Medically reviewed by William Wadzinski | MD, Uniformed Services University of the Health Sciences on April 1st, 2024.
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when your body doesn't have enough insulin to process sugar for energy. Instead, your body starts breaking down fat, which produces acids called ketones. If ketones build up in your blood, it can become dangerously acidic, leading to a life-threatening condition.
DKA symptoms can develop quickly and may even be the first sign of diabetes. Early symptoms include:
Frequent urination
Excessive thirst
High blood sugar levels (over 250 mg/dL)
High ketone levels
Headache
Dehydration
If left untreated, more severe symptoms may occur:
Nausea and vomiting
Weakness and fatigue
Dry mouth and skin
Confusion
Fruity-smelling breath
Stomach pain
Difficulty breathing
DKA usually occurs when there isn't enough insulin in the body. Several factors can contribute to this, including:
Missing insulin doses or improper diabetes management
Undiagnosed diabetes
Illness or infection
Stress
Certain medications (e.g., corticosteroids, diuretics)
Alcohol or drug use
Some people are at higher risk of developing DKA, such as:
Those with type 1 diabetes
Older adults
Children under 5 years old
Those with limited access to insulin
People with a family history of diabetes or autoimmune diseases
To diagnose DKA, your doctor will perform a physical exam, review your symptoms and medical history, and conduct various tests, including:
Blood sugar tests
Ketone tests (urine or blood)
Blood pH and bicarbonate levels
Basic metabolic panel
Urinalysis
Additional tests, such as a chest X-ray, CAT scan, MRI, or electrocardiogram (ECG), may be ordered to rule out other complications or assess the impact of DKA on your body.
DKA requires immediate medical attention and hospitalization. Treatment typically includes:
Insulin administered through an IV to reduce ketones
Fluids to restore hydration and balance blood chemistry
Electrolyte replacement to maintain proper heart, muscle, and nerve function
Antibiotics, if an infection is present
Further heart evaluation, if a heart attack is suspected
To prevent DKA, it's crucial to manage your diabetes effectively through proper diet, exercise, medication, and self-care. Some key steps include:
Staying hydrated with water or sugar-free, non-alcoholic beverages
Taking your medications as prescribed
Following your meal plan and exercise program
Regularly testing your blood sugar and ketone levels
Checking for expired insulin and ensuring proper storage
Monitoring your insulin pump for leaks or air bubbles
Adjusting your insulin dose with guidance from your healthcare team
Creating a DKA emergency plan
If you experience any symptoms of DKA, it's essential to seek medical attention immediately. Go to the emergency room or call 911 if:
Your ketones are moderate to high, and you have DKA symptoms
You have multiple DKA symptoms, even if you haven't tested your ketones
Your blood sugar is 300 mg/dL or higher and isn't responding to home treatments
You're vomiting and unable to keep food or water down
You experience difficulty breathing or feel confused and fatigued
Remember, untreated DKA can lead to serious complications, such as brain swelling, loss of consciousness, or even death. Prompt medical intervention is crucial for a successful recovery.
For more information on diabetic ketoacidosis and diabetes management, consult the following resources:
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