Diabetic Ketoacidosis

What Is Diabetic Ketoacidosis?

Diabetic Ketoacidosis (DKA) is a serious complication of diabetes that can be life-threating. DKA happens when the body can’t produce enough insulin and it creates a buildup of acids, known as ketones. Typically, insulin helps to regulate blood sugar levels, which provides energy to the muscles and other tissues in the body. When the body doesn’t have enough insulin, the body has to use fat for fuel, and this is what leads to an overproduction of ketones.

It is important to know what the symptoms of ketoacidosis are, whether you have diabetes, or are at risk for diabetes. If left untreated, ketoacidosis can lead to coma or even death. Please contact your primary care physician if you are experiencing any symptoms.

What Are the Symptoms of Diabetic Ketoacidosis?

Diabetic ketoacidosis has the potential to develop quickly (sometimes within 24 hours), so it is important to know the early warning signs and seek help when symptoms of DKA are experienced. Because DKA can lead to diabetic coma or death, catching the early warning signs is crucial for treatment and prevention.

For some people, experiencing DKA symptoms may be the first indicator of diabetes. The following symptoms are common early signs and symptoms of diabetic ketoacidosis:

  • Extreme dry mouth and excessive thirst
  • Constant urination
  • High blood glucose (sugar) levels
  • High levels of ketones in urine

Symptoms that may develop later include:

  • Nausea or vomiting, abdominal pain
  • Chronic fatigue
  • Flushed or dry skin
  • Difficulty breathing
  • Fruity smelling breath
  • Confusion or difficulties concentrating

A build up of ketones in the body can be extremely dangerous, and those with type 1 diabetes are at greater risk for DKA because of the body’s inability to produce insulin. Those with type 2 diabetes can still develop symptoms of DKA, although it is rare.

Medical professionals recommend to test blood and urine regularly, in order to monitor glucose and ketone levels, especially if you have had a recent illness or injury, or are under high stress. Levels can be tested at home with a testing kit or by visiting a primary care physician.

Additionally, it is advised to check ketone levels every 4-6 hours if glucose levels are consistently (twice or more) over 240mg/dl, or if glucose levels are at 240mg/dl and you have been ill, or are planning to exercise.

If you are experiencing any symptoms of diabetic ketoacidosis, please seek medical help, immediately.

What Causes Diabetic Ketoacidosis? What Are the Risk Factors?

Insulin is what helps sugar enter the cells and provides energy or fuel to all the muscles and tissues throughout the body. However, when the body is unable to produce enough insulin, it begins to breakdown fat for fuel. In this process, the body can release various hormones to break down the fat, which eventually causes a buildup of ketones in the body. The acids (ketones) first buildup in the blood and then overflow into the urine.

Diabetic ketoacidosis can be caused by the following:

  • Illness: Sometimes a common cold, the flu, pneumonia, urinary tract infections, or other infections can trigger DKA. During an illness or infection, the body can release different hormones, such as adrenaline or cortisol, which work in opposition to the production of insulin.
  • Problems with insulin treatments: Any kind of issue in insulin therapy, such as missed treatments, a faulty insulin pump, or inadequate insulin therapy can trigger symptoms of DKA.

Other potential causes of DKA include:

  • Chronic, acute, or high stress
  • Trauma (physical or emotional)
  • Heart attack or stroke
  • Pancreatitis
  • Pregnancy
  • Certain medications (some types of corticosteroids or diuretics)
  • Alcohol or drug abuse, particularly cocaine

Highest risk factors include:

  • Type 1 diabetes
  • Consistently missed insulin treatments

Although those with type 2 diabetes can experience symptoms of DKA, it is rare. If you are experiencing any of these symptoms, please seek medical help, as DKA can be life-threatening.

How Is Diabetic Ketoacidosis Diagnosed?

DKA can be diagnosed using several different methods. Typically, a medical professional will conduct a physical exam and order blood work and a urinalysis. There may be additional testing to determine what may have caused the onset of DKA. Diagnostics may include blood tests to determine:

  • Blood sugar. If there is an inability to produce insulin, fat will be used for fuel, and sugar will not be able to enter the cells in the body. This will cause blood sugar to rise, leading to hyperglycemia.
  • Ketone level. When the body has to breakdown fat or protein, acids (ketones) buildup in the blood and overflow into the urine.
  • Blood acidity. As ketones buildup in the bloodstream, the blood becomes more acidic and can impact the functioning of organs.

Other diagnostic tests to determine underlying causes for DKA or further complications include:

  • Urinalysis
  • Electrolyte test
  • Electrocardiogram
  • Chest x-ray

If you are experiencing symptoms of DKA, please contact your Baptist Health provider, immediately.

How Is Diabetic Ketoacidosis Treated?

DKA is typically treated with a combination of treatments. Additionally, if a patient is not diabetic but has DKA, a medical professional will put together a diabetic treatment plan to help prevent DKA from happening again. Lastly, because infection or illness can also trigger DKA, antibiotics may be prescribed to help in the course of treatment.

Treatment approaches usually focus on stabilizing blood sugar (insulin) levels, reducing ketones, and balancing electrolytes. The most common ways to do this are through fluid replacement, insulin treatments, and electrolyte replacement.

  • Fluid replacement: Dehydration can be a common culprit in rising blood sugar levels. A medical professional will administer fluid replacement orally or intravenously (through an IV).
  • Insulin therapy: This treatment helps to stabilize blood sugar levels. The insulin is usually given intravenously. Ideally, blood sugar levels need to drop below 240mg/dl to be within an acceptable range.
  • Electrolyte replacement: This treatment is often administered intravenously, and helps to balance electrolytes that have dropped abnormally low. Often, when insulin is low, electrolytes also drop abnormally low. Electrolytes dropping abnormally low can impact organ and nerve functioning.


The main key to preventing DKA is being able to manage your diabetes. It is important to stay consistent in whatever your treatment plan is. This includes consistent insulin treatments and taking any medications for diabetes management, staying hydrated, following a meal plan that helps to regulate sugar levels, and monitoring your blood sugar levels on a consistent basis.

Illness and infection are not always in a person’s control, so it is important to take proactive measures so that you catch changes before they become serious issues. Helpful proactive measures may include:

  • Setting alarms or reminders on a device to remind you to take insulin or other medications for diabetes management.
  • Prefilling syringes for insulin treatments, indicating if daily dose has been taken or not.
  • Regularly testing blood sugar levels and ketone levels, specifically if you’ve been ill, had an injury or surgery, are under high stress, or if you’re planning an intense workout.
  • Talk to your doctor if you think you need to adjust your insulin dosage based on illness, activity level, or any other factor.
  • Have a detailed plan for what you need to do if you start exhibiting symptoms of DKA.

The key to prevention is early detection, which is why regular monitoring and testing of blood sugar levels is paramount. Discrepancies in blood sugar levels can indicate testing for ketone levels. Seek medical help immediately if any symptoms of DKA are present, as it can lead to coma or death, if left untreated.

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