What is Diabetic Ketoacidosis (DKA)?


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Diabetic ketoacidosis is a complication from diabetes that can be serious and life-threatening.

Diabetic ketoacidosis (DKA) is often a common factor when first diagnosed with type 1 diabetes, but it can also occur during management of the disease.

When the body is not receiving enough insulin to break down glucose, it forces the body to start breaking down fat as fuel.

Ketones are then released into the body.

In small amounts—like the amount that develops during a ketogenic diet—ketones are not dangerous. However, in people with diabetes who do not have enough insulin in their system, ketone levels can rise to life-threatening levels and need to be treated immediately.

What are the Dangers of Diabetic Ketoacidosis?

DKA can lead to coma—or even death—if the level of ketones in the body are high enough.

DKA can be caused by:

  • Lack of insulin
  • Consistently high blood-sugar levels (hyperglycemia)
  • Lack of food in the system due to illness/nausea
  • Overnight low blood sugars (hypoglycemia)
  • Infection
  • Dehydration

What Are the Symptoms and Warning Signs of Diabetic Ketoacidosis?

Early symptoms of DKA include:

  • High levels of ketones in the urine
  • Very high blood-sugar levels
  • Frequent urination
  • Dehydration
  • Extreme thirst

More extreme warning signs of DKA include:

  • Constant fatigue
  • Flushed skin
  • Nausea or stomach pain
  • Vomiting
  • Shortness of breath
  • Fruity smell on the breath
  • Disorientation

How to Test for Ketones

Ketone strips (urinalysis) can be purchased at any pharmacy.

Follow the directions given in the instructions insert, and match the result on the stick with the accompanying color chart.

Some blood-glucose meters can also check for ketones, so check with your healthcare provider about which may be best for you.

When to Test for Ketones

  • If you are experiencing any of the symptoms listed above
  • If you have a flu or any other kind of virus (recommended to test every four to six  hours)
  • If your blood-sugar levels are consistently higher than 13.3 mmol/L240 mg/dL 

If tests shows high levels of ketones—or if you experience any extreme symptoms—contact a doctor immediately.

How to Prevent Diabetic Ketoacidosis

DKA is prominent when you are ill, due to factors such as stress hormones and dehydration.

To avoid going into DKA be sure to take precautions such as:

  • Drinking lots of water
  • Taking the appropriate doses of insulin as instructed by your doctor.
  • Eating what you can.
  • Testing blood-sugar often.
  • Testing for ketones.

Read about DKA at diagnosis—stories and more resources.

Read about how to manage DKA—personal stories of DKA and helpful guides.

WRITTEN BY BT1 Editorial Team, POSTED 09/05/15, UPDATED 03/04/24

This piece was authored collaboratively by the Beyond Type 1 Editorial Team.