What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis, or DKA, is a serious complication of diabetes. If the body does not have enough blood glucose (blood sugar) available for energy, it will burn fat instead. This forms ketones in the blood. If the ketones build up, the blood becomes too acidic and can begin to harm the body [1,2].
Early symptoms include dry mouth, increased urination, and high blood sugar levels. Later symptoms are fatigue, vomiting, mental confusion, difficulty breathing, and a sweet, fruity odor on the breath.
Diabetic ketoacidosis can be a life-threatening medical emergency. Treatment is usually administered in a hospital and involves fluids, electrolytes, and insulin.
Call 911 immediately as this requires immediate medical attention.
Diabetic Ketoacidosis Symptoms
Symptoms of diabetic ketoacidosis can develop quickly over the course of a day. DKA can occur if someone with diabetes does not use enough insulin or does not eat enough food, which can easily happen if other illness is present. This is why it is important to test for ketones when you are sick [2,3]. The condition is most common in type 1 diabetics, though it can happen with type 2 as well. If it does occur, it is important to seek medical help.
These symptoms are serious, and as blood sugar continues to rise without treatment, diabetic ketoacidosis can lead to coma.
- Limited function: Frequently, diabetic ketoacidosis begins with feelings of confusion or slowed thoughts.
- You may be slow to respond or have severe attention deficits
- You can also feel a lack of coordination or balance
Common symptoms in children
Children with type 1 diabetes and diabetic ketoacidosis experience certain symptoms more often than adults. This includes:
- Abdominal discomfort: Non-focal pain generally across the belly or abdomen.
- Nausea and vomiting
Because of the increased concentration of acids in the blood from the breakdown of fats, the body tends to urinate to remove these compounds from the blood. Excessive urination in the setting of a continuous production of keto acids can cause dehydration or excessive loss of water. This can contribute to:
- A general feeling of illness
- Slowed mental capacity
Deep and fast breathing
While not particularly common, this is strongly associated with diabetic ketoacidosis, and is often called "Kussmaul" breathing or "breathing hunger," defined by :
- Deep and labored breathing: This usually involves the belly and the chest.
- Breathing is rhythmic: It also involves maximal breath in followed by maximal breath out.
Because of excessive urination, the body's amount of potassium can be extremely low in DKA, called hypokalemia. Ultimately, severe hypokalemia can cause heart problems and eventually death. Signs of low potassium include:
- Vomiting or nausea
- Muscle cramps
- An inability to move arms and legs due to weakness
Other complications that can occur with DKA include :
- Fluid buildup in the brain (cerebral edema)
- Cardiac arrest
- Kidney failure
Diabetic Ketoacidosis Causes
All diabetic ketoacidosis is caused by a single process that can be initiated by many causes. The body's lack of insulin or resistance to the effects of insulin is primarily responsible for diabetic ketoacidosis.
Role of insulin in the body
Insulin is a hormone produced by the pancreas that informs the body that nutrients, particularly sugars, are present in the blood. It also informs the body to store sugars in the liver and that it does not need to burn fat as energy. When insulin is not present, or the body has severe insulin resistance, the body acts as though it is deprived of energy. This can cause the body to break down fat-producing compounds known as keto acids.
There are a variety of reasons why the body's insulin level may change, which can possibly go unnoticed until you begin experiencing symptoms [4,5]. These include iatrogenic reasons, insulin non-compliance, surgery, initial presentation, intoxication, drugs, infection, and pregnancy.
A recent change in your insulin dose or a change in medication can cause diabetic ketoacidosis. If you do not administer the proper amount of insulin or administer insulin incorrectly, it can cause diabetic ketoacidosis.
If you stop taking insulin or are unable to fill your prescription, the lack of insulin may cause diabetic ketoacidosis. It is important to communicate to your provider if you run out of insulin as the high blood sugar caused by not taking insulin can be lethal.
Surgery can cause an inflammatory reaction as the body prepares for a potential infection. An inflammatory reaction takes energy to maintain and can reduce available sugars in the blood.
Often diabetic ketoacidosis occurs in individuals with diabetes who have never been diagnosed. Because they are unaware of their diagnosis, their blood sugar may be poorly controlled, and their insulin resistance may rise to levels that cause diabetic ketoacidosis.
Consuming alcohol can also precede diabetic ketoacidosis because alcohol can reduce or eliminate the insulin output of the pancreas. For those individuals that take insulin, insulin needs should be adjusted around the consumption of alcohol to avoid diabetic ketoacidosis.
