What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body.

Ketoacidosis shouldn’t be confused with ketosis, which is harmless. Ketosis can occur as a result of an extremely low carbohydrate diet, known as a ketogenic diet, or fasting. DKA only happens when you don’t have enough insulin in your body to process high levels of glucose in the blood.

It’s less common in people with type 2 diabetes because insulin levels don’t usually drop so low; however, it can occur. DKA may be the first sign of type 1 diabetes, as people with this disease can’t make their own insulin.

Symptoms of DKA can appear quickly and may include:

• frequent urination
• extreme thirst
• high blood sugar levels
• high levels of ketones in the urine
• nausea or vomiting
• abdominal pain
• confusion
• fruity-smelling breath
• a flushed face
• fatigue
• rapid breathing
• dry mouth and skin

DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA.

If left untreated, DKA can lead to a coma or death. If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place. If you have type 1 diabetes, you should have a supply of home urine ketone tests. You can buy these in drug stores or online.

If you have type 1 diabetes and have a blood sugar reading of over 250 milligrams per deciliter (mg/dL) twice, you should test your urine for ketones. You should also test if you are sick or planning on exercising and your blood sugar is 250 mg/dL or higher.

Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.

The treatment for DKA usually involves a combination of approaches to normalize blood sugar and insulin levels. If you’re diagnosed with DKA but haven’t yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring.

Infection can increase the risk of DKA. If your DKA is a result of an infection or illness, your doctor will treat that as well, usually with antibiotics.

Fluid replacement

At the hospital, your physician will likely give you fluids. If possible, they can give them orally, but you may have to receive fluids through an IV. Fluid replacement helps treat dehydration, which can cause even higher blood sugar levels.

Insulin therapy

Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar level is within an acceptable range, your doctor will work with you to help you avoid DKA in the future.

Electrolyte replacement

When your insulin levels are too low, your body’s electrolytes can also 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 through an IV.

DKA occurs when blood sugar levels are very high and insulin levels are low. Our bodies need insulin to use the available glucose in the blood. In DKA, glucose can’t get into the cells, so it builds up, resulting in high blood sugar levels.

In response, the body starts breaking down fat into a useable fuel that doesn’t require insulin. That fuel is called ketones. When too many ketones build up, your blood becomes acidic. This is diabetic ketoacidosis.

The most common causes of DKA are:

• missing an insulin injection or not injecting enough insulin
• illness or infection
• a clog in one’s insulin pump (for people who are using one)

Your risk of DKA is higher if you:

• have type 1 diabetes
• are under the age of 19
• have had some form of trauma, either emotional or physical
• are stressed
• have a high fever
• have had a heart attack or stroke
• smoke
• have a drug or alcohol addiction

Although DKA is less common in people who have type 2 diabetes, it does occur. Some people with type 2 diabetes are considered “ketone prone” and are at a higher risk of DKA. Some medications can increase the risk of DKA. Talk to your doctor about your risk factors.

Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. They will likely also test your blood sugar level. Other tests your doctor may order are:

• basic bloodwork, including potassium and sodium, to assess metabolic function
• arterial blood gas, where blood is drawn from an artery to determine its acidity
• blood pressure
• if ill, a chest X-ray or other tests to look for signs of an infection, such as pneumonia

There are many ways to prevent DKA. One of the most important is proper management of your diabetes:

• Take your diabetes medication as directed.
• Follow your meal plan and stay hydrated with water.
• Test your blood sugar consistently. This will help you get in the habit of making sure your numbers are in range. If you notice a problem, you can talk to your doctor about adjusting your treatment plan.

Although you can’t completely avoid illness or infection, you can take steps to help you remember to take your insulin and to help prevent and plan for a DKA emergency:

• Set an alarm if you take it at the same time every day, or download a medication reminder app for your phone to help remind you.
• Pre-fill your syringe or syringes in the morning. That will help you easily see if you missed a dose.
• Talk to your doctor about adjusting your insulin dosage levels based on your activity level, illnesses, or other factors, such as what you’re eating.
• Develop an emergency or “sick day” plan so you will know what to do if you develop DKA symptoms.
• Test your urine for ketone levels during periods of high stress or illness. This can help you catch mild to moderate ketone levels before they threaten your health.
• Seek medical care if your blood sugar levels are higher than normal or ketones are present. Early detection is essential.

DKA is serious, but it can be prevented. Follow your treatment plan and be proactive about your health. Tell your doctor if something isn’t working for you or if you’re having trouble. They can adjust your treatment plan or help you come up with solutions for better managing your diabetes.