What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA): Overview

Diabetic ketoacidosis (DKA) happens when the body does not have enough insulin and can't use the sugar it needs for energy. When the body can't use sugar for energy, it starts to use fat for energy. This process makes fatty acids called ketones. The ketones build up in the blood and change the chemical balance in your body.

This problem can be very dangerous and needs to be treated. Without treatment, it can lead to a coma or death.

DKA occurs most often in people with type 1 diabetes. But people with type 2 diabetes also can get it. DKA can be caused by many things. It can happen if you don't take enough insulin. It can also happen if you have an infection or illness like the flu. Sometimes it happens if you are very dehydrated.

DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.).

Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a life-threatening blood chemical (electrolyte) imbalance that develops in a person with diabetes when the cells do not get the sugar (glucose) they need for energy. As a result, the body breaks down fat instead of glucose and produces and releases substances called ketones into the bloodstream.

People with type 1 diabetes and some people with type 2 diabetes are at risk for DKA if they do not take enough insulin, have a severe infection or other illness, or become severely dehydrated.

Symptoms of diabetic ketoacidosis include:

  • High blood sugar and high ketone level.
  • Increased thirst and urination.
  • Flushed, hot, dry skin.
  • A strong, fruity breath odor.
  • Restlessness, drowsiness, or difficulty waking up. Young children may lack interest in their normal activities.
  • Rapid, deep breathing.
  • Loss of appetite, abdominal pain, and vomiting.
  • Confusion.

Severe diabetic ketoacidosis can cause difficulty breathing, brain swelling (cerebral edema), coma, or death.

Treatment involves giving insulin and fluids through a vein (I.V.) while being closely monitored in the hospital.

What are the symptoms of diabetic ketoacidosis (DKA)?

Early symptoms of DKA include increased thirst and urination, high blood sugar, and high ketone levels. Other symptoms are breath that smells fruity and trouble staying awake. Belly pain, vomiting, and feeling confused are also symptoms. Anyone who has these symptoms needs emergency treatment.

How is diabetic ketoacidosis (DKA) treated?

If the symptoms of DKA are severe, you may need to be treated in an intensive care unit. Treatment includes fluids and insulin given through a vein (intravenous, or I.V.). Fluids treat dehydration and balance electrolytes. Insulin lowers blood sugar and keeps the body from producing ketones.

How is diabetic ketoacidosis (DKA) diagnosed?

Your doctor will do a physical exam and ask questions about your health. You will also have tests, including blood and urine tests.

How can you care for yourself to reduce your chance of diabetic ketoacidosis (DKA)?

To reduce your chance of ketoacidosis:

  • Take your insulin and other diabetes medicines on time and in the right dose.
    • If an infection caused your DKA and your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Test your blood sugar before meals and at bedtime or as often as your doctor advises. This is the best way to know when your blood sugar is high so you can treat it early. Watching for symptoms is not as helpful. This is because you may not have symptoms until your blood sugar is very high. Or you may not notice them.
  • Teach others at work and at home how to check your blood sugar. Make sure that someone else knows how to do it in case you can't.
  • Wear or carry medical identification at all times. This is very important in case you are too sick or injured to speak for yourself.
  • Talk to your doctor about when you can start to exercise again.
  • Follow your meal plan to know how much carbohydrate you need for meals and snacks. This will help keep your blood sugar steady.
  • When you are sick:
    • Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. Talk with your doctor about a plan when you are well. Then you will know what to do when you are sick.
    • Drink extra fluids to prevent dehydration. These include water, broth, and sugar-free drinks. If you don't drink enough, the insulin from your shot may not get into your blood. So your blood sugar may go up.
    • Try to eat as you normally do, with a focus on healthy food choices.
    • Check your blood sugar at least every 3 to 4 hours. Check it more often if it's rising fast. If your doctor has told you to take an extra insulin dose for high blood sugar levels (for example, above 240 mg/dL) be sure to take the right amount. If you're not sure how much to take, call your doctor.
    • Check your temperature and pulse often. If your temperature goes up, call your doctor. You may be getting worse.
    • If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 240 mg/dL). Call your doctor if your ketone level is moderate or high.

If you know your blood sugar is high, treat it before it gets worse.

  • If you missed your usual dose of insulin or other diabetes medicine, take the missed dose or take the amount your doctor told you to take if this happens.
  • If you and your doctor decide on a dose of extra-fast-acting insulin, give yourself the right dose. If you take insulin and your doctor has not told you how much fast-acting insulin to take based on your blood sugar level, call your doctor.
  • Drink extra water or sugar-free drinks to prevent dehydration.
  • Wait 30 minutes after you take extra insulin or missed medicines. Then check your blood sugar again.
  • If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor. If you start to feel sleepy or confused, call 911.

What causes diabetic ketoacidosis (DKA)?

DKA is caused by your body not having enough insulin. It can happen if you don't take enough insulin. It can also happen if your body is under stress, such as when you are ill or have an infection. Sometimes it happens if your body loses too much fluid (dehydration).

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a serious problem that can occur with diabetes. It happens when the body doesn't have enough insulin and can't use the sugar needed for energy. The body uses fat for energy instead. This makes ketones, which build up in the blood. Without treatment, this can lead to coma or death.

Diabetic ketoacidosis (DKA): When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You are confused or cannot think clearly.
  • Your blood sugar is very high or very low.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • Your blood sugar stays outside the level your doctor set for you.
  • You have any problems.

©2011-2024 Healthwise, Incorporated

The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.