Any drug that affects the ability of the body to metabolize carbohydrates like sugars (e.g. burn for energy) causes a risk for DKA. Common drugs include:
- Steroid medications: This includes corticosteroids or glucocorticoids.
- Antipsychotic medications
- Medications that work on the sympathetic nervous system: These may adjust either respiration or blood pressure like dobutamine or terbutaline.
- Street drugs: These can also have severe effects on blood sugar. Cocaine in any form is known to increase the risk of DKA.
Any infection can cause the body to alter its sugar metabolism and insulin regulation in a way that requires more insulin to maintain a stable and appropriately low blood sugar level.
Pregnancy can cause temporary diabetes. Often without proper prenatal care and follow-up, this new diabetes is unknown to the woman, and if not properly managed, can cause diabetic ketoacidosis.
Who is most likely to be affected
Diabetic ketoacidosis occurs most frequently if you [5,6]:
- Have type 1 diabetes: However, it can also occur infrequently among type 2 diabetes (10 to 30 percent of cases).
- Have type 2 diabetes: The risk is higher if you are of African or Hispanic descent.
- Are elderly
- Have kidney disease or infection: Especially if it is causing either comas or very low blood pressure.
Diabetic Ketoacidosis Symptom Checker
Take a quiz to find out if you have Diabetic Ketoacidosis
Treatment Options and Prevention for Diabetic Ketoacidosis
Treatment for diabetic ketoacidosis requires immediate attention from medical professionals. The drugs, techniques, and monitoring equipment necessary to safely treat diabetic ketoacidosis are almost exclusively found in hospitals and emergency departments.
Once you are in medical care
Diabetic ketoacidosis can be a deadly condition. Once you are in proper care the following will likely occur.
- Fluids provided: You will likely receive fluids, insulin, and potassium or magnesium if your levels are low.
- Hospital admittance: You will likely be admitted into the hospital for further treatment and observation during treatment.
- Duration of stay: It is important to stay in the hospital until you are cleared to leave and have had your blood sugars reduced to a safe level, your fluids replenished, and your electrolytes normalized.
Although all cases of DKA may not be preventable, it is important to monitor your insulin levels and complete safe insulin practices if you have been diagnosed with diabetes. Maintaining healthy lifestyle practices, such as consuming a diet rich in fruits and vegetables and a regular exercise routine can help you remain at a healthy weight and lower your risk of developing diabetes.
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When to Seek Further Consultation for Diabetic Ketoacidosis
If you suspect that you have diabetic ketoacidosis you must seek emergency medical treatment immediately. Diabetic ketoacidosis and the other conditions it causes (e.g. severe dehydration and hypokalemia) can lead to heart attack, coma, and death and cannot be properly treated at home.
Once a medical professional has confirmed diabetic ketoacidosis
You will be referred to a hospital for further medical treatment.
Questions Your Doctor May Ask to Determine Diabetic Ketoacidosis
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Have you lost your appetite recently?
- Any fever today or during the last week?
- Are you sick enough to consider going to the emergency room right now?
- Have you experienced any nausea?
If you've answered yes to one or more of these questions
Diabetic Ketoacidosis Symptom Checker
Take a quiz to find out if you have Diabetic Ketoacidosis
- Diabetic ketoacidosis. Mayo Clinic. Published June 12, 2018. Mayo Clinic Link
- Wisse B. Diabetic ketoacidosis. U.S. National Library of Medicine: MedlinePlus. Published January 16, 2018. MedlinePlus Link
- DKA (ketoacidosis) & ketones. American Diabetes Association: Diabetes.org. Published March 18, 2015. Diabetes.org Link
- Kaufmann P, Smolle KH, Fleck S, Lueger A. [Ketoacidosis Diabetic Metabolic Dysregulation: Pathophysiology, Clinical Aspects, Diagnosis and Therapy]. Wiener Klinische Wochenschrift. 1994;106(5):119-127. NCBI Link
- Westerberg DP. Diabetic ketoacidosis: Evaluation and treatment. American Family Physician. 2013;87(5):337-346. AAFP Link
- Nyenwe E, Loganathan R, Blum S, et al. Admissions for diabetic ketoacidosis in ethnic minority groups in a city hospital. 2007;56(2):172-8. NCBI Link
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