What Is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a potentially life-threatening consequence of diabetes that is caused by low insulin levels. If you don’t have enough of the hormone insulin in your bloodstream, your body will start to make excessive amounts of ketones . These acids, which provide an alternative source of energy to glucose, are healthy in small concentrations; DKA occurs when ketone production spirals out of control, poisoning the blood and causing severe dehydration and electrolyte imbalances.e60dc2a1-f33c-4a05-9b50-8e3e8e59762979c6e46e-b55d-46d0-8d5f-2232ae80c20a DKA is most common in people with undiagnosed type 1 diabetes, but it’s also possible in those with type 2 diabetes, and in either case it is a health emergency that requires immediate medical attention.
Signs and Symptoms of Diabetic Ketoacidosis Symptoms DKA can develop rapidly, so it’s important to be aware of its symptoms. It usually occurs when blood sugar levels are very elevated. As a result, its first symptoms can be similar to those experienced during periods of high blood sugar (hyperglycemia) , including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629655eda02-be55-4a8c-bb43-cae5f0352405 Excessive urination Unusual thirst or dry mouth Fatigue or exhaustion Hunger Blurry vision Unexplained weight loss These symptoms can develop slowly, over a period of days or weeks. They are among the typical signs of undiagnosed diabetes — or of diabetes that requires more aggressive treatment. DKA occurs more suddenly than chronic hyperglycemia, bringing a new set of potentially intense symptoms, including: Nausea, vomiting, or diarrhea Stomach pain Fast, deep breathing Confusion Fruity smelling breath Flushed skin, especially on the face These symptoms are a sign that you need immediate medical intervention. If untreated, DKA can cause a loss of consciousness and even death.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291566e07c-db22-425a-a034-fd81fde28d0e
Causes and Risk Factors of Diabetic Ketoacidosis Causes Insulin deficiency is the primary cause of diabetic ketoacidosis, although additional factors can also contribute to its development. Insulin is the hormone that is primarily responsible for regulating your blood sugar. It is essential to human life. People with type 1 diabetes experience a catastrophic loss of their ability to make insulin, and they require injections of manufactured insulin to live. People with type 2 diabetes experience impaired insulin production, in addition to insulin resistance , which makes the insulin they make naturally less effective.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294f19f869-ca37-47b8-8f1a-8cf1bc170786 Many cases of DKA occur in children and adults with previously undiagnosed type 1 diabetes. DKA can also occur in people previously prescribed insulin for type 1 diabetes if they stop taking the drug or encounter issues with their insulin use, such as a malfunctioning insulin pump.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc0ffbd5-d4dc-413c-b70d-f61435d362b2 The development of DKA can also be caused or accelerated by other conditions that put the body under acute stress, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b782cd88-ccea-4f3f-b725-2c4db45aff5b Illness, especially when accompanied by dehydrating symptoms such as vomiting or diarrhea Infections, including pneumonia and urinary tract infections Medicines, such as steroids , that cause high blood sugar levels Surgery or traumatic injury Heart attack SGLT-2 inhibitors, a type 2 diabetes medication, when used by people with type 1 diabetes Rarely, DKA can occur in people who do not have high blood sugar levels. This condition is known as euglycemic DKA, and it can be caused by extreme diets, eating disorders, or substance abuse, in addition to other sources of acute physical stress.e60dc2a1-f33c-4a05-9b50-8e3e8e59762966c9655a-a0df-47b3-872c-ba738a04fe95
How Is Diabetic Ketoacidosis Diagnosed? Diagnosis DKA is usually diagnosed in a hospital, based on a combination of clinical findings and laboratory tests. Key features generally include: High blood sugar (greater than 250 mg/dL) Acidic blood (arterial pH less than 7.3 or serum bicarbonate less than 18 mEq/L) High ketone levels in blood or urine Large anion gap (>10 mEq/L), indicating a critical buildup of excess acid in the blood A doctor may choose to perform additional tests to confirm a diagnosis of DKA and rule out other conditions that can cause some of the same issues, such as hyperosmolar hyperglycemic state, pancreatitis, and sepsis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a21c6df8-2abf-4663-9145-6017eacbe6f3
Treatment and Medication Options for Diabetic Ketoacidosis Treatment DKA usually has to be treated in a hospital. Fluid replacement, electrolyte replacement, and insulin therapy are the primary treatments. The overall course of treatment may require a few days. While in the hospital, you will receive both fluids and insulin intravenously. IV fluids will help correct dehydration, which can be severe. Insulin helps stop the production of ketones and reestablishes healthy blood sugar levels. Doctors may also order electrolyte replacement to help balance the levels of critical minerals such as potassium, magnesium, and phosphate.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295a9400fd-5278-442d-8141-ee8555d8c266 When DKA is precipitated by an illness or infection, the root cause also needs simultaneous treatment. In some cases, a clinician may feel comfortable instructing a patient on how to treat early-stage DKA at home. This should involve detailed instructions on insulin use and fluid intake, and it may require diligent self-testing of blood sugar and ketone levels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fb66cac0-8907-4238-aa4b-edbb5efd8328
