There is often some confusion between the ketosis of the keto diet and diabetic ketoacidosis. Diet ketosis is a metabolic state of low sugar levels and low to normal insulin levels, with moderate ketone levels in the blood secondary to the keto diet. Ketoacidosis is a state of extremely high glucose levels secondary to either low insulin levels or insulin resistance in diabetics. Diabetics cannot utilize glucose, so they excrete it in the urine. This causes hyperosmolality, and to sustain energy, the fat cells break down into high levels of ketones. Since they are acidic, this causes acidosis.