What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body.
Ketoacidosis shouldn’t be confused with ketosis, which is harmless. Ketosis can occur as a result of an extremely low carbohydrate diet, known as a ketogenic diet, or fasting. DKA only happens when you don’t have enough insulin in your body to process high levels of glucose in the blood.
It’s less common in people with type 2 diabetes because insulin levels don’t usually drop so low; however, it can occur. DKA may be the first sign of type 1 diabetes, as people with this disease can’t make their own insulin.
What are the symptoms of diabetic ketoacidosis?
Symptoms of DKA can appear quickly and may include:
- frequent urination
- extreme thirst
- high blood sugar levels
- high levels of ketones in the urine
- nausea or vomiting
- abdominal pain
- fruity-smelling breath
- a flushed face
- rapid breathing
- dry mouth and skin
DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA.
If left untreated, DKA can lead to a coma or death. If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place. If you have type 1 diabetes, you should have a supply of home urine ketone tests. You can buy these in drug stores or online.
If you have type 1 diabetes and have a blood sugar reading of over 250 milligrams per deciliter (mg/dL) twice, you should test your urine for ketones. You should also test if you are sick or planning on exercising and your blood sugar is 250 mg/dL or higher.
Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.
How is diabetic ketoacidosis treated?
The treatment for DKA usually involves a combination of approaches to normalize blood sugar and insulin levels. If you’re diagnosed with DKA but haven’t yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring.
Infection can increase the risk of DKA. If your DKA is a result of an infection or illness, your doctor will treat that as well, usually with antibiotics.
At the hospital, your physician will likely give you fluids. If possible, they can give them orally, but you may have to receive fluids through an IV. Fluid replacement helps treat dehydration, which can cause even higher blood sugar levels.
Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar level is within an acceptable range, your doctor will work with you to help you avoid DKA in the future.
When your insulin levels are too low, your body’s electrolytes can also become abnormally low. Electrolytes are electrically charged minerals that help your body, including the heart and nerves, function properly. Electrolyte replacement is also commonly done through an IV.