Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.
The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.
If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care.
Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice:
- Excessive thirst
- Frequent urination
- Nausea and vomiting
- Stomach pain
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include:
- High blood sugar level
- High ketone levels in your urine
When to see a doctor
If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit.
Contact your doctor immediately if:
- You're vomiting and unable to tolerate food or liquid
- Your blood sugar level is higher than your target range and doesn't respond to home treatment
- Your urine ketone level is moderate or high
Seek emergency care if:
- Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
- You have ketones in your urine and can't reach your doctor for advice
- You have many signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion
Remember, untreated diabetic ketoacidosis can lead to death.
Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, insulin helps sugar enter your cells.
Without enough insulin, your body can't use sugar properly for energy. This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones. Excess ketones build up in the blood and eventually "spill over" into the urine.
Diabetic ketoacidosis is usually triggered by:
- An illness. An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits.
- A problem with insulin therapy. Missed insulin treatments or inadequate insulin therapy or a malfunctioning insulin pump can leave you with too little insulin in your system, triggering diabetic ketoacidosis.
Other possible triggers of diabetic ketoacidosis include:
- Physical or emotional trauma
- Heart attack or stroke
- Alcohol or drug abuse, particularly cocaine
- Certain medications, such as corticosteroids and some diuretics
The risk of diabetic ketoacidosis is highest if you:
- Have type 1 diabetes
- Frequently miss insulin doses
Uncommonly, diabetic ketoacidosis can occur if you have type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign that you have diabetes.
Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.
Possible complications of the treatments
Treatment complications include:
- Low blood sugar (hypoglycemia). Insulin allows sugar to enter your cells, causing your blood sugar level to drop. If your blood sugar level drops too quickly, you can develop low blood sugar.
- Low potassium (hypokalemia). The fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves. To avoid this, electrolytes, including potassium are usually given along with fluid replacement as part of the treatment of diabetic ketoacidosis.
- Swelling in the brain (cerebral edema). Adjusting your blood sugar level too quickly can produce swelling in your brain. This complication appears to be more common in children, especially those with newly diagnosed diabetes.
Left untreated, the risks of diabetic ketoacidosis are much greater. Diabetic ketoacidosis can lead to loss of consciousness and, eventually, death.
There's much you can do to prevent diabetic ketoacidosis and other diabetes complications.
- Commit to managing your diabetes. Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
- Monitor your blood sugar level. You might need to check and record your blood sugar level at least three to four times a day, or more often if you're ill or stressed. Careful monitoring is the only way to make sure that your blood sugar level stays within your target range.
- Adjust your insulin dosage as needed. Talk to your doctor or diabetes educator about how to adjust your insulin dosage in relation to factors such as your blood sugar level, what you eat, how active you are, and whether you're ill. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.
- Check your ketone level. When you're ill or stressed, test your urine for excess ketones with an over-the-counter urine ketones test kit. If your ketone level is moderate or high, contact your doctor right away or seek emergency care. If you have low levels of ketones, you may need to take more insulin.
- Be prepared to act quickly. If your blood sugar is high and you have excess ketones in your urine, and you think that you have diabetic ketoacidosis, seek emergency care.
Diabetes complications are scary. But don't let fear keep you from taking good care of yourself. Follow your diabetes treatment plan carefully. Ask your diabetes treatment team for help when you need it.