August 13, 2018 0

Are Exogenous Ketones Beneficial For Blood Sugar?

Posted by:Dr. Brian Mowll onAugust 13, 2018

Type 2 diabetes and obesity have reached epidemic (read: ridiculous) proportions in the past few decades. If left unmanaged, type 2 diabetes can damage vessels that supply blood to vital organs and can also lead to an increased risk of heart disease and stroke.

But a new study published in the Journal of Physiology has shown that a ketone supplement can lower blood sugar levels. 1 While more studies will need to be conducted, the findings suggest a future method to control blood sugar spikes for those with diabetes. This is potentially great news.

Just What are Exogenous Ketones Anyway?

You’ve probably heard of these weird sounding supplements before. If you follow health or diet trends, you know a lot of people are making all kinds of claims about them.

But what the heck are exogenous ketones and why should you care?

Exogenous ketones come in different forms and are used for several different reasons including fat burning, reducing ketosis symptoms, enhancing physical performance and mental performance.

Ketones are actually made by the body in absence of carbohydrates and they are typically made from stored fat.  Your body can run on three different types of ketones – they are acetoacetate, beta-hydroxybutyrate, and acetone. Since Beta-hydroxybutyrate is the active form that can flow freely in the blood, and is used by ALL your tissues, that is the form that most exogenous ketone supplements are formulated from.

“Ketones are organic compounds that result when body fat is broken down for energy. While this may not sound like a bad thing, for people with diabetes, especially Type 1 diabetes, high levels of ketones in the body can be toxic. Should you develop ketones, you need to know how to identify symptoms, how to check for them, and which levels are considered to be dangerous.” – Debra Manzella, RN

But to really understand the benefits of exogenous ketones for people with diabetes, we’ve first got to tackle something most people get wrong: and that is the difference between ketosis and ketoacidosis.

Ketosis and Ketoacidosis: Two VERY Different Things

While they may be similar in name (which is why there is SO much confusion) ketosis and ketoacidosis are two very different things.

Ketoacidosis, also called diabetic ketoacidosis or DKA, is a complication of type 1 diabetes and can be life-threatening. The condition results in dangerously high levels of ketones and blood sugar, which makes your blood too acidic, and that in turn can damage vital organs. DKA can happen very quickly, even in less than 24 hours, and generally occurs due to an illness, improper diet, or not taking an adequate dose of insulin.

What is ketosis?

Ketosis, or sometimes called nutritional ketosis, is simply the presence of ketones in the bloodstream. This typically happens to people who are on a low-carbohydrate diet or who are fasting. The difference between ketosis and DKA is the amount of ketones in the blood. In ketosis, you have a higher-than-normal amount of ketones, but not high enough to causes problems. In other words, ketosis is a natural result of your body using stored fat for energy and is NOT harmful. In fact, it can be a really good thing.

Symptoms of Ketosis and Ketoacidosis

The main symptom of ketosis is “acetone breath”. When ketones from stored fat are broken down to be used as a fuel source, acetone is the byproduct. This acetone has a rather fruity smell, though not a good one.

Ketoacidosis, on the other hand, has many symptoms, including:

  • extreme thirst
  • frequent urination
  • dehydration
  • nausea
  • vomiting
  • stomach pain
  • tiredness
  • shortness of breath
  • feelings of confusion

Exogenous Ketones for Diabetes

Hopefully now you understand that ketones are a byproduct of using stored fat as fuel, and in an of themselves are not harmful, and can even be a good thing.

A ketogenic diet, one that focuses on eating healthy fats and protein instead of carbohydrates, has been scientifically studied and shown to be beneficial for diabetes.2   Ketones, the units of energy from fat break down, do not require insulin to enter the cells. So, for those with diabetes, switching the body away from glucose metabolism and towards ketone metabolism can be very helpful. 

Another benefit of ketones resulting from the ketogenic diet is that they enhance insulin sensitivity. 3 A landmark study looked at the direct impact of ketogenic diets and insulin sensitivity and found that ketones can substantially increase insulin sensitivity in obese subjects with type 2 diabetes.

Even if you are on the ketogenic diet to manage your diabetes, it can be beneficial to supplement with external or exogenous ketones, as we saw with that first study I mentioned. Exogenous ketones can give you greater control over when (and how deep) you are in ketosis. Diabetics who supplement may find they have increased energy and are better able to control blood sugar spikes.

If you have diabetes, it is extremely important that you speak with your own doctor before supplementing with ketones. You will most likely find that once you start taking them, you will have to monitor your blood glucose closely and, more than likely, reduce your insulin injections or risk hypoglycemic events.

Final Thoughts

Exogenous ketones are an excellent way to enhance the benefits of a ketogenic diet, especially for those people with type 2 or pre-diabetes. Again, be sure to work with your doctor when using this diet or supplementation.


[1] Etienne Myette-Côté, Helena Neudorf, Hossein Rafiei, Kieran Clarke, Jonathan Peter Little. Prior ingestion of exogenous ketone monoester attenuates the glycemic response to an oral glucose tolerance test in healthy young individualsThe Journal of Physiology, 2018; DOI: 10.1113/JP275709

[2] Amy L McKenzie, PhD ;  Sarah J Hallberg, DO, MS ;  Brent C Creighton1 ;  Brittanie M Volk, RD, PhD ;  Theresa M Link, RD, CDE ;  Marcy K Abner, RD ;  Roberta M Glon, RN, BSN;  James P McCarter, MD, PhD ;  Jeff S Volek, RD, PhD ;  Stephen D Phinney, MD, PhD. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. Journal of Medical Internet Research publications,  Vol 2, No 1 (2017): Jan-Jun

[3] Boden, Guenther, et al. “Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes.” Annals of internal medicine 142.6 (2005): 403-411.

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