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Diabetic ketoacidosis (DKA): signs, causes and treatment

December 06, 2022

Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes. It’s the result of very high blood sugar and low insulin levels, which causes ketones to build up in the blood. Left untreated, DKA can be life threatening.

Learn more about the early signs of DKA, its causes, how to help prevent it, and how to check for ketones, as part of your type 1 diabetes management.

About diabetic ketoacidosis (DKA)

Diabetic ketoacidosis is a serious condition that can occur in people who live with type 1 diabetes (T1D). It starts when a person has a high blood sugar level for a long period of time, with not enough insulin to break down the glucose (sugars) to use for energy. The body then starts burning fat stores instead.

This process creates ketones, which build up the blood. In large amounts these ketones are toxic. If not treated, this can make the person living with T1D very ill, and can be life threatening.

Signs and symptoms of DKA

Everyone who lives with T1D – and/or their loved ones and caregivers – needs to be familiar with the signs and symptoms of DKA. There are several things to check for if you suspect you or your loved one living with T1D may be experiencing DKA.

The first signs of DKA are often:

  • frequent urination
  • excessive thirst.

Later signs of DKA can include:

  • having flu-like symptoms (feeling exhausted, weak, achy or sick)
  • feeling confused, or having trouble concentrating
  • stomach pain
  • being unable to keep fluids down, or persistent vomiting or diarrhoea
  • fruity smelling breath
  • deep, rapid breathing, or shortness of breath
  • ketones detected in urine or blood testing.

If DKA has been occurring for longer, you may also notice:

  • signs of dehydration (extreme thirst, dry mouth, weakness, confusion and not urinating)
  • excessive weight loss.

Causes of DKA

DKA is commonly caused by an infection or illness. Sickness can change the body’s hormone levels, interfering with the way insulin usually works. Being sick can also change the amount you normally eat and drink, which makes managing your blood sugar levels more difficult.

DKA can also occur when insulin doses are missed, or not enough insulin is taken.

How to try to prevent DKA

There are a few ways to help prevent blood sugars levels rising too high, or insulin levels dropping too low:

  • check your blood sugar levels throughout the day (and test more often if you’re sick or stressed)
  • stick to the management plan advised by your diabetes healthcare team
  • talk to your diabetes healthcare team about what to do on a sick day, and have a plan in place
  • check for ketones (read more about this below).

What do in the case of DKA

If you think you or someone you care for is experiencing DKA, seek urgent medical attention – go the emergency department of your nearest hospital, or call your doctor or credentialled diabetes educator (CDE).

Hospital treatment usually includes fluids, electrolyte replacement and insulin therapy to bring all levels back to a more stable and less dangerous range.

Checking ketones

You can check for ketones using a monitor that can detect both glucose and ketones in your blood. You can also use urine monitoring strips, but keep in mind that blood ketone monitoring is more accurate.

Keep ketone testing supplies in stock so you don’t get left without any when you really need them. Talk to your healthcare team to learn how to use them properly, and how to understand the results.

Read more about when to test for ketones:

Please note: Talk to your healthcare team for advice specific to your health needs. 

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