Diabetic Ketoacidosis: What It Is and How To Prevent It

What is diabetic ketoacidosis?

Diabetic ketoacidosis (say: key-toe-acid-oh-sis), or DKA, happens when you have high blood sugar (also called glucose) levels and a build-up of acids called ketones. If it isn't treated, it can lead to coma and even death. It mainly affects people who have type 1 diabetes. However, it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy).

What causes DKA?

The main cause of DKA is not enough insulin. This causes your body's glucose levels to rise, but stops the body from using the glucose for energy. To get energy, the body starts to burn fat. This causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often, which leads to a lack of fluids in the body (dehydration).

For some people, DKA may be the first sign that they have diabetes. For others, DKA can be caused by missing an insulin dose, eating poorly or feeling stressed. Infections can also lead to DKA. If you have signs of infection, such as fever, cough, sore throat, or pain when you go to the bathroom, contact your doctor to make sure you are getting the right treatment.

What are the warning signs of DKA?

DKA is a very serious condition. People with diabetes should contact their doctor right away if they have any of the following:

  • Vomiting more than once
  • Stomach pain
  • Diarrhea 5 or more times in 6 hours
  • 2 blood glucose level tests higher than 300 mg per dL
  • A blood glucose level less than 70 mg per dL more than once, or symptoms of low blood sugar
  • Trouble breathing
  • Moderate or high ketones if you are using urine test strips
  • High beta-hydroxybutyrate levels if you are using blood test strips

How can I prevent DKA?

When you are sick, you need to watch your blood glucose very closely so that it doesn't get too high or too low. Ask your doctor what your critical blood glucose level is. Most patients should watch their glucose levels closely when they are higher than 250 mg per dL.

When you're sick, you should check your blood glucose level every 3 to 4 hours. If your blood glucose reaches a critical level, check it every 1 to 2 hours. Test your blood glucose levels at least every 4 hours during the night.

You should talk to your doctor to develop a plan if your blood glucose level gets too high. Make sure that you know how to reach your doctor in an emergency.

You should also test your urine for ketones or your blood for beta-hydroxybutyrate every 4 hours or if your blood glucose is over 250 mg per dL.

Should I keep taking insulin when I'm sick?

Yes, you should keep taking your insulin, even if you are too sick to eat. Your body needs insulin even if you are not eating. Ask your doctor whether it is necessary to adjust your dose or take extra insulin.

If you are on an insulin pump, make sure that you have short-acting insulin, long-acting insulin and needles in case your pump is not working right. You also should have an emergency phone number to call for help with your pump.

What else should I do?

When you're sick, drink lots of sugar-free, caffeine-free liquids. Sip small amounts every few minutes if you are feeling sick to your stomach.

If your blood glucose is more than 250 mg per dL, do not eat or drink foods that are high in carbohydrates.

More Information

For more information talk to your doctor.

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Written by familydoctor.org editorial staff.

Diabetic Ketoacidosis by David E. Trachtenbarg, M.D., (American Family Physician May 1, 2005, http://www.aafp.org/afp/20050501/1705.html)

Reviewed/Updated: 11/06
Created: 07/05