Acetone breath


Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate.

Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.

Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis.

Ketoacidosis can be smelled on a person’s breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also give off an odor, but the odor is usually more subtle due to lower concentrations of acetone.

Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia.

What causes bad breath in diabetes?

Diabetes-related halitosis has two main causes: periodontal disease and high levels of ketones in the blood.

Periodontal diseases

Periodontal diseases, also called gum diseases, include gingivitis, mild periodontitis, and advanced periodontitis. In these inflammatory diseases, bacteria attack the tissues and bone that support your teeth. Inflammation can affect metabolism and increase your blood sugar, which worsens diabetes.

While diabetes can lead to periodontal diseases, these diseases can also create further problems for people with diabetes. According to a report in IOSR Journal of Dental and Medical Sciences, an estimated one in three people with diabetes will also experience periodontal diseases. Heart disease and stroke, which can be complications of diabetes, are also linked to periodontal disease.

Diabetes can damage blood vessels, which can reduce blood flow throughout your body, including your gums. If your gums and teeth aren’t receiving a proper supply of blood, they may become weak and more prone to infection. Diabetes may also raise glucose levels in your mouth, promoting bacteria growth, infection, and bad breath. When your blood sugars are high, it becomes hard for the body to fight infection, which makes it harder for the gums to heal.

If someone with diabetes gets a periodontal disease, it may be more severe and take longer to heal than in a person without diabetes.

Bad breath is a common sign of periodontal disease. Other signs include:

  • red or tender gums
  • bleeding gums
  • sensitive teeth
  • receding gums


When your body can’t make insulin, your cells don’t receive the glucose they need for fuel. To compensate, your body switches to plan B: burning fat. Burning fat instead of sugar produces ketones, which build up in your blood and urine. Ketones can also be produced when you’re fasting or if you’re on a high-protein, low-carbohydrate diet, although not to the same level as they are in diabetic ketoacidosis.

High ketone levels often cause bad breath. One of the ketones, acetone (a chemical found in nail polish), can cause your breath to smell like nail polish.

When ketones rise to unsafe levels, you’re at risk of a dangerous condition called diabetic ketoacidosis (DKA). Symptoms of DKA include:

  • a sweet and fruity odor on your breath
  • more frequent urination than normal
  • abdominal pain, nausea, or vomiting
  • high blood glucose levels
  • shortness of breath or difficulty breathing
  • confusion

DKA is a dangerous condition, mostly limited to people with type 1 diabetes whose blood sugars are uncontrolled. If you have these symptoms, seek medical help immediately.



Managing bad breath from diabetes

Along with neuropathy, cardiovascular disease, and others, periodontitis is a common complication of diabetes. You can, however, take steps to stave off gum diseases or to lessen their severity. Take control with these daily tips:

  • Brush your teeth at least twice a day and floss daily.
  • Don’t forget to brush or scrape your tongue, a prime breeding place for foul-smelling bacteria.
  • Drink water and keep your mouth moist.
  • Keep your blood sugar levels in their target range.
  • Use sugar-free mints or gum to stimulate saliva.
  • Visit your dentist regularly and follow their treatment recommendations. Make sure the dentist knows you have diabetes.
  • Your doctor or dentist may prescribe a medication to stimulate the production of saliva.
  • If you wear dentures, make sure they fit well and take them out at night.
  • Don’t smoke.


Bad breath may be a sign of something more. If you have diabetes, it’s important to be aware of what your breath may be telling you. Your understanding may save you from advanced gum disease or the dangers of DKA.


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