Diabetic ketoacidosis (DKA) occurs when a person’s blood 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.
Factors that may increase your risk of DKA:
New infection that may not be obvious, such as
urinary tract infection, or
insulin as prescribed
or not taking enough insulin at all
New heart disease, such as
Recreational drug use, such as
cocaineBlood clot to the lungs
DKA may cause: High blood glucose levels (greater than 250 mg per dL)Dry mouth and skinThirstFrequent urination
Call for emergency medical services right away if you have: DrowsinessVomiting and nauseaSevere stomach painTrouble breathingFruity breath odorRapid pulse
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.
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.
IV Being Placed in Hand
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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 doctorIncrease your insulin as recommendedEat foods that are low in carbohydratesDrink plenty of sugar-free and caffeine-free fluidsDo not exercise until your glucose is in balance again
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.
Last reviewed September 2016 by Kim Carmichael, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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