X
Table of contents

Diabetic ketoacidosis

Feel like sharing?

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening condition caused by a build-up of waste products called ketones in the blood. It occurs in people with diabetes mellitus when they have no, or very low levels of, insulin.

DKA mostly occurs in people with type 1 diabetes, but it can also occur in some people with type 2 diabetes and pregnant women with gestational diabetes.

Causes

Glucose is an essential energy source for the body's cells. When food containing carbohydrates is eaten, it is broken down into glucose that travels around the body in the blood, to be absorbed by cells that use it for energy.

Insulin works to help glucose pass into cells. Without insulin, the cells cannot absorb glucose to use for energy. This leads to a series of changes in metabolism that can affect the whole body.

The liver attempts to compensate for the lack of energy in the cells by producing more glucose, leading to increased levels of glucose in the blood, also known as hyperglycemia.

The body switches to burning its stores of fat instead of glucose to produce energy. This leads to a build-up of acidic waste products called ketones in the blood and urine. This is known as ketoacidosis, and it can cause heart rhythm abnormalities, breathing changes and abdominal pain.

The kidneys try to remove some of the excess glucose and ketones. However, this requires taking large amounts of fluid from the body, which leads to dehydration.

This can cause:

Risk factors

For people with type 1 diabetes, factors that can increase the risk of DKA include:

  • Missing insulin injections, or insulin pump doses;
  • Bacterial infections, such as urinary tract infections, or other illnesses;
  • Alcohol use;
  • Surgery or injury, and;
  • Emotional stress.

The risks are highest in the period just before diabetes is diagnosed. The symptoms of DKA may be the first sign of type 1 diabetes. Younger people - particularly in their teens - with type 1 diabetes tend to be at greater risk of developing DKA.

DKA is much less common in people with type 2 diabetes, but factors that can increase the risk include:

Pregnant women who have pre-existing diabetes or develop gestational diabetes during pregnancy can also be at risk of developing ketoacidosis.

Signs and symptoms

Symptoms of DKA can develop over the course of hours. They can include:

DKA can rapidly cause severe dehydration.

People who self-test their own blood and urine may notice:

If you notice signs or symptoms of DKA, it is important to contact your doctor immediately or seek emergency treatment. This is the case even if there has not been a previous diagnosis of diabetes.

Methods for diagnosis

Your doctor may ask you about your symptoms, results of any self-testing of blood glucose and ketone levels and any factors that might have triggered DKA.

A physical examination can help to evaluate the severity of symptoms. In particular, your doctor may focus on checking for signs of dehydration.

Blood tests and urine tests are used to detect DKA by measuring the levels of glucose and ketones.

A hand-held portable glucose measuring device. 

Other tests may be recommended to detect any underlying conditions that may have triggered the DKA and determine if you have any complications.

These can include:

Types of treatment

DKA usually requires treatment in a hospital. Treatment aims to:

It is important that this treatment be monitored carefully to make sure that glucose and electrolyte levels are maintained at safe levels, or complications may develop.

Any underlying conditions that may have triggered DKA may also need treatment. If the DKA is a sign of undiagnosed diabetes, your doctor will develop a plan to help you manage your diabetes.

Potential complications

Complications that can occur with treatment of DKA include:

Hypoglycemia

If insulin causes blood glucose levels to drop too low, this can cause hypoglycemia, a serious condition that can cause people to lose consciousness.

Hypokalaemia

Replacement of fluids to treat dehydration can lead to potassium levels falling too low, known as hypokalaemia. As potassium is vital for the function of muscles, nerves and the heart, this can be dangerous.

Cerebral edema

If blood sugar levels change too quickly, it can lead to swelling in the brain (cerebral edema), particularly in children. In turn, this swelling restricts the flow of oxygen-rich blood to the brain, which can result in the damage or death of brain cells.

Careful monitoring of blood glucose and electrolyte levels during treatment can help to prevent these complications.

Prognosis

With prompt treatment, the prognosis of DKA is generally good. However, every year people still continue to die from diabetic ketoacidosis, often as a result of not seeking treatment early.

