Diabetic Ketoacidosis

Written by Carmella Wint and Marijane Leonard | Published on July 25, 2012
Medically Reviewed by Peggy Pletcher, RD, CDE on April 15, 2014

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious condition that is linked to diabetes. If you don’t have enough insulin to help your body process sugars (glucose), your body will start burning fat to fuel itself. As a result, acids called ketone bodies build up in the body.

Left untreated, these ketone bodies poison you. DKA can occur in people who have type 1 or type 2 diabetes, but it’s considered more rare in those with type 2. DKA can also appear if you are at risk for diabetes but have not received a formal diagnosis. It can be the first sign of type 1 diabetes.

DKA is a medical emergency. If you suspect this complication, immediately contact your physician or go to an emergency room.

If you have type 1 diabetes and have a glucometer reading of over 300 milligrams per deciliter, you should test your urine for ketones. Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you have unexplained nausea and vomiting.

What Causes Diabetic Ketoacidosis?

The most common triggers for the breakdown of fat that causes DKA are:

  • missing an insulin injection or not injecting enough insulin
  • illness or infection
  • for people that are using an infusion pump, a clog in the pump

Who Is at Risk for Developing Diabetic Ketoacidosis?

Your risk of developing DKA might be higher if you:

  • have type 1 diabetes
  • are under the age of 19
  • have had some form of trauma, whether emotional or physical
  • stress
  • have a high fever
  • have had a heart attack or stroke
  • smoke
  • abuse drugs or alcohol

Although DKA is rare in people who have type 2 diabetes, it does occur.

What Are the Symptoms of Diabetic Ketoacidosis?

Symptoms of DKA can appear quickly and may include:

  • frequent urination
  • extreme thirst
  • nausea
  • vomiting
  • abdominal pain
  • confusion
  • breath that smells fruity
  • a flushed face
  • fatigue
  • rapid breathing
  • dry mouth and skin

If you have type 1 diabetes, you should maintain a supply of home urine tests. A high ketone test result after one of these tests is a symptom of DKA. This test may show that you have high ketone levels in your urine.

If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place.

It is important to make sure you consult with your doctor if you experience any of these symptoms:

  • inability to keep food or liquid down
  • blood sugar levels of 240 mg/dL or more that do not come down after treatment at home
  • multiple signs of DKA

How Is Diabetic Ketoacidosis Diagnosed?

Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. Tests of blood acidity and sugar levels are also commonly done. Other tests your doctor may order are:

  • potassium blood test—to assess metabolic function
  • arterial blood gas—to determine the acidity of your blood
  • amylase blood test—to test pancreatic function
  • chest X-ray—to look for signs of an infection such as pneumonia

How Is Diabetic Ketoacidosis Treated?

The treatment for DKA usually involves a combination of several approaches to normalize abnormal blood sugar and insulin levels. If you’re diagnosed with DKA but have not yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from reoccurring. If your DKA is a result of an infection or illness, your doctor will treat that as well, likely with antibiotics.

Fluid Replacement

You should replace fluids. At the hospital, your physician will likely give you fluids (orally, if possible, or intravenously) to replace the fluid that is usually lost as a result of DKA. Fluid replacement is also helpful in diluting the amount of sugar in your blood.

Insulin Therapy

Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar levels are within an acceptable range, your physician may let you resume your normal insulin regimen.

Electrolyte Replacement

Lower than normal levels of insulin can cause the levels of electrolytes in your body to become abnormally low. Electrolytes are electrically charged minerals that help your body—including the heart and nerves—function properly. Electrolyte replacement is also commonly done intravenously.

Preventing Diabetic Ketoacidosis

There are many ways to prevent DKA. One of the most important is proper management of diabetes. Take your diabetes medication as directed, eat healthfully, and monitor your blood glucose to help prevent DKA.

Additional preventive measures include:

  • making sure that your blood sugar levels are within their normal range by checking them several times per day
  • never skipping insulin doses
  • talking to your doctor about adjusting your insulin dosage levels based on your activity level, illnesses, or other factors, such as what you’re eating
  • developing an emergency or “sick-day” plan so you will know what to do if you develop DKA symptoms
  • testing your urine for ketone levels during periods of high stress or illness—tåhis can help you catch moderate to high ketone levels before they threaten your health
  • seeking medical care if your blood sugar and ketone levels are higher than normal—early detection is essential
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