Diabetic ketoacidosis (DKA) is a complication of diabetes. It can occur when the body does not have enough insulin to use sugar as energy. Instead, it breaks down fat and produces ketones. This can lead to symptoms such as excessive thirst and urination.

Diabetes is a chronic condition that occurs when blood glucose levels become too high. There are three main types of diabetes:

  • Type 1 diabetes: A person with type 1 diabetes is unable to produce insulin. This type is likely the result of an autoimmune reaction, where the body attacks insulin-producing beta cells in the pancreas.
  • Type 2 diabetes: This type typically occurs due to insulin resistance. This is when the body becomes unable to use insulin effectively. Type 2 diabetes is the most common type of diabetes and occurs due to a combination of lifestyle factors and genes.
  • Gestational diabetes: This type only occurs during pregnancy and is the result of the body being unable to produce enough insulin. Although gestational diabetes usually disappears after the birth of the child, about 50% of people with gestational diabetes later develop type 2 diabetes.

DKA is a potential life threatening complication of diabetes. It occurs when there is an insufficient level of insulin to allow the body to use sugar as energy.

During DKA, the lack of insulin results in the liver using fat for fuel instead, which produces acids called ketones. When the body produces too many ketones too fast, they can build up to dangerous levels.

DKA most commonly affects those with type 1 diabetes, but it can also occur in those with another type of diabetes.

In this article, we will discuss some common signs and symptoms of DKA.

A person checking their ketone levels-2.Share on Pinterest
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DKA typically develops slowly. However, when vomiting occurs, this life threatening condition can develop in a few hours. People may notice early symptoms of DKA, which can include being very thirsty and urinating more than usual.

Other early symptoms of DKA may include:

As ketones accumulate, other symptoms may develop, such as:

  • fatigue
  • dry or flushed skin
  • difficulty breathing
  • difficulty paying attention
  • confusion
  • fruity odor on the breath
  • nausea
  • abdominal pain
  • vomiting

DKA occurs due to a lack of insulin in the body. In some cases, experiencing DKA is the first sign of diabetes in people yet to receive a diagnosis.

If a person already has diabetes, DKA may arise due to:

However, it is important to highlight that sometimes there is not an obvious trigger for DKA.

There are several ways a person can check their ketone and blood sugar levels.

For blood sugar, it is advisable for a person to regularly monitor their levels. An individual can use a continuous glucose monitoring (CGM) device or a blood sugar meter.

A CGM measures a person’s interstitial glucose level. This is the glucose in the fluid between cells. A person inserts the CGM in the stomach or arm, and the CGM’s sensor wirelessly sends information to an insulin pump, smartphone, or separate device.

A blood sugar meter works by measuring the approximate concentration of glucose in the blood. It requires a person to prick their finger with a lancet and place a droplet of blood on a test strip connected to the meter.

For measuring ketones, a person should check their levels any time they are sick or if their blood sugar readings are 240 milligrams per deciliter (mg/dL) or above. In these cases, the American Diabetes Association (ADA) suggests monitoring for ketones every 4–6 hours.

Some blood sugar meters have separate test strips for ketones. This means a person can check ketone levels in a similar way. The results for blood ketones are in real time, and ranges are as follows:

  • 0.6 to 1.5 mmol/L suggests a person is at a slightly increased risk of DKA and should test again in 2 hours
  • 1.6 to 2.9 mmol/L indicates an increased risk of DKA, and a person should contact a healthcare professional as soon as possible
  • > 3 mmol/L or above suggests a very high risk of DKA, and a person should receive medical help immediately

A person can also measure the level of ketones in their urine, which will show results from a few hours ago. Results higher than 80 mg/dL in urine suggest an increased risk of DKA.

Alternatively, a person can use a urine dipstick test. These tests indicate the presence of ketones through a color change. The packaging of the test kit typically provides a chart for a person to compare their results against.

The Centers for Disease Control and Prevention (CDC) suggest that a person take steps to prevent DKA, including:

  • monitoring their blood sugar regularly, particularly if they are unwell
  • maintaining blood sugar levels in the target range, as established by their healthcare professional, as much as possible
  • taking medication as prescribed, even if they feel OK
  • speaking with their healthcare team about how to adjust insulin for when they are unwell, their level of activity, and what they eat

DKA is a medical emergency. As such, if a person is experiencing DKA symptoms, they should seek immediate medical care. A person may also consider reaching out to their healthcare team if they have concerns about DKA or questions about how to manage their diabetes.

For individual guidance around diabetes management, a person can also ask for a referral to diabetes self-management education and support (DSMES). This service provides tailored guidance and practical skills to manage diabetes in a way that suits a person’s lifestyle.

Diabetic ketoacidosis is a potential life threatening complication of diabetes. It happens when the body breaks down fats for energy, which produces ketones. Early symptoms of DKA can include increased thirst and urination. Other symptoms include fatigue, nausea, and a fruity odor on the breath.

If a person is unwell or experiencing blood glucose levels of 240 mg/dL or above, it is advisable for them to check their ketone levels. If they have moderate to large amounts of ketones, a person should seek immediate medical attention.