What you should know about 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 glucose is very high and ketones build up to dangerous levels in your body. When you don’t have enough insulin in your body to process high levels of glucose in the blood DKA occurs.

DKA can often be the first sign of type 1 diabetes.

What are the symptoms of ketoacidosis?

Symptoms of DKA can appear quickly and may include:

  • frequent urination
  • extreme thirst
  • high blood glucose levels
  • high levels of ketones in the urine
  • nausea or vomiting
  • abdominal pain
  • confusion
  • fruity-smelling breath
  • a flushed face
  • fatigue
  • rapid breathing
  • dry mouth and skin

DKA is a medical emergency. Seek treatment immediately if you think you are experiencing DKA.

Who’s at risk for developing DKA?

Your risk of DKA is higher if you:

  • have type 1 diabetes
  • are under the age of 19
  • have had some form of trauma, either emotional or physical
  • are stressed
  • have a high fever

How is ketoacidosis diagnosed?

Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. The doctors will likely also test your blood glucose level. Other tests your doctor may order are:

  • basic bloodwork, including potassium and sodium, to assess metabolic function
  • arterial blood gas, where blood is drawn from an artery to determine its acidity
  • blood pressure
  • if ill, a chest X-ray or other tests to look for signs of an infection, such as pneumonia

How is it treated?

The treatment for DKA usually involves a combination of approaches to normalize blood glucose 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.

  • Fluid replacement

At the hospital,  you will likely be given fluids. This may have to be done through an IV. Fluid replacement helps treat dehydration, which can cause even higher blood glucose levels.

  • Insulin therapy

Insulin will likely be administered until your blood glucose levels normalise. When your blood glucose levels are within an acceptable range, your doctor will work with you to help you avoid DKA in the future.

  • Electrolyte replacement

When your insulin levels are too low, your body’s electrolytes can also become abnormally low. Electrolytes help your body, heart and nerves, function properly. Electrolyte replacement is also commonly done through an IV.

Preventing ketoacidosis

There are many ways to prevent DKA. One of the most important is the management of your diabetes:

  • Take your diabetes medication as directed.
  • Follow your meal plan and stay hydrated with water.
  • Test your blood glucose consistently. This will help you get in the habit of making sure your numbers are in range. If you notice a problem, you can talk to your doctor about adjusting your treatment plan.


DKA is serious, but it can be prevented. Follow your treatment plan and be proactive about your health.

Tell your doctor if something isn’t working for you or if you’re having trouble. They can adjust your treatment plan or help you come up with solutions for better managing your diabetes.

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