Diabetic Ketoacidosis (DKA): Signs, Causes, Prevention and Treatment

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. It is most common in people with type 1 diabetes, but people with type 2 diabetes can develop it too.

It develops when the body has too little insulin to let blood sugar into the cells to be used for energy. The liver breaks down fat for fuel instead, a process that makes acids called ketones. When too many are made too fast, they can build up to dangerous levels.

Signs and symptoms

DKA usually develops slowly. Early signs:

• being very thirsty
• urinating much more than usual

Left untreated, more severe symptoms can appear quickly:

• fast, deep breathing
• dry skin and mouth
• a flushed face
• fruity-smelling breath
• headache
• stiff or aching muscles
• being very tired
• nausea and vomiting
• stomach pain

Sometimes DKA is the first noticeable sign of diabetes in someone not yet diagnosed.

Causes

Very high blood sugar and low insulin lead to DKA. The two most common causes:

• illness, which can keep you from eating or drinking as usual and make blood sugar hard to manage;
• insulin problems: missed insulin shots, a clogged insulin pump or the wrong dose.

Other causes include a heart attack or stroke, a physical injury such as from a car accident, alcohol or drug use, and certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation).

Prevention

• Check your blood sugar often, especially when you are sick.
• Keep it within your target range as much as you can.
• Take medicines as prescribed, even when you feel fine.
• Ask your doctor how to adjust your insulin for what you eat, how active you are, and when you are sick.

If you are at risk of type 1 diabetes, early treatment can also prevent DKA. Even without that treatment, watching for the signs of DKA can head off an emergency.

If you are worried about DKA or have questions about managing your diabetes, talk to your diabetes care team and ask for a referral to diabetes self-management education and support (DSMES), which offers individual guidance.

Testing for ketones

If you have diabetes and you are sick, or your blood sugar is 250 mg/dL or higher, check your blood sugar every 4 to 6 hours and test your urine for ketones. Test kits are affordable and sold over the counter. Test as well if you have any symptom of DKA. Raised ketones are a sign of DKA, a medical emergency that needs treatment at once.

Call 911 or go to the emergency room right away if:

• your blood sugar stays at 300 mg/dL or above;
• your breath smells fruity;
• you are vomiting and cannot keep food or drink down;
• you are having trouble breathing;
• you have several signs and symptoms of DKA.

Treatment

DKA is treated in the emergency room or in hospital. Treatment is likely to include:

• fluids, to replace those lost through frequent urination and to help dilute the excess sugar in the blood;
• electrolytes (minerals in the body), which too little insulin can lower;
• insulin, which reverses the conditions that cause DKA;
• medicine for any illness that brought on DKA, such as antibiotics for an infection.

Sources

• Centers for Disease Control and Prevention, "Diabetic Ketoacidosis." https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html
• A stock photograph of a ketone test tube is not reproduced here.