Ketosis That’s Safe and Sustainable: Today’s DKA Focus (Dec 4, 2025) — Practical Keto, Electrolyte Math, and Flavorful Meals to Stay in Nutritional Ketosis

Why this matters right now

ADCES ran a live webinar today about ketones and diabetic ketoacidosis (DKA), sponsored by Abbott, signaling growing attention from clinicians and device companies to ketone monitoring and patient education. That conversation matters to keto eaters because it clarifies how to distinguish safe nutritional ketosis from dangerous DKA, and how to use monitoring and electrolyte strategy to stay safe. ^[1]

How to keep your ketosis metabolic — not pathologic

1) Know your numbers (what to measure)

• Blood BHB (gold standard): target nutritional ketosis 0.5–3.0 mmol/L. If BHB >3.0 mmol/L, check blood glucose and call your clinician. ^[3]
• Capillary blood glucose: watch for unexpected hyperglycemia (≥200 mg/dL) together with high BHB — that raises DKA risk. ^[4]
• Basic metabolic panel (BMP): sodium, potassium, chloride, bicarbonate and creatinine — check baseline and with symptoms. (See lab guidance below.)
• Practical tools: reusable breath meters and blood ketone meters exist; Keto‑Mojo and similar blood meters are commonly used and have low per‑strip costs for frequent checking. Example price snapshot: Keto‑Mojo starter kits run in the ~$50–$60 range and strips ≈ $0.99 each (varies by seller). ^[5]

2) Electrolyte basics and “keto math”

Very‑low‑carbohydrate diets cause rapid natriuresis (loss of sodium) and water loss in early adaptation; potassium and magnesium can fall too. Reasonable, evidence‑aligned targets used in keto practice and in several clinical trials: sodium ~1,500–3,000+ mg/day depending on symptoms and medical risk, potassium food targets ~2,600–3,400 mg/day (NIH ODS AIs), and magnesium RDA ~310–420 mg/day (NIH ODS). Use food first, supplement carefully, and get labs if you’re on BP meds or have kidney disease. ^[6]

Daily macros and a practical sample plan

Below is an evidence‑based, flexible example for a 70 kg (154 lb) adult who is not a competitive athlete and wants sustained nutritional ketosis while preserving muscle.

Target	Range / Value	Rationale
Net carbs	15–30 g/day	Keeps most people in nutritional ketosis (individual variation applies).
Protein	1.2–1.6 g/kg body weight → 84–112 g/day (for 70 kg)	Protects lean mass and supports metabolic health (older adults often aim higher within range). [10]
Fat	Fill to satiety — ~60–75% calories (~140–180 g/day depending on energy needs)	Fat provides energy and ketone substrate; quality matters (olive oil, avocado, fatty fish).
Calories	Adjust to goals (weight loss vs maintenance)	Protein and carbs fixed first; remaining calories from fat.

Sample day (approx. 1,900–2,000 kcal, target: ~25 g net carbs, 95 g protein)

Practical recipes & swaps

Electrolyte sip (easy, evidence‑informed)

Ingredient swaps that keep flavor and lower carbs

• Mashed cauliflower instead of mashed potatoes (net carbs ≈ 5–8 g per serving).
• Shirataki noodles or spiralized zucchini for pasta (net carbs <5–8 g depending on portion).
• Full‑fat Greek yogurt (unsweetened) as a sour cream substitute — watch portion for carbs.

Supplements, devices, and lab testing — practical guidance

Devices

• Blood ketone meter: good for definitive BHB measurement. Keto‑Mojo GK+ is widely used; kit prices and per‑strip costs are competitive for routine testing. ^[14]
• Breath ketone meters: reusable, no strip cost, but less precise as BHB rises; useful for trend tracking rather than medical decisions. (Device pricing varies.)
• CGMs: useful for people using glucose data to inform carbohydrate tolerance; if you’re combining keto with glucose‑lowering drugs or GLP‑1s, CGM can be informative (discuss with clinician).

