Diabetic Ketoacidosis

Stethoscope and vial with ketone label

Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated right away.

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA.

DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.

Read on to learn more about DKA, how you can prevent DKA, and how to treat it if needed.

DKA Signs and Symptoms

DKA usually develops slowly. Early symptoms include:

  • Being very thirsty.
  • Urinating a lot more than usual.

If untreated, more severe symptoms can appear quickly, such as:

  • Fast, deep breathing.
  • Dry skin and mouth.
  • Flushed face.
  • Fruity-smelling breath.
  • Headache.
  • Muscle stiffness or aches.
  • Being very tired.
  • Nausea and vomiting.
  • Stomach pain.

Sometimes DKA is the first sign of diabetes in people who haven’t yet been diagnosed.

Causes of DKA

Very high blood sugar and low insulin levels lead to DKA. The two most common causes are:

  • Illness. When you get sick, you may not be able to eat or drink as much as usual, which can make blood sugar levels hard to manage.
  • Missing insulin shots, a clogged insulin pump, or the wrong insulin dose.

Other causes of DKA include:

  • Heart attack or stroke.
  • Physical injury, such as from a car accident.
  • Alcohol or drug use.
  • Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).
High ketones? Call your doctor ASAP

High ketones can be an early sign of DKA, which is a medical emergency. Checking your ketones at home is simple. Call 911 if your ketones are high and you can’t reach your doctor.

Test for Ketones

Anytime you’re sick or your blood sugar is 240 mg/dL or above, use an over-the-counter ketone test kit to check your urine or a meter to test your blood for ketones every 4 to 6 hours. You should also test for ketones if you have any of the symptoms of DKA. Call your doctor if your ketones are moderate or high. Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated immediately.

Go to the emergency room or call 911 right away if you can’t get in touch with your doctor and are experiencing any of the following:

  • Your blood sugar stays at 300 mg/dL or above.
  • Your breath smells fruity.
  • You are vomiting and can’t keep food or drinks down.
  • You’re having trouble breathing.
  • You have multiple signs and symptoms of DKA.

Treatment for DKA

If you have DKA, you’ll be treated in the emergency room or admitted to the hospital. Your treatment will likely include:

  • Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood.
  • Replacing electrolytes (minerals in your body that help your nerves, muscles, heart, and brain work the way they should). Too little insulin can lower your electrolyte levels.
  • Receiving insulin. Insulin reverses the conditions that cause DKA.
  • Taking medicines for any underlying illness that caused DKA, such as antibiotics for an infection.

Prevent DKA

DKA is a serious condition, but you can take steps to help prevent it:

  • Check your blood sugar often, especially if you’re sick.
  • Keep your blood sugar levels in your target range as much as possible.
  • Take medicines as prescribed, even if you feel fine.
  • Talk to your doctor about how to adjust your insulin based on what you eat, how active you are, or if you’re sick.

If you’re concerned about DKA or have questions about how to manage your diabetes, be sure to meet with your diabetes care team and ask for a referral to diabetes self-management education and support (DSMES) services for individual guidance. DSMES services are a vital tool to help you manage and live well with diabetes while protecting your health.

Page last reviewed: January 20, 2021