Definition

Diabetic ketoacidosis (DKA) occurs when a person’s blood sugar (glucose) is too high because there is not enough insulin. Instead, the body starts to burn fat for energy. Fat is broken down into acids, causing acid levels to build up in the blood. These acids appear in urine and blood as ketones. DKA is a serious condition that can lead to coma or death if it is not promptly treated.

Causes

DKA is most often caused by uncontrolled type 1 diabetes and sometimes type 2 diabetes.

Risk Factors

Factors that may increase your risk of DKA:

• New infection that may not be obvious, such as pneumonia, urinary tract infection, or sepsis
• Not taking insulin as prescribed or not taking enough insulin at all
• New heart disease, such as heart attack
• Recent stroke
• Pregnancy
• Surgery
• Recreational drug use, such as cocaine
• Blood clot to the lungs

Symptoms

DKA may cause:

• High blood glucose levels (greater than 250 mg per dL)
• Dry mouth and skin
• Thirst
• Frequent urination

Call for emergency medical services right away if you have:

• Drowsiness
• Vomiting and nausea
• Severe stomach pain
• Trouble breathing
• Fruity breath odor
• Rapid pulse

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A urine and/or blood test will be done to look for the presence of ketones.

Treatment

DKA is treated with insulin and fluids. This may require treatment in an intensive care unit.

Insulin may be given by IV or injections. The insulin will immediately start reversing the cycle causing DKA. The insulin will let the body use glucose for fuel again. Fat will not be needed for fuel, so new ketones will not be made. The body will then be able to get rid of the extra ketones.

Fluids and electrolytes will also be given through IV to help your blood restore balance.

Prevention

You and your doctor will make a plan to manage your diabetes. These steps will also reduce the chance of DKA. Steps may include:

• Take your insulin as recommended. Always have insulin available. Plan ahead for refills.
• Monitor your blood glucose level as recommended, generally at least 3-4 times per day. Monitor more often when you are sick or you have high blood glucose levels.
• Drink plenty of fluids throughout the day.
• Check for ketones in your urine if you have a high blood glucose reading or are ill.
• Create a sick day plan that may include changes in insulin dose and what to do if you are having trouble eating.
• See your doctor if you have infection, cough, sore throat, or pain when you urinate.

If your blood glucose is high and you have moderate amounts of ketones in your urine:

• Contact your doctor
• Increase your insulin as recommended
• Eat foods that are low in carbohydrates
• Drink plenty of sugar-free and caffeine-free fluids
• Do not exercise until your glucose is in balance again

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

Public Health Agency of Canada http://www.phac-aspc.gc.ca

Ketoacidosis (DKA). American Diabetes Association website. Available at:
http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html
Updated March 18, 2015. Accessed September 8, 2015.

Westerberg D. Diabetic ketoacidosis: Evaluation and treatment. Am Fam Physician. 2013;87(5):337-346.