Diabetic Ketoacidosis

Overview

What is diabetic ketoacidosis?

Diabetic ketoacidosis (say: "key-toe-acid-oh-sis"), or DKA, happens when a combination of high blood sugar levels and not enough insulin in the body cause a build-up of acids called ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. It mainly affects people who have type 1 diabetes. However, it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy).

Symptoms

What are the warning signs of DKA?

DKA is a very serious condition. People who have diabetes should contact their doctor or get to a hospital right away if they have the symptoms of DKA. The first symptoms to appear are usually:

The next stage of DKA symptoms include:

  • Excessive thirst

  • Dry mouth

  • Frequent urination

  • Moderate or high ketone level in the urine (which can be tested with a home urine kit)

  • High blood sugar level

  • Vomiting (usually more than once)

  • Abdominal pain

  • Diarrhea

  • Trouble breathing

  • Confusion or trouble concentrating

  • Loss of appetite

  • Weakness and fatigue

  • A fruity odor on the breath

Causes & Risk Factors

What causes DKA?

The main cause of DKA is not enough insulin. A lack of insulin means the sugar can’t get into your cells, which need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often, which leads to a lack of fluids in the body (dehydration).

DKA can be caused by missing an insulin dose, eating poorly or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection, such as a fever, cough or sore throat, contact your doctor to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes.

Treatment

How is DKA treated?

DKA causes excessive urination, which means you can become dehydrated and your body can lose electrolytes (minerals in your blood that help your body function). If you are diagnosed with DKA, your doctor will most likely treat you with fluids containing electrolytes and insulin (usually through an IV). Fluids can help rehydrate you and dilute some of the sugar in your blood. Electrolytes will help your body function normally. Insulin will help lower your blood sugar level.

Should I keep taking insulin when I’m sick?

Yes, you should keep taking your insulin, even if you are too sick to eat. Your body needs insulin even if you are not eating. Ask your doctor whether it is necessary to adjust your dose or take extra insulin.

If you use an insulin pump, make sure that you have short-acting insulin, long-acting insulin and needles in case your pump is not working right. You also should have an emergency phone number to call for help with your pump.

What else should I do?

When you’re sick, drink lots of sugar-free, caffeine-free liquids. Sip small amounts every few minutes if you are feeling sick to your stomach.

If your blood sugar level is more than 250 mg per dL, avoids foods that are high in carbohydrates.

Prevention

How can I prevent DKA?

When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels closely when they are more than 250 mg per dL.

When you’re sick or stressed, you should check your blood sugar level more often than normal (sometimes every 3 to 4 hours). If your blood sugar reaches a critical level, check it every 1 to 2 hours. Ask your doctor if you should test your blood sugar level during the night.

You should also test your urine for ketones every few hours if you’re sick, stressed or if your blood sugar level is more than 250 mg per dL.

You should talk to your doctor to develop a plan if your blood sugar level gets too high. Make sure that you know how to reach your doctor in an emergency.

Other Organizations

Questions to Ask Your Doctor

  • I’ve never been diagnosed with diabetes, but I have many of the symptoms of diabetic ketoacidosis. Do I have diabetes?

  • I’m having a hard time controlling my blood sugar levels. Am I at risk of diabetic ketoacidosis?

  • Will diet and exercise help me to avoid diabetic ketoacidosis?

  • If I notice I’m having symptoms of diabetic ketoacidosis, what should I do first?

  • Is it safe for me to exercise?

  • What is the best way for me to check the ketone level in my body?

  • I missed a dose of insulin. Should I start testing my blood sugar level and ketone level right away?

Citations

  • Diabetic Ketoacidosis by David E. Trachtenbarg, M.D.( 05/01/05, http://www.aafp.org/afp/20050501/1705.html)