Supplements to consider (discuss with your clinician)

• Magnesium glycinate/citrate — 100–300 mg nightly as tolerated (keep supplement elemental mg ≤350 mg/day unless supervised). ^[15]
• Electrolyte blends without added sugar (look at sodium/potassium content per serving).
• Fish oil (EPA/DHA) for cardiovascular and anti‑inflammatory benefits — dosing individualized.

Lab testing routine (suggested)

• Baseline: BMP (Na, K, Cl, CO2/bicarb, creatinine), fasting lipids, ALT/AST, TSH; consider fasting insulin/HbA1c if metabolic health is a goal.
• Early adaptation (first 2–4 weeks): repeat BMP if symptomatic (dizziness, palpitations, cramps, syncope) or if you’re using BP meds.
• Ongoing: 3–6 month check for lipids and basic metabolic panel, then individualized yearly review. Adjust based on personal risk (age, CVD risk, kidney disease).

Grocery budget & pricing (real examples)

Food costs matter. Recent U.S. retail price snapshots show eggs and chicken remain variable after market disruption, and avocados and salmon are seasonally sensitive. Examples from late‑2025 market data:

• Eggs (retail average): roughly $4.00–$5.00 per dozen (regional variability, 2025 data). Use eggs as a budget protein when possible. ^[17]
• Boneless chicken breast: broadly in the $3–4.50 per lb range (U.S. city average late‑2025). Buying whole chickens or bone‑in cuts can reduce cost per meal. ^[18]
• Avocado: retail around $2.00–$2.50 each in 2025 market snapshots (season and region dependent). Buy when on sale and freeze extra avocado flesh for smoothies. ^[19]

Red flags — when to stop, test, and call your clinician or 911

• Persistent vomiting, abdominal pain, severe weakness, confusion, or rapid breathing. These can be DKA signs — seek emergency care.
• BHB >3.0 mmol/L PLUS blood glucose ≥200 mg/dL or low bicarb/pH — urgent evaluation needed. ^[20]
• New palpitations, syncope, recurrent cramps despite electrolyte steps — get BMP and ECG where recommended (medication interactions possible).

Putting it together: a two‑week starter routine

1. Week 0: Baseline labs (BMP, lipids, ALT/AST, fasting glucose/HbA1c) if you have risk factors or take meds.
2. Days 1–7: Net carbs 15–30 g/day, protein ~1.2–1.4 g/kg, salt food to taste but add one electrolyte sip/day (½ tsp salt + water) if you feel lightheaded. Track symptoms and weigh in weekly.
3. Days 8–14: Check fasting BHB and glucose 2–3 mornings this week. Aim for BHB 0.5–3.0 mmol/L. If BHB >3.0, check glucose and call your clinician. Increase food potassium (avocado, salmon, spinach) and magnesium (nuts, seeds) daily. ^[21]

Final verdict — balance, monitoring, and flavor

Sources & further reading

• ADCES webinar listing — "Ketones and DKA: Are they a bigger problem than we know?" (Dec 4, 2025). ^[26]
• Cleveland Clinic summary of the 2024 international consensus on hyperglycemic crises (DKA diagnostic criteria). ^[27]
• Definition of nutritional ketosis and related review (nutritional ketosis = BHB ~0.5–3.0 mmol/L). ^[28]
• NIH Office of Dietary Supplements — Potassium fact sheet (AIs and food sources). ^[29]
• NIH Office of Dietary Supplements — Magnesium fact sheet (RDAs, ULs, food sources). ^[30]
• Keto‑Mojo and consumer meter comparisons (price/strip examples). ^[31]
• U.S. food price snapshots (eggs/chicken/avocado examples) from BLS, USDA and market summaries (late‑2025). ^[32]

Summary: Keep ketosis enjoyable and safe by monitoring BHB and glucose when appropriate, replacing electrolytes primarily with whole foods (and careful supplements if needed), and using clinical thresholds (BHB ≥3 mmol/L plus hyperglycemia/acidosis) to trigger urgent care. Today’s clinician spotlight (Dec 4, 2025) reinforces that measured, monitored keto is both practical and responsible — and delicious meals make it sustainable. 🥑🥓🥤