Diabetic Ketoacidosis

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening condition that happens when diabetes is not controlled. Your blood sugar level becomes dangerously high because your body does not have enough insulin. Insulin is a hormone that helps your body take sugar out of your blood and use it for energy. The lack of insulin forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels.

What increases my risk of diabetic ketoacidosis?

Diabetes that is not controlled is the main risk factor. The following may also increase your risk:

  • You are not taking your insulin or are not getting the right amount.

  • You had a stroke, heart attack, injury, infection, or surgery. Any condition that stresses your body may lead to DKA.

  • You are having your monthly period. This may change how your body reacts to glucose.

  • You are taking certain medicines. Ask your healthcare provider if any of the medicines you take can lead to DKA.

  • You take street drugs. Cocaine is the most common street drug that can increase your risk for DKA.

What are the signs and symptoms of diabetic ketoacidosis?

  • More thirst and more frequent urination than usual

  • Abdominal pain, nausea, and vomiting

  • Decreased appetite and weight loss

  • Blurry vision

  • Dry mouth, eyes, and skin, or your face is red and warm

  • Fast, deep breathing, and a faster heartbeat than normal for you

  • Weak, tired, and confused

  • Fruity, sweet breath

  • Mood changes and irritability

How is diabetic ketoacidosis diagnosed?

Your healthcare provider will ask about your symptoms and when they started. He will ask how you manage your diabetes. He will look for signs of dehydration and check your height and weight. Healthcare providers may order other tests to find out what triggered your DKA. Your blood and urine may be tested to check your blood sugar, ketone, and acid levels. The tests will also show if you are dehydrated.

How is diabetic ketoacidosis treated?

DKA can be life-threatening. You must get immediate treatment. The goal of treatment is to replace lost body fluids, and to bring your blood sugar level back to normal. Treatment also works to decrease the amount of ketones and acid in your body.

  • IV fluids: Fluids are given to treat dehydration. Electrolytes (body salts) may be added to the fluids to replace what has been lost from your body.

  • Insulin: Insulin is given to decrease the amount of sugar in your blood. You may need to take insulin until your blood sugar level becomes normal. Insulin also decreases the acid level in your body.

  • Glucose: Glucose may be given when your blood sugar level begins to decrease. This is to prevent your blood sugar level from dropping too quickly while you are getting insulin.

What can I do to prevent diabetic ketoacidosis?

The best way to prevent DKA is to control your diabetes. Ask your healthcare provider for more information on how to manage your diabetes. The following may help decrease your risk for DKA:

  • Check your blood sugar levels: Follow your healthcare provider's instructions about when to test your blood sugar level. You may need to check at least 3 times each day. If your blood sugar level is too high, give yourself insulin as directed by your healthcare provider. Your healthcare provider can show you how to use a blood glucose monitor to check your levels.



  • Check your ketones: Follow your healthcare provider's instructions about when you should check your blood or urine for ketones. Your healthcare provider may give you a machine to check your blood ketones. Urine ketones can be checked with sticks you dip in your urine. Do not exercise if you have ketones in your urine or blood.

  • Know how to manage your sick days: When you are sick, you may not eat as much as you normally would. You will need to change the amount of insulin you give yourself. You may need to check your blood sugar level more often. You also may need to check for ketones. Make a plan with your healthcare provider about how to manage your diabetes when you are sick.

  • Know how to treat DKA: If you have signs of DKA, drink more liquids that do not contain sugar, such as water and diet soda. Take your insulin as directed by your healthcare provider.

  • Call your diabetes team when needed: Ask your healthcare provider about a diabetes team that you can call for help. Call the team if your blood sugar level is high, or you have ketones in your blood or urine. A diabetes team is available for any questions or concerns you have about your diabetes.

What are the risks of diabetic ketoacidosis?

  • DKA increases your risk for severe dehydration. The loss of body salts may cause life-threatening abnormal heartbeats. Blood flow to your organs may be decreased and cause organ failure. Decreased blood flow to your brain may lead to swelling, seizures, coma, and death.

  • Treatment may cause your blood sugar level to become too low. Very low blood sugar levels may cause seizures, or you may become unconscious. IV fluid replacement may cause trouble breathing from fluid buildup. Fluids may also cause cerebral edema (water around the brain), which can be life-threatening.

When should I contact my healthcare provider?

  • Your blood sugar level is lower or higher than your healthcare provider says it should be.

  • You have ketones in your blood or urine.

  • You have a fever or chills.

  • You are more thirsty than usual.

  • You are urinating more often than usual.

  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You have fruity, sweet breath.

  • You have severe, new stomach pain and are vomiting.

  • You are more drowsy than usual.

  • You begin to breathe fast, or are short of breath.

  • You become weak and confused.

  • You have a seizure.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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