Diabetic ketoacidosis is a serious
complication of diabetes.
Diabetic ketoacidosis develops
when you have too little insulin in your body. Without enough
insulin, sugar (glucose) can't enter your cells for energy.
Your blood sugar level rises, and your body begins to break
down fat for energy. This produces toxic acids known as
ketones. Left untreated, diabetic ketoacidosis may cause you
to lose consciousness. Eventually, untreated diabetic
ketoacidosis can be fatal.
Diabetic ketoacidosis is most
common in people who have type 1 diabetes, but people who have
type 2 diabetes may develop diabetic ketoacidosis, too. In
fact, in a few cases diabetic ketoacidosis is the first sign
that a person has diabetes. If you have diabetes or you're at
risk of diabetes, learn the warning signs of diabetic
ketoacidosis — and know when to seek emergency care.
Diabetic ketoacidosis symptoms
often develop quickly, sometimes within 24 hours. You may
- Excessive thirst
- Frequent urination
- Nausea and vomiting
- Abdominal pain
- Loss of appetite
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
More specific signs of diabetic
ketoacidosis — which can be detected through home blood and
urine testing kits — include:
- High blood sugar level
- High ketone level in your urine
Remember, untreated diabetic
ketoacidosis can be fatal. Seek emergency care if you suspect
that you have diabetic ketoacidosis, even if you haven't been
diagnosed with diabetes
Sugar is a main source of energy
for the cells that make up your muscles and other tissues.
Normally, sugar enters your cells with the help of insulin. If
you don't have enough insulin in your body, your body won't be
able to use sugar for energy. This prompts the release of
hormones that break down fat as an alternate fuel. In turn,
this process produces toxic acids known as ketones. Excess
ketones accumulate in the blood and eventually "spill
over" into the urine.
Diabetic ketoacidosis is usually
- An illness.
An infection or other illness can cause your body to
produce certain hormones, such as adrenaline.
Unfortunately, these hormones work against insulin —
sometimes triggering an episode of diabetic ketoacidosis.
Pneumonia and urinary tract infections are common
- A problem
with insulin therapy. Missed insulin treatments or
inadequate insulin therapy can leave you with too little
insulin in your system, triggering an episode of diabetic
Other possible triggers of
diabetic ketoacidosis may include:
- Physical or emotional trauma
- High fever
- Heart attack
- Alcohol or drug abuse
When to seek medical advice
Signs and symptoms of diabetic
ketoacidosis may mimic those of the flu, so it can be tricky
to know whether you have a viral infection or a more serious
health problem. If you feel ill, stressed, or you've had a
recent illness or injury, check your blood sugar level often.
You might also try an over-the-counter urine ketones testing
Contact your doctor if:
- You're vomiting and unable to
tolerate any food or liquid
- Your blood sugar level is
higher than your target range and doesn't respond to home
- Your urine ketone level is
moderate or high
Seek emergency care if:
- Your blood
sugar level is consistently higher than 300 milligrams per
deciliter (mg/dL) or 16.5 millimoles per liter (mmol/L)
- You have
excess ketones in your urine and can't reach your doctor
- You have
multiple symptoms of diabetic ketoacidosis — excessive
thirst or urination, nausea and vomiting, abdominal pain,
loss of appetite, shortness of breath, fruity-scented
Remember, untreated diabetic
ketoacidosis can be fatal.
Tests and diagnosis
If your doctor suspects diabetic
ketoacidosis, he or she will do a physical exam and various
blood tests. The blood tests will measure:
- Blood sugar
level. If there isn't enough insulin in your body to allow
sugar to enter your cells, your blood sugar level will
rise (hyperglycemia). As your body breaks down fat and
protein for energy, your blood sugar level will continue
level. When your body breaks down fat and protein for
energy, toxic acids known as ketones enter your
acidity. If you have excess ketones in your blood, your
blood will become acidic (acidosis). This can damage
organs throughout your body.
In some cases, additional tests
— such as a urinalysis, a chest X-ray or a recording of the
electrical activity of the heart (electrocardiogram) — may
be needed to help the doctor determine what triggered the
episode of diabetic ketoacidosis or what damage the
ketoacidosis may have caused
Treatments and drugs
If you're diagnosed with diabetic
ketoacidosis, you may be treated in the emergency room or
admitted to the hospital. Treatment is usually a three-prong
replacement. You'll receive fluids — either orally or
through a vein (intravenously) — until you're rehydrated.
The fluids will replace those you've lost through
excessive urination, as well as help dilute the excess
sugar in your blood.
replacement. Electrolytes are minerals in your blood that
carry an electric charge, such as sodium, potassium and
chloride. The absence of insulin can lower the level of
several electrolytes in your blood. You'll receive
electrolytes through your veins to help keep your heart,
muscles and nerve cells functioning normally.
therapy. Insulin reverses the processes that cause
diabetic ketoacidosis. Along with fluids and electrolytes,
you'll receive insulin therapy — usually through a vein.
When your blood sugar level falls below 250 mg/dL (14 mmol/L)
and your blood is no longer acidic, you may be able to
stop intravenous insulin therapy and resume your normal
As your body chemistry returns to
normal, your doctor will consider what may have triggered the
episode of diabetic ketoacidosis. Depending on the
circumstances, you may need additional treatment. For example,
if you have undiagnosed diabetes, your doctor will help you
create a diabetes treatment plan. If your doctor suspects a
bacterial infection, he or she may prescribe antibiotics. If a
heart attack seems possible, your doctor may recommend further
evaluation of your heart.
There's much you can do to prevent
diabetic ketoacidosis and other diabetes complications.
- Make a
commitment to managing your diabetes. Make healthy eating
and physical activity part of your daily routine. Take
oral diabetes medications or insulin as directed.
your blood sugar level. You may need to check and record
your blood sugar level at least several times a day — or
more if you're ill or under stress. Careful monitoring is
the only way to make sure that your blood sugar level
remains within your target range.
- Adjust your
insulin dosage as needed. Talk to your doctor or diabetes
educator about how to adjust your insulin dosage depending
on your blood sugar level, what you eat, how active you
are, whether you're ill and other factors. If your blood
sugar level begins to rise, follow your diabetes treatment
plan to return your blood sugar level to your target
- Check your
ketone level. When you're ill or under stress, test your
urine for excess ketones with an over-the-counter urine
ketones test kit. If your ketone level is moderate or
high, contact your doctor right away or seek emergency
- Be prepared
to act quickly. If you suspect that you have diabetic
ketoacidosis — your blood sugar level is high and you
have excess ketones in your urine — seek emergency care.
Diabetes complications are scary.
But don't let fear keep you from taking good care of yourself.
Follow your diabetes treatment plan carefully, and ask your
diabetes treatment team for help when you need it.