What Is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a potentially life-threatening consequence of diabetes that is caused by low insulin levels.

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.

DKA can develop rapidly, so it’s important to be aware of its symptoms.

• 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

Insulin deficiency is the primary cause of diabetic ketoacidosis, although additional factors can also contribute to its development.

• 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

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

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.

When DKA is precipitated by an illness or infection, the root cause also needs simultaneous treatment.

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.

Sick Day Management

• 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.

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.

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.

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.