Prevention of Diabetic Ketoacidosis Prevention The best way to prevent diabetic ketoacidosis is to take your diabetes medication as directed by your healthcare team. It is also important to frequently attend checkups to assess the ongoing efficacy of your treatment. Many people with diabetes live their whole lives without ever experiencing DKA. If you are experiencing the symptoms of hyperglycemia, including blurry vision, increased thirst and urination, or unexplained weight loss, contact a doctor before your condition worsens. If you cannot keep your blood sugar in your target range, talk to your doctor. If you’re at risk of DKA, you should also own a ketone monitor. These devices sample either blood or urine to measure how many ketones are in your body. Small levels of ketones may not be a cause for concern, especially if you follow a low-carb or ketogenic diet. Moderate ketone levels indicate a risk of DKA, and high ketone levels indicate a full medical emergency.e60dc2a1-f33c-4a05-9b50-8e3e8e597629300c6f93-9e6d-4fbe-b801-2fc5f3dafc75 Sick Day Management The odds of experiencing DKA increase considerably when your body is under significant physical stress, such as during an illness or infection. If you have diabetes, you and your doctor should prepare a plan to handle sick days, especially during dehydrating illnesses such as the stomach flu. This plan will make decision-making easier when you’re sick, and it should include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b59608b2-1302-41d7-94a8-b0b5a56ba255 Hydration goals What foods to eat How often to monitor your blood sugar When and how often to monitor your ketone levels using a blood or urine ketone meter When to call a doctor or visit the emergency room Don’t hesitate to seek emergency care if you’re unable to lower your blood sugar or ketone levels. Type 1 Diabetes Screening If you or a loved one has a family history of type 1 diabetes, screening for type 1 diabetes autoantibodies can significantly reduce the risk of DKA at diagnosis. With a simple blood test, it is possible to identify type 1 diabetes long before it causes high blood sugar levels. Type 1 diabetes screening programs are very effective at preventing DKA. An effort in Germany that screened over 90,000 children found hundreds of children with presymptomatic diabetes. Those families were able to plan ahead and monitor their children’s blood sugar, and as a result only a tiny fraction of the children developed DKA.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991db57ec-455f-445f-92a1-0e9529a7af86
Diabetic Ketoacidosis Prognosis Prognosis With prompt treatment, recovery from DKA typically occurs within 24 hours, although it may take longer to fully reestablish a healthy hydration level and electrolyte balance.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab1788c4-43e0-42aa-ac66-c71e3fa0bf08 The hospital team may want to keep patients under observation for an additional day or two just to be safe. When DKA occurs in people with previously undiagnosed diabetes, the hospital stay may last more than a few days. Even after DKA has been resolved, there is still an immense amount for patients and their families to learn about the treatment of type 1 diabetes.
Complications of Diabetic Ketoacidosis Complications DKA does not always cause additional complications, especially if it is treated promptly. In the most severe cases, however, the condition can lead to deadly consequences, such as cerebral edema (brain swelling).e60dc2a1-f33c-4a05-9b50-8e3e8e59762920f4b836-f736-4f3c-aef8-47331364e3e4 There is also evidence that DKA creates some health issues that linger long after it has been resolved. Children who are diagnosed with type 1 diabetes while being treated for DKA may experience some cognitive impairment, including memory and IQ declines.e60dc2a1-f33c-4a05-9b50-8e3e8e59762904ae1ae6-82bf-4199-80b5-0719391e8c77 They may also have a more difficult time managing their blood sugar in the years after diagnosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629067ef141-c499-469d-8b65-97add20c71c1
Disparities and Inequities in Diabetic Ketoacidosis Disparities In the United States, there are significant racial and socioeconomic disparities in the prevalence of DKA. People from low-income neighborhoods and those with public insurance have a higher risk of DKA, both at the time of diabetes diagnosis and during ongoing management. Black patients and other minorities also appear to have higher DKA rates. Experts believe that these disparities are largely explained by underlying socioeconomic factors rather than genetic health characteristics.e60dc2a1-f33c-4a05-9b50-8e3e8e59762995d93b81-9de7-4722-9f8e-a6e718565b42e60dc2a1-f33c-4a05-9b50-8e3e8e597629a9d967ac-f839-4e9b-afef-f308549bd92d If you belong to a racial or socioeconomic group that is at higher risk of DKA, prioritize regular diabetes checkups, seek out community health resources or support programs, and don’t hesitate to ask your healthcare provider about affordable ways to access diabetes education and supplies.
Related Conditions Related Conditions Hyperglycemic hyperosmolar state, or HHS, is a different acute life-threatening complication of diabetes that is also characterized by severe high blood sugar and dehydration. HHS does not involve ketones or acidic blood; instead, the condition occurs when hyperglycemia and dehydration cause the blood to become too concentrated. Though it may cause similar symptoms to DKA, this condition usually develops more slowly and is more likely to affect people with type 2 diabetes. Like DKA, it is an emergency that needs immediate treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cce1fd85-8d2e-4de1-8034-83af1cf4ed24 Diabetic ketoacidosis may also be related to or caused by a variety of other health crises, including a heart attack, pulmonary embolism (blood clots in the lung), stroke, or pancreatitis.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298d3c560a-bf22-4a92-9a3a-25f6c10770f8 The Takeaway Diabetic ketoacidosis is a potentially life-threatening consequence of diabetes caused by a lack of insulin. It often occurs in people with previously undiagnosed type 1 diabetes. DKA can also affect people with type 1 or type 2 diabetes who are already using glucose-lowering medications, often when accelerated by dehydration, illness, infection, or other health crises. DKA is an emergency. It typically requires hospitalization and expert treatment with intravenous fluids, insulin, and electrolyte replacement. If you have diabetes, you can help prevent DKA by staying consistent with your blood sugar management and by monitoring ketones during periods of illness and episodes of stubborn hyperglycemia.
Resources We Trust Cleveland Clinic: Ketones in UrinePediatric Endocrine Society: Insulin Pump Failure: A Guide for FamiliesUCLA Health: Ketosis, Ketoacidosis Sound Similar, But Not the Same ThingCenters for Disease Control and Prevention: 10 Surprising Things That Can Spike Your Blood SugarInternational Diabetes Federation: How to Manage Diabetes During an Illness?