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What You Should Know About Diabetic Ketoacidosis

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars.

Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes.

DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA.

What are the symptoms of diabetic ketoacidosis?

Symptoms of DKA can appear quickly and may include:

  • frequent urination
  • extreme thirst
  • high blood sugar levels
  • high levels of ketones in the urine
  • nausea or vomiting
  • abdominal pain
  • confusion
  • fruity-smelling breath
  • a flushed face
  • fatigue
  • rapid breathing
  • dry mouth and skin

It is important to make sure you consult with your doctor if you experience any of these symptoms.

If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help.

If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA.

If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for ketones. You should also test if you are sick or planning on exercising and your blood sugar is 250 mg/dL or higher. Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.

What causes diabetic ketoacidosis?

The most common triggers for the breakdown of fat that causes DKA are:

  • missing an insulin injection or not injecting enough insulin
  • illness or infection
  • for people that are using an infusion pump, a clog in the pump

You cannot avoid illness or infection, but there are steps you can take to help you remember to take your insulin:

  • Set an alarm if you take it at the same time every day, or download an app for your phone to help remind you to take your medication.
  • Pre-fill your syringe or syringes in the morning. That will help you easily see if you missed a dose.
  • Be vigilant about testing your glucose levels. This will help you quickly identify if your blood sugar level is within your target range. You can then talk to your doctor about adjusting your medication if needed.

Who is at risk for developing diabetic ketoacidosis?

Your risk of developing DKA might be higher if you:

  • have type 1 diabetes
  • are under the age of 19
  • have had some form of trauma, whether emotional or physical
  • are stressed
  • have a high fever
  • have had a heart attack or stroke
  • smoke
  • have a drug or alcohol addiction

Although DKA is rare in people who have type 2 diabetes, it does occur.

How is diabetic ketoacidosis diagnosed?

Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. If home urine testing confirms ketosis, contact your doctor, who may order more testing. Tests of blood acidity and sugar levels are commonly done. Other tests your doctor may order are:

  • a basic blood panel, including potassium and sodium, to assess metabolic function
  • arterial blood gas to determine the acidity of your blood
  • blood pressure measurement
  • if ill, a chest X-ray or other lab tests to look for signs of an infection, such as pneumonia

How is diabetic ketoacidosis treated?

The treatment for DKA usually involves a combination of several approaches to normalize abnormal blood sugar and insulin levels. If you’re diagnosed with DKA but have not yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring. If your DKA is a result of an infection or illness, your doctor will treat that as well, likely with antibiotics.

Fluid replacement

At the hospital, your physician will likely give you fluids to replace fluid that’s lost as a result of DKA. If possible, they can give them orally, but you may have to receive fluids through an IV, or intravenously. Fluid replacement helps treat dehydration, which can cause even higher blood sugar levels.

Insulin therapy

Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar levels are within an acceptable range, you will need to work with your doctor to help you avoid the risk of DKA in the future.

Electrolyte replacement

Lower than normal levels of insulin can cause the levels of electrolytes in your body to also become abnormally low. Electrolytes are electrically charged minerals that help your body, including the heart and nerves, function properly. Electrolyte replacement is also commonly done through IV.

What’s the outlook?

DKA is a serious potential complication of diabetes, but it can be prevented. Follow the treatment plan your doctor has recommended, and take a proactive approach to your health. Let your doctor know if you think your treatment is no longer working or if you’re having trouble sticking to it. They can adjust your treatment plan or help you come up with solutions for managing your condition.

Preventing diabetic ketoacidosis

There are many ways to prevent DKA. One of the most important is proper management of diabetes:

  • Take your diabetes medication as directed.
  • Follow your meal plan and stay hydrated with water.
  • Monitor your blood glucose consistently to help prevent DKA.

You can also try the following prevention methods:

  • Never skip your insulin doses. Use a mobile app or an alarm to remind you to take your medication.
  • Talk to your doctor about adjusting your insulin dosage levels based on your activity level, illnesses, or other factors, such as what you’re eating.
  • Develop an emergency or "sick day" plan so you will know what to do if you develop DKA symptoms.
  • Test your urine for ketone levels during periods of high stress or illness. This can help you catch mild to moderate ketone levels before they threaten your health.
  • Seek medical care if your blood sugar levels are higher than normal or ketones are present. Early detection is essential. 

Content licensed from:

Written by: Carmella Wint and Marijane Leonard
Medically reviewed on: Oct 20, 2016: Peggy Pletcher, MS, RD, LD, CDE

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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