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Diabetic Ketoacidosis: Symptoms, Causes & Prevention

Diabetic ketoacidosis, or DKA, is a serious condition caused by a lack of insulin leading to high blood ketone levels. It's important for people with diabetes to be aware of DKA risk factors and symptoms in order to seek medical help when needed.

Last Modified: July 2, 2024
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What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. It happens when the body doesn’t have enough insulin to use glucose for energy, leading to the breakdown of fat for fuel.

This produces acids called ketones, which can build up in the bloodstream and make it dangerously acidic. DKA is a severe complication of diabetes and can lead to coma or death if not treated promptly.

It’s more common in people with Type 1 diabetes, but those with Type 2 diabetes can also develop it, especially when sick, stressed or taking certain medications. Keeping track of medication schedules and keeping your doctor up-to-date on your health information, symptoms and lifestyle factors can help monitor the condition and ensure timely treatment.

Medication-Induced DKA

Taking certain medications may increase your risk of developing DKA. If you have diabetes, it is important to inform your health care provider of any medications you take. This information could influence the type of medication they prescribe.

Medications That May Cause DKA
Antipsychotic Drugs
These medications, like clozapine and olanzapine, can cause metabolic disturbances that lead to diabetic ketoacidosis.
These drugs impact carbohydrate metabolism, affecting blood sugar and sometimes triggering DKA.
This is another class of drug that affects the metabolism of carbohydrates.
SGLT2 inhibitors
SGLT2 inhibitors, such as Invokana and Farxiga, may cause DKA. Patients taking these medications should stay alert for symptoms like abdominal pain, lethargy, difficulty breathing, nausea and vomiting.
Steroids can increase insulin resistance and raise blood sugar levels, contributing to DKA.

It is important to talk to your doctor about the risks of taking a medication before you start. Some have rare but serious side effects, so being informed can help you detect early warning signs. Diabetic ketoacidosis is one of the main injuries cited by plaintiffs filing SGLT2 inhibitor lawsuits.

Managing Medications To Reduce DKA Risk

Medication management is a crucial part of controlling blood sugar levels and reducing your risk of developing diabetic ketoacidosis. Always follow the medication schedule and dosages prescribed by your doctor. Insufficient or missed dosages can have serious consequences.

Attend regular medical appointments to discuss any symptoms you experience along with your overall health. Be transparent about your diet, exercise and lifestyle habits as they can impact your insulin needs. These discussions ensure your health care provider stays informed about your condition and allows you to work together to develop the most effective treatment plan for your needs.

Recognizing & Treating DKA Symptoms

A high ketone level indicates that your diabetes is not under control. Therefore, it is important for diabetics to recognize the symptoms of diabetic ketoacidosis. These can appear quickly, with initial symptoms sometimes appearing within the first 24 hours.

Sometimes, DKA symptoms are the first sign that someone might have diabetes.

Initial DKA Signs and Symptoms
  • Dry mouth
  • Extreme thirst
  • Frequent urination

Elevated blood sugar and ketone levels are serious and can rapidly turn dangerous. Your doctor can help you decide what your target range should be and inform you on what actions to take if your numbers rise above normal levels.

Severe DKA Signs and Symptoms
  • Abdominal Pain
  • Confusion
  • Constant tiredness
  • Dry or flushed skin
  • Fruity-scented breath
  • Muscle aches and stiffness
  • Nausea and vomiting
  • Rapid, deep breathing
  • Shortness of breath

Elevated blood sugar levels and severe DKA symptoms are a medical emergency. Untreated DKA can be fatal, so hospitalization may be required for emergency medical treatment to prevent diabetic coma or other serious consequences.

Treatment includes insulin, fluid replacement and careful monitoring to restore blood sugar and electrolyte balance. Diabetics at higher risk for DKA can use home test kits to check for high blood sugar and ketone levels.

Ketone Testing Methods
Blood Ketone Test
This test usually calculates the level of ketone beta-hydroxybutyrate in your blood. It’s similar to a blood glucose test, and some home glucose monitors allow for separate test strips to measure ketones.
Urine Ketone Test
Urine test strips check for ketone acetoacetate and change color to indicate the levels. Urine tests are available for purchase without a prescription.

Your doctor can help you determine when and how to test for ketones. If you are feeling sick and have a high blood sugar reading of 240 mg/dL or more, a high level of urine ketones can indicate you are developing DKA. If you have moderate to high ketone levels, your doctor can advise you on additional treatment steps.

Understanding Other Causes & Risk Factors

DKA occurs when low levels of insulin in the blood cause the body to switch to breaking down fat to use as fuel instead of sugar. This process occurs in the liver and produces acids called ketones. When ketones build up to dangerous levels in the blood, they lead to DKA. There are several causes of diabetic ketoacidosis, such as incorrect use of insulin, underlying and untreated health concerns and lifestyle factors.

Common Causes of DKA
Any illness that affects appetite and liquid consumption can make it harder for diabetics to regulate their blood sugar levels.
Insulin Therapy Problems
Any illness that affects appetite and liquid consumption can make it harder for diabetics to regulate their blood sugar levels.

Once you know the risk factors of DKA, you can take action to reduce them. Knowing your risks and the symptoms to watch for can help ensure you pursue diagnosis and treatment as soon as possible.

Additional DKA Triggers and Risk Factors
  • Alcohol or drug abuse
  • Blood clots in the lungs
  • Certain medications like steroids, diuretics and antipsychotic drugs
  • Failure to treat diabetes or take medications as directed
  • Infections like pneumonia and urinary tract infections
  • Pancreatitis
  • Physical injuries
  • Pregnancy
  • Significant illness or trauma
  • Stomach illness with excessive vomiting
  • Sudden health issues like heart attack or stroke
  • Surgery
  • Undiagnosed diabetes

High ketone levels can signal diabetes in undiagnosed individuals. In people who have diabetes, it is a sign their condition is not under control and requires treatment.

Preventing DKA

Proactive management of your diabetes can help to prevent DKA. Along with medication management, staying hydrated, getting enough exercise and eating a balanced, healthy diet can significantly lower your chances of experiencing diabetic ketoacidosis.

Additional Tips For DKA Prevention
  • Check your blood sugar levels often to keep them in your target range. Increase the frequency of your blood sugar checks if you get sick, or as your doctor recommends.
  • Take all prescription medications exactly as advised. If you become ill or intend to change your diet or lifestyle, talk to your doctor about adjusting your insulin dosage.
  • Seek immediate medical assistance if you experience DKA symptoms.

It’s important to take your medications and follow your doctor’s prescribed treatment plan, even if you feel fine. Managing diabetes and preventing DKA is an ongoing effort. The goal is to achieve and maintain healthy levels to keep you feeling your best.

Editor Lindsay Donaldson contributed to this article.

Please seek the advice of a medical professional before making health care decisions.