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Diabetic Ketoacidosis: Symptoms, Causes, & Prevention

Diabetic ketoacidosis, also called DKA, is a serious condition that becomes life-threatening if untreated. It occurs when blood ketone levels rise as a result of insufficient insulin to manage glucose. People with diabetes must understand the risk factors of DKA and learn to recognize the symptoms so they know when to seek medical attention.

Last Modified: April 18, 2024
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What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis, or DKA, is a potentially life-threatening complication of diabetes that occurs when the body is unable to produce enough insulin to use glucose effectively, or the cells don’t respond to insulin correctly. The hormone insulin is instrumental in the process of sugar entering the cells to provide energy. When the body has insufficient insulin levels, it can’t absorb or use its preferred glucose fuel source, so it starts to break down fat to use as fuel instead.

When the liver burns fat as energy, glucose levels in the blood increase and produce acids called ketones that build up in the bloodstream. This rise in blood acidity levels from excess ketones is dangerous and can lead to diabetic ketoacidosis if not treated.

Diabetic ketoacidosis is one of the most severe complications of diabetes, along with hypoglycemia, and you must take it seriously. It can lead to a diabetic coma, or death in extreme cases. Diabetic ketoacidosis can also alter the balance of electrolytes like potassium, sodium and bicarbonates, which can cause additional problems. DKA is more common in people who have type 1 diabetes, but those with type 2 diabetes can also develop the complication. Type 2 diabetes patients generally develop DKA if they are sick, stressed or taking certain medications.

You need to understand the medication-related risk factors of DKA and learn to recognize the symptoms so you can take action to prevent diabetic ketoacidosis and act swiftly to treat it if symptoms occur. Tracking your medication schedule, symptoms and lifestyle factors is a great way to monitor your condition and share your health information with your doctor to receive the best possible treatment.

Recognizing & Treating DKA Symptoms

A high ketone level is a clear indication that your diabetes is not under control, making it essential for diabetics to recognize diabetic ketoacidosis symptoms. These can appear quickly, with initial symptoms showing up in as little as 24 hours. DKA symptoms are sometimes a person’s first indication that they have diabetes.

Initial DKA Signs and Symptoms
  • Dry mouth
  • Extreme thirst
  • Frequent urination
  • High blood sugar (hyperglycemia)
  • High ketone levels (metabolic acidosis)

Elevated blood sugar and ketone levels are serious symptoms and can rapidly turn dangerous. Speak with your doctor about what your target range is and take action if your numbers climb above normal levels.

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

If you have elevated blood sugar levels accompanied by any severe DKA symptoms, call 911 or go to the emergency room immediately. Untreated DKA is potentially fatal and serious cases require hospitalization to administer emergency medical treatment to prevent diabetic coma or other life-threatening consequences. Emergency DKA treatments may include receiving insulin, taking medications to treat underlying illnesses that caused DKA, replacing electrolytes to healthy levels or replacing fluids to treat dehydration and dilute excess blood sugar.

Ongoing management and treatment of diabetic ketoacidosis involves keeping your blood sugar levels within your target range by following your doctor’s advice on medication dosages, diet, exercise and other lifestyle changes. Discuss any diet or lifestyle changes you make, like beginning an exercise program, before you start so your doctor can adjust your medications as needed to keep your blood sugar levels in your target range.

Diabetics at higher risk for experiencing DKA can also use home blood or urine test kits to check for high blood sugar levels and high ketone levels. These are certain signs of diabetic ketoacidosis.

Ketone Testing Methods
Blood Ketone Test
This test 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 indicate the levels by turning a specific color. 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 sick or have a high blood sugar reading of 240 mg/dL or more, your doctor will likely recommend that you increase testing frequency to every four to six hours until the condition subsides. Call your doctor if you have moderate to high ketone levels to get advice on additional treatment steps.

Understanding 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. 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, from incorrect use of insulin to underlying and untreated health concerns to 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
Diabetics who take insulin to manage their condition and either miss an insulin shot, take the wrong dosage, have a clogged insulin pump or use spoiled or expired insulin can develop DKA.

Once you know the risk factors of DKA, you can take action to reduce them. The more you know about your risks along with the various signs and symptoms to watch for can help make sure you seek out earlier diagnosis and treatment.

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, sepsis 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 a warning sign of diabetes in undiagnosed individuals. In people who have diabetes, it is a sign their condition is not under control and requires treatment.

Medication-Induced DKA

Taking certain medications may increase your risk of developing DKA. Always inform your health care providers of any current medications you take and make it known that you have diabetes. Your illness 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, which affects blood sugar and can sometimes trigger DKA.
This is another class of drug that affects the metabolism of carbohydrates.
SGLT2 inhibitors
SGLT2 inhibitors, particularly Invokana and Farxiga may cause DKA. Patients taking these medications should stay alert for symptoms like abdominal pain, lethargy, difficulty breathing, nausea and vomiting.
Taking steroids can increase insulin resistance and raise blood sugar levels, contributing to DKA.

It’s important to talk to your doctor about all the possible risks associated with taking a medication before you start. Some have rare but serious side effects you must know about so you can watch for any 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 open and transparent about your diet, exercise and lifestyle habits as they can impact your insulin needs. These medical reviews keep your health care provider apprised of your condition and let you work together to come up with the most effective treatment plan for your needs.

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.

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 recommended by your doctor.
  • 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 remember that you must 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, but you still must follow your management plan to live well and keep yourself healthy.

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