Diabetic Ketoacidosis: Symptoms, Treatment, Causes

Diabetic Ketoacidosis: Symptoms, Treatment, Causes

What is Diabetic Ketoacidosis?

Diabetic ketoacidosis is a major complication of diabetes that happens when your body produces high levels of blood acids called ketones.

The condition develops when your body cannot produce sufficient insulin. Insulin usually plays a key function in assisting sugar (glucose) — a significant source of energy for your muscles and other tissues — enter your cells. Without sufficient insulin, your body starts to break down fat as fuel. This procedure produces a buildup of acids in the blood stream called ketones, eventually resulting in diabetic ketoacidosis if neglected.

If you have diabetes or you’re at risk of diabetes, discover the warning signs of diabetic ketoacidosis — and understand when to look for emergency care.


Diabetic ketoacidosis signs and symptoms typically develop quickly, often within 24 hours. For some, these symptoms and signs may be the first indicator of having diabetes. You may observe:

  • Excessive thirst
  • Frequent urination
  • Nausea and vomiting
  • Abdominal pain
  • Weakness or fatigue
  • Shortness of breath
  • Fruity-scented breath
  • Confusion

More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine screening packages — consist of:

  • High blood glucose level (hyperglycemia)
  • High ketone levels in your urine

See also: Diabetic Coma: Symptoms, Causes, Prevention

When to see a doctor

If you feel ill or stressed out or you’ve had a current disease or injury, examine your blood sugar level typically. You might likewise attempt an over-the-counter urine ketones checking package.

Contact your doctor immediately if:

  • You’re vomiting and unable to endure 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

Look for emergency situation care if:

  • Your blood sugar level is consistently greater 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 guidance
  • You have numerous signs and symptoms of diabetic ketoacidosis — extreme thirst, regular urination, queasiness and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion

Keep in mind, untreated diabetic ketoacidosis can be fatal.


Sugar is a primary source of energy for the cells that comprise your muscles and other tissues. Usually, insulin assists sugar enter your cells.

Without sufficient insulin, your body cannot use sugar correctly for energy. This prompts the release of hormonal agents that break down fat as fuel, which produces acids called ketones. Excess ketones build up in the blood and ultimately “overflow” 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 specific hormones, such as adrenaline or cortisol. Unfortunately, these hormonal agents counter the impact of insulin — often triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common offenders.
  • An issue with insulin therapy. Missed insulin treatments or insufficient insulin therapy can leave you with too little insulin in your system, triggering diabetic ketoacidosis.

Other possible triggers of diabetic ketoacidosis include:

  • Physical or psychological injury
  • Cardiovascular disease
  • Alcohol or substance abuse, particularly cocaine
  • Particular medications, such as corticosteroids and some diuretics

Risk factors

The risk of diabetic ketoacidosis is greatest if you:

  • Have type 1 diabetes
  • Frequently miss out on insulin dosages

Unusually, diabetic ketoacidosis can take place if you have type 2 diabetes. Sometimes, diabetic ketoacidosis might be the first sign that an individual has diabetes.


Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Maybe surprisingly, the most typical complications of diabetic ketoacidosis belong to this lifesaving treatment.

Possible complications of the treatments

Treatment complications consist of:

  • Low blood sugar level (hypoglycemia). Insulin permits sugar to enter your cells, causing your blood sugar level to drop. If your blood sugar level drops too quickly, you can establish 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.
  • Swelling in the brain (cerebral edema). Changing your blood sugar level too quickly can produce swelling in your brain. This issue seems more typical in children, particularly those with recently detected diabetes.

Left untreated, the threats are much greater. Diabetic ketoacidosis can lead to loss of awareness and, eventually, it can be fatal.

Also read: Diabetic Hyperosmolar Syndrome

Medical diagnosis

If your doctor believes diabetic ketoacidosis, he or she will do a physical exam and different blood tests. In some cases, additional tests may be had to help determine what set off the diabetic ketoacidosis.

Blood tests

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

  • Blood sugar level. If there isn’t really enough insulin in your body to enable sugar to enter your cells, your blood sugar level will increase (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 level of acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can change the normal function of organs throughout your body.

Extra tests

Your doctor might purchase tests to recognize underlying health issue that may have contributed to diabetic ketoacidosis and to look for complications. Tests may include:

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


If you’re diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or confessed to the healthcare facility. Treatment usually involves:

  • Fluid replacement. You’ll get fluids — either by mouth or through a vein (intravenously) — until you’re rehydrated. The fluids will replace those you’ve lost through extreme urination, along with help water down the excess sugar in your blood.
  • Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as salt, potassium and chloride. The lack of insulin can reduce the level of a number of electrolytes in your blood. You’ll get electrolytes through a vein to help keep your heart, muscles and nerve cells operating generally.
  • Insulin therapy. Insulin reverses the procedures that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you’ll get insulin therapy — normally through a vein. When your blood sugar level falls below 240 mg/dL (13.3 mmol/L) and your blood is not acidic, you might be able to stop intravenous insulin therapy and resume your normal insulin therapy.

As your body chemistry go back to normal, your doctor will think about additional screening to look for possible triggers for the diabetic ketoacidosis. Depending on circumstances, you may require extra treatment.

For instance, for previously undiagnosed diabetes, your doctor will help you create a diabetes treatment plan. For a bacterial infection, he or she may recommend antibiotics. If a cardiovascular disease seems possible, your doctor may advise more evaluation of your heart.


There’s much you can do to prevent diabetic ketoacidosis and other diabetes complications.

  • Devote to managing your diabetes. Make healthy eating and exercise part of your everyday regimen. Take oral diabetes medications or insulin as directed.
  • Screen your blood sugar level. You may need to examine and tape your blood sugar level at least three to 4 times a day — regularly if you’re ill or under stress. Cautious tracking is the only method to make sure your blood sugar level remains within your target range.
  • Adjust your insulin dosage as required. Talk with your doctor or diabetes teacher about how to adjust your insulin dosage in relation to your blood glucose level, what you eat, how active you are, whether you’re ill and other aspects. If your blood sugar level starts to increase, follow your diabetes treatment plan to return your blood sugar level to your target variety.
  • Examine your ketone level. When you’re ill or under stress, test your urine for excess ketones with a non-prescription urine ketones test kit. If your ketone level is moderate or high, call your doctor immediately or look for emergency situation care. If you have low levels of ketones, you might have to take more insulin.
  • Be prepared to act quickly. If you think that you have diabetic ketoacidosis — your blood glucose level is high, and you have excess ketones in your urine — seek emergency care.

Diabetes complications are frightening. However don’t let fear keep you from taking excellent care of yourself. Follow your diabetes treatment plan carefully, and ask your diabetes treatment group for assistance when you require it.

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