and ketones are high, as this can worsen the situation.

Ketones are produced when your body breaks down fat for energy, a natural process that can occur during fasting or following a low-carbohydrate diet. For most healthy individuals, this state—known as nutritional ketosis—is not a cause for concern. However, dangerously high levels of ketones can lead to ketoacidosis, a medical emergency that primarily affects people with type 1 diabetes but can also impact individuals with type 2 diabetes or those with alcoholic ketoacidosis. This comprehensive article outlines the essential actions and necessary distinctions to keep you safe.

Recognizing the signs of danger

It is vital to distinguish between a moderate, safe level of nutritional ketosis and dangerously high ketone levels. Monitoring your ketone and blood sugar levels is a key part of managing your health. High ketone levels, particularly when accompanied by high blood sugar in diabetics, can indicate an impending or active episode of Diabetic Ketoacidosis (DKA), which requires immediate medical intervention.

Symptoms of DKA can develop quickly, sometimes within 24 hours.

Common symptoms of high ketones and DKA:

Extreme thirst and frequent urination
Fruity-smelling breath, similar to pear drops
Nausea and vomiting, and/or abdominal pain
Shortness of breath or rapid, labored breathing (Kussmaul breathing)
Confusion, fatigue, and weakness
Dry or flushed skin

If you experience these symptoms, especially if your blood glucose is also high (typically over 250 mg/dL), you should not ignore them. Contacting your healthcare provider or seeking emergency medical care is paramount.

Immediate actions for managing high ketones

The appropriate course of action depends on your health status and the severity of your ketone levels. Below are general guidelines, but you must consult your healthcare provider for a personalized plan, especially if you have diabetes.

If you have diabetes and high ketones

If you use insulin and your ketone test results show moderate to high levels, you must act promptly.

Hydrate immediately: Drink plenty of water or sugar-free fluids to help flush excess ketones out of your system through urination.
Administer a corrective insulin dose: Follow the instructions provided by your diabetes care team for high-ketone situations. This typically involves taking a dose of rapid-acting insulin to help your body use glucose for energy again.
Check levels regularly: Retest your blood sugar and ketones every few hours as directed by your healthcare provider. You need to ensure the levels are decreasing and returning to a safe range.
Do not exercise: Physical activity when both blood sugar and ketones are high can increase ketone levels further.
Seek medical help: If your ketone levels continue to rise, you cannot keep fluids down, or your blood sugar remains elevated, seek emergency care immediately.

If you do not have diabetes but have high ketones

This can occur due to various reasons, such as prolonged fasting, intense exercise, or a low-carb diet. While not typically as urgent as DKA, it still requires attention.

Increase carbohydrate intake: Reintroduce some carbohydrates into your diet. This provides your body with glucose as a primary energy source, signaling it to stop producing high levels of ketones.
Focus on hydration: Increase your intake of water and electrolyte-rich beverages to rehydrate and help flush out ketones.
Avoid prolonged fasting: If you practice intermittent or prolonged fasting, you may need to reduce the fasting window to ensure your body has access to glucose.
Consider potential causes: Factors like prolonged illness, excessive alcohol consumption, or eating disorders can also lead to high ketones in non-diabetics. Addressing these underlying issues is crucial.

Nutritional strategies to manage ketones

For those on a ketogenic diet, managing ketone levels is part of the process, but exceeding your personal optimal range may require an adjustment in diet. If your healthcare provider has deemed it safe to adjust your diet, here are some strategies.

Comparing nutritional ketosis and DKA management


Feature	Nutritional Ketosis	Diabetic Ketoacidosis (DKA)
Ketone Levels	Mild to moderate.	Very high, can be significantly elevated.
Blood Sugar	Stable or slightly lower than normal.	Extremely high, often >250 mg/dL.
Insulin Status	Normal insulin function.	Insufficient or absent insulin.
Symptom Severity	Mild, temporary effects like 'keto flu'.	Severe, urgent symptoms like nausea, confusion, and fruity breath.
Risk Level	Generally safe for healthy individuals.	Life-threatening medical emergency.
Management	Dietary adjustments and hydration.	Immediate medical intervention (insulin, fluids, electrolytes).

The role of hydration and electrolytes

Proper hydration is a cornerstone of managing elevated ketones, regardless of the cause. When your body expels ketones through urine, it also loses vital fluids and electrolytes, which can lead to dehydration.

Foods and drinks to help lower ketones and rebalance electrolytes:

Water: Drinking plenty of plain water is the most fundamental step to help flush ketones from your system.
High-carb foods (non-diabetics): Healthy, complex carbohydrates like whole grains, legumes, and fruits can help shift the body's fuel source back to glucose.
Electrolyte-rich foods: Incorporate foods like avocados, leafy greens (spinach, kale), and salmon to replenish key minerals such as potassium and magnesium.
Sugar-free electrolyte drinks: If you are diabetic, stick to sugar-free electrolyte replacements.
Bone broth: A rich source of sodium, potassium, and other minerals, bone broth can help restore electrolyte balance.

Conclusion

Knowing what to do if ketones are too high is a critical part of health management, especially for those with diabetes or who follow restrictive diets. The key is to differentiate between nutritional ketosis and the life-threatening condition of DKA. In cases of DKA, immediate emergency medical attention is the only safe course of action. For those without diabetes, high ketones typically result from dietary or fasting practices and can be managed by reintroducing carbohydrates and focusing on hydration and electrolyte balance. Regular monitoring and a clear management plan, developed with your healthcare provider, are your best defenses against the potential dangers of high ketone levels.

Important safety note

This article is for informational purposes only and is not a substitute for professional medical advice. If you suspect you have diabetic ketoacidosis or are unsure of the cause of your high ketone levels, seek emergency medical care immediately. Never adjust your insulin regimen without consulting your doctor.

Frequently Asked Questions

Ketosis is a normal metabolic state where the body burns fat for fuel, producing moderate levels of ketones. Ketoacidosis is a dangerous, life-threatening condition, usually linked to uncontrolled diabetes, where dangerously high ketone levels cause the blood to become acidic.

If a person with diabetes and high ketones is experiencing DKA symptoms like vomiting or confusion, they should seek immediate emergency medical care. If only ketones are elevated, they should follow their doctor's sick-day plan, including hydrating with non-sugary fluids and taking corrective insulin doses as instructed.

Yes, high ketones can occur in non-diabetics due to prolonged fasting, intense exercise, or a low-carb diet. Conditions like excessive alcohol consumption or eating disorders can also be a cause. However, persistent, very high levels warrant a medical evaluation to rule out other issues.

To lower ketone levels, you need to provide your body with glucose. For non-diabetics, this means reintroducing carbohydrates into your diet. For diabetics, this is done by following a specific meal and insulin plan recommended by a healthcare provider.

No, if your ketones are moderate or high, especially with high blood sugar, you should avoid exercising. Exercise can increase ketone production further. It is best to rest and manage your levels until they return to a normal range.

When ketone levels are high, the body attempts to flush the excess acids out through urine, which can lead to dehydration. Drinking plenty of water or other fluids helps this flushing process and prevents further dehydration, which is a major complication of ketoacidosis.

Foods rich in electrolytes include avocados, leafy greens like spinach, and bone broth. Sugar-free electrolyte drinks are also an option, particularly for diabetics who need to avoid sugary sports drinks.

You should go to the hospital immediately if you have moderate to high ketones accompanied by severe symptoms like vomiting, abdominal pain, trouble breathing, or confusion. This is particularly critical for anyone with diabetes, as it could indicate DKA.