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Diabetic Ketoacidosis

Last Updated May 2022 | This article was created by editorial staff and reviewed by Beth Oller, MD

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) happens when your blood sugar is higher than normal and your insulin level is lower than normal. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death.

DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (diabetes during pregnancy).

Symptoms of diabetic ketoacidosis

DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or go to a hospital right away. The first symptoms to appear are usually:

  • Excessive thirst
  • Dry mouth
  • Frequent urination

The next stage of DKA symptoms includes:

  • 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

If your sugar is very high or symptoms are severe (especially confusion), you should go to the nearest emergency room.

What causes diabetic ketoacidosis?

The main cause of DKA is not producing enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This lack of insulin causes your body’s glucose levels to rise. To get energy, your 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. This leads to 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 (fever, cough, or sore throat), contact your doctor. It’s important to get the right treatment. For some people, DKA may be the first sign they have diabetes.

How is diabetic ketoacidosis diagnosed?

If you think you may have diabetic ketoacidosis, contact your doctor right away. They will want to run some blood tests before giving you an official diagnosis. These tests include checking your blood sugar and ketone level. Your doctor also may order a urinalysis (requiring a urine sample) and chest X-ray.

Can diabetic ketoacidosis be prevented or avoided?

If you have diabetes, there are some things you can do to watch for diabetic ketoacidosis. When you’re sick, watch your blood sugar level very closely so it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Patients should watch their glucose level closely when those levels 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.

Diabetic ketoacidosis treatment

DKA causes excessive urination. This means you will urinate more than usual. 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 (usually through an IV). These fluids will contain electrolytes and insulin. Electrolytes will help your body function normally. Insulin will help lower your blood sugar level. Overall, fluids can help rehydrate you and dilute some of the sugar in your blood.

Living with diabetic ketoacidosis

Keeping the balance between blood sugar and insulin is the key to controlling diabetic ketoacidosis. In most cases, this means sticking to your insulin schedule. But you may need to adjust the amount of insulin you’re taking.

You should also try to recognize when you feel stressed or sick. Small adjustments to your eating or drinking can make a big difference.

Should I keep taking insulin when I’m sick?

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

If you use an insulin pump, keep a variety of supplies on hand. 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’re feeling sick to your stomach.

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

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?
  • How often should I check my blood sugar level if I’m sick?
  • 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?
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