What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis is a serious complication of high blood sugar. It is a life-threatening condition that must be treated immediately. If you have ketoacidosis you are at risk for, diabetic coma.

How does it occur?

At first, your blood sugar (glucose) level rises above normal. This is called hyperglycemia. Hyperglycemia occurs when you do not have enough insulin to keep your blood sugar in the target range. If your blood sugar keeps going up, you may develop ketoacidosis. In ketoacidosis the body breaks down fat into fatty acids and uses the fatty acids for energy instead of blood glucose. The fatty acids form ketones. Some of the ketones are passed out in the urine. Ketoacidosis occurs most often among people with type 1 diabetes.

Kketoacidosis may result from:

• not enough insulin
• expired or damaged insulin
• illness
• infection
• surgery
• heart attack
• physical or emotional stress
• during pregnancy

If you have not yet been diagnosed with diabetes, ketoacidosis may be the first sign that you have type 1 diabetes.

What are the symptoms?

Symptoms of hyperglycemia include:

• increased thirst
• increased hunger
• dry mouth
• increased urination

If you have ketoacidosis you may also have these signs & symptoms:

• excessive urination
• severe thirstiness
• fruity-smelling breath
• abdominal pain
• nausea
• vomiting
• ketones in the urine
• deep or difficulty breathing
• extreme tiredness
• mental confusion

The onset the symptoms of ketoacidosis is usually gradual but can lead to a coma.

How is it diagnosed?

Blood and urine tests are used. A physical exam is also done, paying attention to:

• possible infection
• the amount of fluid in your body (hydration)
• how clearly you are able to think
• breathing difficulty
• your heart and kidneys.

If necessary, the doctor will also order a chest x-ray and an ECG.

How is it treated?

Ketoacidosis is treated with insulin. Your blood sugar levels will be monitored frequently and electrolytes and blood gases checked as needed. You will probably be given intravenous (IV) fluids. Your treatment will include antibiotic or other medications if you have an infection.

How long will the effects last?

Ketoacidosis will continue until enough insulin is available to the body.

What can be done to help prevent and detect diabetic ketoacidosis?

To help take care of yourself and prevent ketoacidosis, follow these guidelines:

• An illness such as a cold or flu can raise blood sugar levels and lead to diabetic ketoacidosis. Work with your nurse, doctor, or dietitian to make a plan to care for your diabetes when you are ill.
• Monitor your blood sugar at home and keep track of your blood sugar levels.
• Test for ketones in your urine when your blood sugars are high or you are ill or under more stress than usual.
• Know the early signs and symptoms of ketoacidosis and when to contact your health care team.
• Drink extra sugar-free fluids when your blood sugars are high.
• Teach a family member or friend how to give you an insulin injection if necessary.

Call your doctor if:

• Your blood sugar is 240 or more for 2 consecutive tests.
• Your ketone test is positive.
• You are vomiting and unable to keep food down.
• You have symptoms of high blood sugar.
• You have symptoms of confusion or dehydration or ketoacidosis.

Information provided (reviewed) by Martha Funnell, MS, RN, CDE, Michigan Diabetes Research and Training Center, October, 2002.