Prevention

While DKA cannot always be prevented, by managing diabetes well, you can significantly reduce the risk of it occurring.

Steps you can take include:

10 Most frequently asked questions (FAQs)

What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a life-threatening condition caused by a build-up of waste products called ketones in the blood. It occurs in people with diabetes when they have little or no insulin.
What are the symptoms of diabetic ketoacidosis?
Symptoms of diabetes ketoacidosis include increased thirst and urination, abdominal pains, vomiting, shortness of breath and rapid breathing, a fruity smell to the breath and drowsiness and confusion.
What causes diabetic ketoacidosis?
Diabetic ketoacidosis occurs because of a lack of insulin, which leads to the body burning its fat stores to provide energy for cells. This produces ketones, acidic substances that are toxic at high levels.
Who can develop diabetic ketoacidosis?
Diabetic ketoacidosis most commonly occurs in people with type 1 diabetes, but can also occur in people with type 2 diabetes and in pregnant women with gestational diabetes.
How is diabetic ketoacidosis diagnosed?
Blood and urine tests to measure levels of ketones and blood glucose are used to diagnose diabetic ketoacidosis.
How is diabetic ketoacidosis treated?
Treatment for diabetic ketoacidosis should occur in a hospital. It involves replacing fluids lost through dehydration and making sure that electrolyte levels, particularly potassium, are maintained at safe levels. Insulin may be given to help reduce blood glucose levels.
Can diabetic ketoacidosis be cured?
With prompt treatment, most people recover from diabetic ketoacidosis. However, it is important to properly manage diabetes to reduce the risk of diabetic ketoacidosis from recurring.
Will diabetic ketoacidosis clear on its own?
Diabetic ketoacidosis will not clear on its own and requires treatment as soon as possible. Untreated, it can cause organ failure, shock, coma and ultimately death.
Can diabetic ketoacidosis be prevented?
While diabetic ketoacidosis cannot be completely prevented, you can reduce your risk by managing diabetes well, including taking insulin and medications as prescribed, and regularly monitoring blood glucose levels as recommended by your doctor.
Is diabetic ketoacidosis serious?
Untreated, diabetic ketoacidosis can be life-threatening. If symptoms occur, it is important for people with diabetes to seek medical advice immediately. It can also be one of the first signs of type 1 diabetes, particularly in children, so if symptoms occur, it is also important to seek advice, even if the person has not been diagnosed with diabetes.

Related topics

Diabetes insipidus

Diabetes insipidus (DI) is caused by a chemical imbalance that hinders the body’s ability to control its fluids. It can cause people to become very thirsty and pass large amounts of urine. If left untreated, the condition can cause life-threatening dehydration.

Type 2 diabetes

Type 2 diabetes is a condition that affects the body’s ability to control blood sugar levels, and can lead to serious health problems. Although it is a lifelong condition, it can be effectively managed by controlling blood sugar levels, having regular check-ups and seeking early treatment for any complications.

Metabolic syndrome

Metabolic syndrome, also known as syndrome X or insulin resistance syndrome, is a collection of conditions that together increases the risk of developing heart disease or type 2 diabetes. These conditions include an increased waistline, hypertension (high blood pressure), increased blood sugar levels, high amounts of triglycerides and low levels of high density lipoprotein (HDL), also known as 'go

Type 1 diabetes

Type 1 diabetes is a long-term condition with impaired control of glucose (sugar) in the blood. It occurs when the pancreas cannot produce the hormone insulin, which normally controls the entry of glucose into cells. Individuals with type 1 diabetes need careful management, including insulin injections several times a day, or an insulin pump, to prevent complications.

About this article

Title: Diabetic ketoacidosis

Author: Lauren Donley BSc (Hons)

First Published: 13 Jul 2015

Last reviewed: 17 Jan 2022

Category: Information on Diabetic ketoacidosis

Average rating: 5.0 out of 5 (1554 votes)

Processing your vote now...

Sorry your vote failed to process.

Rate this report below.

Feel like sharing?

X

Your privacy

We use cookies to improve our website and service. By continuing to browse this website you accept the use of cookies by us and our partners. If you require more information please read our privacy policy and terms and conditions before proceeding.