Diabetic ketoacidosis (DKA): signs, causes and treatment

Diabetic ketoacidosis (DKA):

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.


What is 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, as well as their loved ones and caregivers, need 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, achy or sick)
  • feeling confused, or having trouble concentrating
  • stomach pain
  • being unable to keep fluids down, or persistent vomiting or diarrhoea
  • feeling weak or tired
  • 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, not urinating)
  • excessive weight loss.


Causes of DKA

DKA is commonly caused by various factors, including infections, illnesses, and certain medications.

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 glucose levels more difficult.

For people with type 1 diabetes, DKA can also occur when insulin doses are missed, or not enough insulin is taken (for example, if an insulin pump stops working).

In addition to infections and illnesses, there are other specific diseases and circumstances that can contribute to the development of DKA, such as:

  • certain acute conditions, such as a heart attack, pneumonia, or urinary tract infections
  • taking certain medications, such as prednisone, dexamethasone, or other glucocorticoid medicines
  • the use of illegal drugs, such as cocaine, which can have detrimental effects on blood sugar control.


Treatment of diabetic ketoacidosis

If you suspect you or someone you care for has DKA, seek urgent medical attention. Go to the emergency department of your nearest hospital, or call your doctor or credentialled diabetes educator (CDE).

Here’s what to expect as the medical team tries to stabilise your levels:

  • insulin therapy. The medical team will administer insulin intravenously to help regulate your blood glucose levels and restore balance to your body. Once your blood glucose level drops to approximately 11.1 mmol/L and your blood is no longer acidic, you may be able to resume regular insulin therapy
  • fluids and electrolyte replacement. You’ll receive essential nutrients and fluids through a vein to restore proper hydration to your body, ensuring optimal functioning
  • continuous monitoring. Your healthcare providers will keep a vigilant eye on your brain, kidneys and lungs to promptly address any potential serious issues.

Once you’ve made progress and reach a point where you can eat and drink comfortably, and tests confirm safe ketone levels in your body, you’ll be deemed ready for discharge from the hospital.


Complications of DKA

While the information in this section may be confronting, it’s important to understand the risks of DKA. You can then work with your diabetes team to create, monitor and adjust a treatment plan that will help you avoid the condition and associated complications.

DKA can give rise to various complications, such as:

  • low levels of potassium (hypokalemia). Inadequate potassium levels can lead to serious issues, including muscle weakness and irregular heart rhythms (and in severe cases, death)
  • swelling inside the brain (cerebral edema). The occurrence of cerebral edema can be life-threatening
  • fluid accumulation inside the lungs (pulmonary edema). Pulmonary edema poses a significant risk to your health and can lead to fatal consequences
  • damage to kidneys and other organs due to fluid loss. The fluid loss associated with DKA can harm your kidneys and other vital organs.

By seeking prompt treatment for DKA, you’ll greatly reduce the risk9 of encountering these significant complications.

Your healthcare team understands the gravity of these complications and will take every measure to prevent them, guiding you towards a successful recovery.


How 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).


Checking ketones

Having high levels of ketones in your blood or urine is a signal that you may be at risk of developing DKA. There are a number of ways you can keep an eye on your ketone levels:

  1. Check for ketones using a monitor that can detect both glucose and ketones in your blood. This will provide a real-time snapshot of your ketone levels.
  2. Use urine monitoring strips (but keep in mind that blood ketone monitoring is more accurate, as urine tests reveal your ketone levels from a few hours ago).

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

Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes that can be life-threatening. Recognising the early signs, understanding the causes, and seeking prompt treatment are essential for managing DKA effectively as part of your diabetes care.

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