Can DKA Be Traumatic? Understanding the Emotional Impact of Diabetic Ketoacidosis

Editor’s Note: This article discusses medical trauma and DKA, which some readers may find distressing.

If you’re one of the 46% of people with type 1 diabetes who were in DKA at the time of your diagnosis, you likely woke up to a whole new way of life. The conversation likely shifted quickly from “What happened?” to “What happens now?”

Before you could fully process what happened, you were introduced to a new set of daily routines—insulin, finger pricks, carb counting, site changes—all essential moving forward. Even something as simple as a meal can feel different, and your new routine may feel unfamiliar.

What is diabetic ketoacidosis?

DKA is a serious, life-threatening diabetes complication. Ketones are produced when your body doesn’t have enough insulin. Without enough insulin, glucose (sugar) builds up in your blood and can’t get into your cells. Instead, the cells start burning fat for energy. This process creates ketones, which can end up in your blood and urine. If ketones build up, it can cause a dangerous condition called DKA.

Signs of DKA include:

• Moderate or large ketones
• Nausea
• Vomiting
• Stomach pain
• Fruity breath
• Breath that smells like nail polish remover
• Fast breathing
• Extreme fatigue or tiredness

If not treated quickly, DKA can lead to a serious, life-threatening coma or even death. The good news is that the survival rate DKA is over 95% with immediate medical treatment. 

Still, DKA can be a traumatic experience—also known as medical trauma—and should be given the appropriate attention, tools and resources for healing.

What is medical trauma?

Medical trauma is defined as the emotional and physiological responses that arise from painful, invasive or threatening healthcare experiences.

Medical trauma doesn’t necessarily reflect the quality of care you received. So your DKA experience could still have been traumatic for you, even if you had a great team of doctors and nurses in the hospital.

“Medical trauma can look and feel different from other forms because the threat is inside your own body,” says Janie Glassmith, licensed marriage and family therapist and owner of Spaces Therapy, a relational and trauma-informed therapy practice in Los Angeles.

What are signs of medical trauma for people who have survived DKA? 

Just like other types of trauma, medical trauma impacts your nervous system. Your body perceives the threat as ongoing rather than an isolated incident that has passed. “This leads your body to create a new kind of operating system where the body’s sense of safety and trust in itself is replaced by different behaviors and ways of thinking,” Janie says.

Some of these signs include:

• Hypervigilance. Your body and brain constantly monitor for threats, and scan for them everywhere. With DKA, this can look like obsessively checking glucose levels or making meaning of anything that feels “slightly off” in your body. Janie likens this to a smoke detector that goes off every time you use the oven, whether it’s needed or not.
• Resistance: With DKA at diagnosis, there’s a clear “before” and “after” of what your life was like. It can be overwhelming to learn about and accept your new body. “If your nerves and emotions are fried, it can seem easier to dissociate and try to live as though you’re still in your body before DKA and your diabetes diagnosis,” Janie says. This is your brain trying to avoid the reminders that your body was in danger, like checking your blood sugar, administering insulin or counting carbs.
• Turning feelings towards your body: Grief, or even distrust of the body, is a common response to medical trauma and can lead to feeling angry or punishing toward yourself. This usually shows up in the way you talk to yourself: instead of empathy and hope, the self-talk becomes unkind and you may blame yourself for what happened.
• PTSD: Flashbacks or intrusive thoughts can cause the body to respond as though you are currently experiencing DKA, rather than recalling it as a past event. When the body reacts as if the threat is happening in real time—racing heart, sweaty palms, compulsive body scanning—you often don’t have the mental or emotional resources to push those memories back into the past on your own. 

“It can help to work with a professional who can train your brain to recategorize the DKA experience as a difficult chapter of your past rather than an ever-present threat,” Janie recommends.

What are some of the risks of not processing your medical trauma?

Unprocessed trauma can create lasting changes in your body and brain, and is even known to alter your DNA. “In your everyday life, thoughts or behaviors that feel minimal can pile up into a weight that eventually restricts your freedom, internally and externally,” Janie says. For people with diabetes, the weight of not processing your trauma can put you at risk of:

• Diabetes Burnout: As most people living with type 1 diabetes know, the risk for burnout is real. The constant decision-making and monitoring required on a daily basis can feel overwhelming. “There’s a difference between natural moments of exhaustion or frustration, and more serious trauma responses like compulsive body scanning or constant blood sugar checks compared to a sustainable cadence that fits your life,” Janie says. “And without recognizing that distinction, trauma can tip into a burnout that makes it difficult to keep up with your diabetes care. The risk grows if hypervigilance drives up cortisol levels, which in turn makes blood sugar harder to regulate.”
• Isolation: Chances are that you’re the only one in your friend group living with a condition like type 1 diabetes that requires full-time management. The community of people who know you well may not know how to relate to your experiences—or specifically this new version of you after DKA. “It’s important to remember that your entire identity isn’t ‘DKA survivor’ or ‘person living with diabetes,’” Janie says. “Yes, those are important parts of who you are, but understanding those identities can help you relate to others from a more whole place.”

How can trauma therapy help people who have survived DKA?

Not everyone has the resources, safety and space to process medical trauma.

“You likely need space to process the before and after,” Janie says. “And to grieve any aspects of your old life or old self that call for it.” She recommends trauma therapies over talk therapy when possible. “Trauma-specific therapy explores how to move your body’s responses away from ‘active threat’ and toward ‘past memory.’ If you retell the story—which sometimes happens in general talk therapy—it’s with the purpose of using tools to make your body less reactive to it. The work focuses on resolving triggers and rebuilding trust with the version of your body that exists today.”

Trauma therapy vs. talk therapy for people with type 1 diabetes

While talk therapy can be effective for daily stressors and coping strategies, trauma requires a more specialized approach.

For people living with diabetes, finding a trauma specialist is especially important because you may need more than just a place to talk and vent. Your body plays such a big role in your daily life and DKA experience, so you may need a safe space to rebuild your relationship with your body and your diagnosis.

A trauma specialist may use conversation to explore your experiences and emotional responses. They’ll also use tools like bilateral stimulation or eye movements (like with EMDR) to retrain your body to experience medical trauma as an event of your past rather than an ongoing threat. 

Because DKA is also a physical trauma, somatic (body-based) therapies can help release tension trapped in the body that talking alone can’t reach.

How long does trauma therapy take to work?

There is no fixed timeline for processing trauma. However, compared to talk therapy alone, trauma therapy is more targeted because it focuses on the specific experience that brought you in, such as DKA, with the goal of walking out of treatment with improvement or resolution of PTSD symptoms. This can be 8-12 weeks, or longer depending on your circumstances.

How do I find a trauma therapist?

• Ask your healthcare provider for a referral.
• Search the American Diabetes Association’s online Mental Health Professionals Directory.
• Get recommendations from your diabetes community. That could be online through the Beyond Type 1 community app, or the local chapter of a diabetes organization.
• Check your insurance for in-network providers that specialize in trauma or medical trauma.

Mental health and community go hand-in-hand. Find strength in shared experiences and connect with people living with type 1 diabetes who get what you’re going through. Learn about Beyond Ambassadors, our ambassador program, today.