The Fidelis Care Blog 

Understanding Diabetic Ketoacidosis
11/15/2021 • Posted by By Dr. Natalie Schwartz, Fidelis Care Medical Director and endocrinologist in Health and Wellness

Woman talking to doctorWhat is Diabetic Ketoacidosis or “DKA”?

Glucose (sugar) is your body’s normal source of energy. When the body doesn’t have enough insulin to use glucose the right way for fuel, it starts to break down fat for energy. Burning a lot of fat very quickly causes a buildup of acids, called “ketones,” which can become toxic to many of the body’s key  functions. When ketone levels become too high, it can lead to a severe, and potentially life-threatening condition, called diabetic ketoacidosis or DKA.  

I have type 1 diabetes (T1DM).  Am I at risk of developing DKA?

DKA mostly occurs in people with T1DM. About of the time DKA is a common sign of the disease. DKA is more common in young children and adolescents (under age 19), but can occur at any age. The most common causes of DKA are: not taking insulin injections as directed; missing insulin doses due to illness, vomiting, or alcohol intake; bacterial and other types of infections (especially, urine infections); medical or emotional stress; and faulty or clogged insulin infusion pump.

I have type 2 diabetes (T2DM) and my doctor said I still make insulin. Can I still get DKA?

While DKA is less likely to occur with T2DM, it is not uncommon in certain types of T2DM that are more likely to develop ketones. It can also occur with stressful medical conditions (like having a heart attack, stroke, pneumonia, an inflamed pancreas, urine infection, or other type of infection); taking certain drugs (like prednisone) for other illnesses or even one of the drugs used to treat diabetes (called “SGLT2 inhibitors”); and using illegal drugs (for example, cocaine). COVID-19 infection may also increase the risk of DKA.

What are the signs and symptoms of DKA?

The most common early symptoms of DKA are feeling very thirsty, drinking a lot, and urinating a lot - especially at night. Other signs and symptoms can develop and progress quickly (within 24 hours) and include:

  • Generalized weakness and becoming easily tired
  • • Nausea and vomiting, often associated with belly pain and decreased appetite
  • Rapid weight loss, especially in newly diagnosed T1DM
  • Decreased sweating
  • Confusion, disorientation, and rarely, difficulty being awakened
  • Rapid breathing and fruity smelling breath
  • Symptoms of heart attack (chest pain), pneumonia (fever, cough), other infections (fever, chills)

Contact your healthcare provider immediately, if you have any of the symptoms listed above. If you cannot reach your provider and you have blood sugars consistently over 300 mg/dl and/or positive ketones in your urine, go to your nearest emergency room.  

How is DKA treated?

If you have symptoms and signs of DKA, you will likely need treatment in a hospital. With DKA and high blood sugars, excessive fluid is drawn out of your body (in the urine), along with important chemicals in the blood (called electrolytes)- like sodium (salt) and potassium. An essential part of treatment is the replacement of these lost fluids and electrolytes. The other part of treatment is giving back enough insulin to restore your body’s ability to use glucose for fuel and to stop its breakdown of fat into ketones. With proper treatment, the prognosis of DKA is excellent.

How can I reduce my chances of developing DKA?

  • Take your insulin exactly as instructed by your healthcare provider
  • Eat a healthy diet
  • Get adequate sleep and exercise
  • Maintain a healthy weight
  • Stay hydrated
  • Monitor your blood sugar levels regularly
  • If you are feeling ill, are under extreme stress, and especially, if you are unable to tolerate food or are vomiting, check your blood sugar levels more frequently, and call your healthcare provider for instructions on how to adjust your insulin.

For more resources about diabetes prevention and management, visit our Diabetes Resources page.