Diabetic Ketoacidosis: All You Need to Know

Braden G. Barnett, MD

2021 Apr 01

7 min read

Diabetic ketoacidosis (DKA) is a dangerous and possibly fatal complication of diabetes. If you have type 1 diabetes and take insulin, you are at greater risk of developing this condition when sugar levels go high. However, it might also occur for people with other diabetes forms and might even be one of the first symptoms for those who haven’t been diagnosed yet. 

On average, there are over 200,000 cases of ketoacidosis annually in the United States. It is not to be taken lightly – it should be rightly treated as a medical emergency. You need to be under hospital treatment if you have symptoms of DKA.

What Happens When You Have Diabetic ketoacidosis and Why?

When you have this complication of diabetes, you will have high blood sugar and ketones in the urine and blood. This can happen quite suddenly over a period of 24 hours or less. 

If you have type 1 diabetes and have not taken insulin in a sufficient quantity or missed one or more doses, you are at risk of DKA. When you don’t have enough insulin, the glucose available from food cannot be used for energy. This causes the liver to break down fat into ketones in an effort to use the energy from fat. 

As ketone production goes up, the ketones are excreted in the urine, and the blood turns acidic. This happens rapidly and causes ketoacidosis. Under normal circumstances, when your diabetes is under control, or you don’t have diabetes, the liver breaks down fat very slowly, and the ketones produced are actually used by the heart and muscles. 

High blood sugar, too fast breaking down of fat, high production of ketones all contribute to DKA. 

What Causes Ketoacidosis in Diabetes?

You are diagnosed with diabetes when your blood sugar levels are higher than normal. There are many causative factors of this serious and life-threatening condition. 

Diabetic ketoacidosis can occur due to varied reasons such as: 

  • Not enough insulin in the body
  • Certain medications that trigger DKA (steroids, antipsychotics)
  • You don’t know that you have type 1 diabetes – DKA can be the first sign of insulin-dependent diabetes
  • You experience some physical stress like infection or illness
  • Stroke, heart attack, or pancreatitis can also cause DKA
  • Drinking a lot of alcohol 
  • Indulging in high doses of narcotic drugs like cocaine

If you have undiagnosed diabetes, you must look out for signs and symptoms that could potentially signal this condition. In case you’ve already been diagnosed with type 1 or type 2 diabetes, you should be aware of the warning signs of DKA, so you can take action quickly. 

At any time, if you are ill or have a serious infection, do inform your doctor about your diabetes. You should also be wary about taking medicine and supplements on your own, even supposedly natural and herbal products, as they can interact with any diabetic medications and cause problems. 

What Are the Warning Signs of Diabetic ketoacidosis?

Even though diabetic ketoacidosis can develop suddenly, if you experience some of the symptoms together and you know you have diabetes, do contact your medical service provider or rush to the hospital. Some of the signs are:

  • Sudden abdominal pain 
  • Extremely frequent urination
  • Severe thirst
  • Smelly urine that signifies the presence of ketones
  • Fruity smelling breath
  • Red or flushed face
  • Hyperglycemia
  • Fatigue
  • Rapid breathing or panting for breath
  • Dry skin
  • Muscle pain
  • Nausea and vomiting
  • Confusion 
  • Falling blood pressure

If you don’t know whether you have diabetes, you should also take greater care and, at the first signs, check with your medical advisor or do a blood sugar test. 

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What Organs Are Affected by Ketoacidosis?

Your body and your brain can be affected by DKA. As you continue to urine often, you can get dehydrated, and this can affect your kidneys and cause organ damage. DKA also affects the brain, causing confusion and irritability. You may act as if you are drunk and lose your sense of balance and control over your emotions. Your mental state may also be affected. 

Internal swelling can happen in your brain due to excess fluid build-up, resulting in cerebral edema or fluid in the brain. Fluid build-up can also affect your lungs, causing heavy breathing and shortness of breath. 

As ketones increase, you can suffer from a heart attack or stroke, or you can also fall into a coma. 

Before any of these complications happen, take steps to normalize your blood glucose levels. If you are in a bad state, rush to the emergency room or call 911. 

Prevention of Diabetic ketoacidosis

It is absolutely crucial that you manage your diabetes, no matter the type. As far as possible, avoid getting your sugar levels too high or too low. As a matter of course, you should:

  1. Monitor your blood sugar levels regularly. If you’re doing fine on your medications and insulin but experience any kind of stress or trauma, check your sugar. If you overeat, miss a meal, drink alcohol, or do anything that will affect your glucose levels, just check. You can get really small and portable monitors that you can keep with you. You can even get ones that use smartphones for checking and tracking. 
  2. While exercise is very good to manage diabetes, make sure that you suddenly don’t over-exercise or indulge in strenuous physical activity. 
  3. Eat regularly and have meals that are generally with a low glycemic load. 
  4. Check ketone levels via a urine test, available at most pharmacies. Any time you feel that you are urinating very often or have ketones in the urine, just check. 
  5. Adjust insulin intake if necessary. Or talk to your doctor if you note any symptoms of high blood sugar.

If you feel that your sugar levels are high, you don’t have access to a sugar monitor or insulin and experience symptoms of DKA, just go to the emergency room. 

How Is Diabetic ketoacidosis Diagnosed?

Apart from testing your blood sugar levels, you will probably have to undergo a number of tests for a definitive diagnosis: 

  • Blood sugar test to check the levels of blood sugar
  • A urine test may show ketones in the urine
  • Arterial blood test for gas in the blood may show that the blood is acidic
  • Electrolyte level check
  • Blood pressure is a basic test
  • A chest x-ray for breathing-related problems and to rule out pneumonia
  • Electrocardiogram to check the effect of ketoacidosis on the heart
  • Kidney function test

These tests may be repeated as required and as your condition stabilizes and improves. 

What Are the Treatment Options of DKA?

Even if you’re treated in a hospital, you should be aware of the treatment protocols. The aim of the treatment is to get you out of diabetic ketoacidosis as quickly as possible. So you will be given fluids, either orally (if you can take them) or via I.V. so that your body is no longer dehydrated. Hydration is an important method to reduce hyperglycemia.

You will be given insulin so that your blood sugar levels normalize. These should be below 240mg/dL.

Electrolyte imbalance often occurs with DKA. As sodium and potassium levels are not normal, they can affect the functioning of your body. You will be given electrolytes, again via I.V. 

Key takeaways:

  • Diabetes invariably carries some risks – diabetic ketoacidosis is a complication when you are severely hyperglycemic. It can occur if you have undiagnosed or poorly controlled diabetes.
  • Familiarize yourself with the symptoms of DKA – when you know what the signs of this complication are, you can take steps to save your health and prevent organ damage or worse.
  • Always aim to keep blood sugar levels under control – balance your insulin or medications, your diet, and activity levels and monitor your blood sugar levels regularly, several times a day, if necessary, so that you can manage your diabetes better.
Written by

Braden G. Barnett, MD

Dr. Braden G. Barnett is an endocrinologist in Los Angeles, California and is affiliated with multiple hospitals in the area, including Keck Medical Center of USC and USC Norris Comprehensive Cancer Center. He received his medical degree from University of Southern California and has been in practice around 8 years. A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. He is also a recipient of several awards and honors.

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