Diabetic ketoacidosis

Diagnosis

If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and order blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis.

Blood tests

Blood tests used in the diagnosis of diabetic ketoacidosis will measure:

• Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise.
• Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream.
• Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body.

Additional tests

Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include:

• Blood electrolyte tests
• Urinalysis
• Chest X-ray
• A recording of the electrical activity of the heart (electrocardiogram)

Treatment

If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves:

• Fluid replacement. You'll receive fluids — either by mouth or through a vein — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood.
• Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through a vein to help keep your heart, muscles and nerve cells functioning normally.
• Insulin therapy. Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein. When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.

As your body chemistry returns to normal, your doctor will consider additional testing to check for possible triggers for the diabetic ketoacidosis. Depending on circumstances, you might need additional treatment.

For example, your doctor will help you create a diabetes treatment plan. If a bacterial infection is found, he or she might prescribe antibiotics. If a heart attack seems possible, your doctor might recommend further evaluation of your heart.

Preparing for your appointment

Diabetic ketoacidosis is life-threatening. If you develop mild signs and symptoms, contact your doctor immediately.

Call 911 or your local emergency number if:

• You can't reach your doctor
• Your symptoms are getting worse
• Your symptoms are already severe

A medical provider who sees you for possible diabetic ketoacidosis will need answers to these questions as quickly as possible:

• What are your signs and symptoms?
• When did these signs and symptoms develop? Are they getting worse?
• Have you been diagnosed with diabetes?
• Have you recently checked your blood sugar level?
• Have you recently checked your ketone level?
• Have you lost your appetite?
• Can you keep fluids down?
• Are you having trouble breathing?
• Do you have chest pain?
• Have you had a recent illness or infection?
• Have you had recent stress or trauma?
• Have you recently used alcohol or recreational drugs?
• How closely have you been following your diabetes treatment plan?
• How well would you say your diabetes has been managed just before these symptoms?