Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes. It occurs when the body begins to break down fat too quickly, producing ketones, which can build up in the blood and make it dangerously acidic. DKA primarily affects people with Type 1 diabetes, but those with Type 2 diabetes can also develop this condition under certain circumstances.
Understanding how to treat, avoid and recognize the warning signs of DKA, and monitor for moderate or high ketone levels is crucial for anyone managing diabetes.
Defining Diabetic Ketoacidosis
Glucose, a type of sugar, is the primary energy source for all the body’s cells. Insulin, a hormone the pancreas produces, helps glucose enter the cells. In people with Type 1 diabetes, the body either produces no insulin or not enough insulin. For people with Type 2 diabetes, insulin cannot be effectively used when it is made. Without sufficient insulin, glucose cannot enter the cells and remains in the bloodstream, leading to high blood sugar levels.
When the body cannot use glucose for energy due to a lack of insulin, it breaks down fat for fuel. This process produces acidic byproducts called ketones. The body can usually manage small amounts of ketones, but with DKA, the production of ketones becomes excessive, leading to a dangerous buildup in the bloodstream. High ketone levels can cause the blood to become acidic, affecting the function of internal organs and leading to a medical emergency.
Causes of Diabetic Ketoacidosis
DKA can be triggered by various factors, including poorly managed diabetes, infections or illness. Understanding what causes ketoacidosis can help to prevent it.
Key causes of DKA include:
- Missed insulin doses. Skipping insulin injections or not taking the proper dose is a significant risk factor for DKA.
- Physical stress. Your body may need more insulin during times of physical stress, such as surgery, when you’re injured or during illness.
- Severe dehydration. Dehydration can worsen DKA by increasing ketone concentration in the blood.
- Medications. The class of medications known as sodium-glucose cotransporter 2 inhibitors, such as empagliflozin, dapaglifozin, ertuglifozin and canagliflozin, may also raise your risk of DKA.
Signs and Symptoms of DKA
Recognizing the warning signs of DKA early can prevent the condition from becoming life-threatening. Common symptoms include:
- Confusion or difficulty concentrating. High levels of ketones can impair brain function, leading to confusion or lethargy.
- Fruity-smelling breath. The buildup of ketones can cause the breath to have a fruity or acetone-like smell.
- High blood sugar levels. Consistently high blood glucose readings (over 200 mg/dL) can be an early indicator of DKA.
- Nausea and vomiting. As ketones build up, they can cause nausea, vomiting and abdominal pain.
- Rapid breathing. The body may attempt to expel excess acid by breathing more rapidly, sometimes described as “Kussmaul breathing.”
If you experience any of these symptoms or notice them in someone else, contact a provider, seek medical help at an urgent care facility, go to the emergency room or call 911.
How to Treat DKA
DKA is a medical emergency that requires prompt medical treatment and typically involves:
- Insulin therapy. The primary treatment for DKA is administering insulin to lower blood glucose levels and stop ketone production. This is usually done intravenously in a hospital setting.
- Fluid replacement. Patients with DKA are often severely dehydrated. Rehydration with intravenous fluids restores normal body fluid levels.
- Electrolyte replacement. Electrolytes like sodium, potassium and chloride are often depleted during DKA. Because they are essential for normal cell function, they must be replaced.
Recovery from DKA depends on the severity of the condition and how quickly you receive treatment. On average, it takes 24 hours after starting treatment to recover from ketoacidosis. However, full recovery—including stabilization of blood sugar levels and resolution of the underlying cause—may take several days.
Preventing DKA
Preventing DKA is primarily about managing diabetes and staying aware of warning signs. You can help avoid diabetic ketoacidosis with some of these tips:
- Be prepared. Keep an emergency kit with insulin, glucose monitoring supplies and ketone urine test strips on hand.
- Check your blood sugar regularly and test for ketones. Monitor your blood glucose levels multiple times a day, especially if you’re sick. Early detection of high blood sugar can help prevent DKA. Regularly test for ketones in your urine or blood if your glucose levels are elevated.
- If you have an insulin pump, talk with your provider about risks of DKA. Some studies found a higher incidence of DKA with insulin pump use versus regular insulin injections and blood sugar testing.
- Take insulin as prescribed. Never skip your insulin doses. If you’re having trouble with your insulin regimen, consult your health care provider.
When to Seek Help for DKA
If you or someone else is experiencing any of these DKA symptoms, seek emergency department care immediately or call 911 if:
- You have persistent high blood sugar levels (over 200 mg/dL) despite taking insulin.
- When testing, you notice medium to high amounts of ketones in your urine or blood, particularly if they are combined with high blood sugar.
- You experience nausea, vomiting or rapid breathing.
Without prompt intervention, DKA can progress rapidly, leading to severe dehydration, coma, kidney failure and even death. However, the condition is treatable with timely medical care, and most people recover fully.
Constantly monitor your blood sugar levels, follow your prescribed treatment plan and seek immediate medical attention if you suspect DKA. Staying informed and proactive is the best way to stay safe and healthy while living with diabetes.
Diabetes is a common condition, but there is still a lot of misinformation about the disease. In this video we are busting the myths and sharing the facts so you can live a healthier life.
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- The Connection Between Diabetes and Kidney Disease
- Living with Diabetes: Empower Yourself to Stay Healthy
Medically reviewed by Kashif M. Munir, MD.
