Diabetic Ketoacidosis

Symptoms, Treatments, and Prevention

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One of the many complications of diabetes is something called diabetic ketoacidosis (DKA). It most commonly occurs with Type 1 diabetes and is often the first symptom of Type 1 diabetes. DKA is caused when the body has little or no insulin to use and, as a result, blood sugars rise to dangerous levels and the blood becomes acidic.

How Does This Occur? 

Insulin is a hormone that helps transport sugar or glucose into the body's cells so that it can be used for energy.

When you have no insulin, sugar remains in the blood and blood sugar rises to dangerous levels. It causes severe hyperglycemia (high blood sugar), resulting in an emergency situation. As the blood glucose continues to increase, the body goes into an "energy crisis" and starts to break down stored fat as an alternate energy source. When fat is used for energy, ketones are produced and as the ketone levels rise, the blood becomes more and more acidic.

High blood sugars can progress to ketosis (build-up of ketones) in the body. Ketosis can lead to acidosis, which is a condition in which the blood has too much acid. When this happens it is known as diabetic ketoacidosis. This is a medical emergency and must be treated immediately by medical professionals.


  • The sudden start of Type 1 diabetes.
  • Common infections like pneumonia or urinary tract infections. Infection raises the level of "stress" hormones, such as cortisol and epinephrine, which raise the glucose levels in the blood.
  • When someone doesn't do the things necessary to control blood glucose or can't afford their insulin or other medications they can also be at risk for DKA.
  • Insulin pump failure can lead to DKA. If a person is unaware that their pump has stopped administering insulin, blood glucose levels can rise quickly.
  • Kids who are going through adolescence can experience endocrine changes that can alter glucose levels and insulin effectiveness.

Signs and Symptoms

The symptoms to watch for are not always obvious. They can start slowly and can be mistaken for other illnesses. Often, toddlers do not show the classic signs of DKA.

Early Signs:

  • Feeling tired or fatigued
  • Excessive thirst and/or excessive urination
  • Signs of dehydration such as dry mouth

Later Signs:

  • Weight loss 
  • Nausea/vomiting
  • Abdominal pain
  • Confusion
  • Rapid, deep, labored breathing (Kussmaul's respirations)
  • Breath that smells fruity
  • Fever
  • Unconsciousness


Treating DKA means medical intervention. It's important to treat dehydration by replacing fluids that have been lost, so most likely IV therapy will be used. Electrolyte imbalances need to be corrected and insulin therapy must be started to control hyperglycemia. All of this must be done under careful medical supervision.


When You Are Sick:

  • Have a plan in place for when you are sick.
  • Check blood sugar every three to four hours during illness. If blood sugar gets high (usually over 250 mg/dl), check more often and check for ketones in your urine.
  • During illness, make sure to drink plenty of sugar-free, caffeine-free liquids. Even if you are sick to your stomach, try to sip small amounts of liquid at frequent intervals. If your blood sugar is over 250 mg/dl, do not eat or drink high carbohydrate foods or fluids.
  • Don't stop taking your insulin when you are sick, even if you are not eating. Discuss if insulin dosages must be changed with your physician. 
  • Have your doctor's emergency number on hand, in case you need to call.

Preventing DKA Not Associated With Illness:

  • If you use an insulin pump, check it often to make sure that it is working properly and administering insulin.
  • Check blood sugar often throughout the day, usually four times a day.
  • Drink plenty of sugar-free beverages. 
  • Discuss medicine administration with your physician. You do not want to skip insulin doses or oral medications, but your physician may want to make some alterations. ​


    Cohen, Anita Stanziale MSN, RN, CS, CDE; and Edelstein, Elaine L. MS, RN, CDE. "Sick-day Management for the Home Care Client with Diabetes." Home Healthcare Nurse Vol 23, Number 11.Nov 2005 717-724.

    Carroll MD, Mary F; Schade MD, David S . "Ten Pivotal Questions About Diabetic Ketoacidosis." Postgraduate Medicine Online Vol 110, Number 5, Nov 2001.

    "When Blood Sugar Is Too High." Teens Health. July 2005. Nemours Foundation.