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Diabetic Ketoacidosis

Diabetic ketoacidosis, also known as DKA, is a severe and potentially life-threatening complication of diabetes. When the body can’t efficiently absorb and use glucose due to an insulin deficiency, dangerous levels of acidic ketones can build up in the blood.

Last Modified: September 5, 2023
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What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis, or DKA, is a serious condition that can occur in those with diabetes. DKA can lead to a diabetic coma or, in extreme cases, death. It is more common among people living with Type 1 diabetes, but those with Type 2 diabetes can also develop the complication.

DKA happens when ketones build up in the blood. As glucose circulates in your blood, your body’s cells use insulin to absorb it. Normally cells take in glucose as a primary energy source. But if you have diabetes your cells don’t absorb and use glucose, either because the body does not make enough insulin or the cells don’t respond to it.

Instead, the body burns fat as energy through the liver, leading to glucose buildup in the blood. The process produces ketones that can increase the acidity of your blood, which is dangerous. DKA can also affect the balance of electrolytes in the body such as potassium, sodium and bicarbonates, causing further problems.

Diabetic Ketoacidosis Symptoms

DKA symptoms vary depending on the condition’s severity. Initial symptoms, which can appear within 24 hours, include excessive thirst and frequent urination. Left untreated, other diabetes symptoms can appear quickly.

Symptoms of DKA may include:
  • Constant thirst
  • Urinating more often than usual
  • High blood glucose levels
  • High ketone levels in urine

DKA often occurs in people living with Type 1 diabetes. In rare cases, people with Type 2 diabetes can get DKA if they are under stress, sick or taking certain medications.

When to Seek Medical Help

DKA is a dangerous medical condition when left untreated. It is important to pay close attention to any severe symptoms that arise.

Severe Symptoms of DKA
  • Fast, deep breathing
  • Flushed face
  • Dry skin and mouth
  • Fruity smelling breath
  • Aching muscles and stiffness
  • Stomach pain
  • Nausea and vomiting
  • Feeling constantly tired

If you experience any of these severe symptoms — especially multiple symptoms — call your physician, get to the nearest emergency room or immediately call 911.

Causes of Diabetic Ketoacidosis

DKA occurs when low insulin levels in the blood cause the body to break down fat for fuel. The process occurs in the liver and produces acidic ketones. When ketones build up in the blood, they lead to DKA.

The two common diabetic ketoacidosis causes are:
  • Illness: Having an illness that reduces your appetite may cause you to eat and drink less, making it harder for your body to regulate blood sugar levels if you have diabetes.
  • Problems with insulin therapy: Missing insulin shots, taking the wrong insulin dosage, having a clogged insulin pump, or using expired or spoiled insulin can all lead to DKA.
Other triggers of DKA include:
  • Sudden health problems such as stroke, heart attack, urinary tract infections or pneumonia
  • Alcohol or drug abuse
  • Physical injury
  • Certain medications such as diuretics, corticosteroids, prednisone, dexamethasone or glucocorticoids
  • Undiagnosed diabetes, which causes the body to break down fats for fuel
  • Failure to treat or take diabetes medications as required

Ketone levels can be a warning sign of diabetes if you are undiagnosed. It can also be a sign that your diabetes is not under control.

Diabetic Ketoacidosis Risk Factors

Uncontrolled Type 1 diabetes can often lead to diabetic ketoacidosis. Although less common, DKA can also develop in Type 2 diabetes patients.

Risk factors of DKA may include:
  • Failure to take insulin as specified or not taking it at all
  • Untreated or undiagnosed diabetes
  • Infections such as sepsis, pneumonia or urinary tract infections
  • Surgery
  • Pregnancy
  • Stroke
  • Heart issues such as a heart attack
  • Pancreatitis
  • Taking steroids, antipsychotic drugs or diuretics
  • Blood clots in the lungs
  • Stomach illness with excessive vomiting
  • Significant illness or trauma

Knowing your risk factors can help you reduce them. And understanding your risks coupled with knowing what signs and symptoms to watch for can help ensure earlier diagnosis and treatment.

Tests for Diabetic Ketoacidosis

In addition to tests for diabetes, there are also tests to determine your ketone levels. Several ketone tests are available for home use. Others require seeing a health care provider.

Ketone testing methods:

  • Blood ketone test: This test is similar to a blood glucose test and calculates the ketone beta-hydroxybutyrate in your blood. Some home glucose monitors also allow the use of separate test strips to measure ketones.
  • Urine ketone test: These test strips check for the ketone acetoacetate. The strip turns a particular color depending on the ketones in your urine. These tests can be purchased over the counter without a prescription.

Your doctor will advise when and how to test for ketones. Many specialists recommend checking ketone levels every four to six hours when you are sick or if you have a high blood sugar reading of 240 mg/dL or over.

Call your doctor if your ketone levels rise to moderate or high. Call emergency services or go to the nearest ER if you experience any severe DKA symptoms with elevated blood sugar levels.

Diabetic Ketoacidosis Treatment

DKA can be fatal if left untreated, and it requires hospitalization for emergency medical treatment to prevent a diabetic coma or death.

Once test results confirm the condition, treatment focuses on lowering blood sugar levels. Emergency DKA treatments include:

  • Replacing fluids lost through urination or vomiting to treat dehydration as well as to dilute excess blood sugar
  • Replacing lost electrolytes needed to help the brain, heart, muscles and nerves work
  • Receiving insulin to reverse DKA-causing conditions
  • Taking medicines to treat underlying illnesses that caused diabetic ketoacidosis

Always check with your physician or another medical provider if you feel your diabetes is not under control.

Diabetic Ketoacidosis Prevention

Managing your diabetes can significantly lower your chances of getting DKA.

Take the following preventative steps:
  • Check blood sugar levels often, including every four to six hours when sick
  • Keep blood sugar levels within your target range
  • Take prescription medications as advised
  • Talk to your doctor about adjusting your insulin based on illnesses, lifestyle or diet
  • Seek medical help if you experience DKA symptoms

Always seek medical help if you experience DKA symptoms. Talk to your doctor to receive further health information about diabetes and its associated conditions such as diabetic ketoacidosis and learn how to lower blood sugar and manage the disease.

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