What Is It?

Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when insulin levels are far lower than what your body needs. This problem causes the blood to become acidic, and the body to become dangerously dehydrated.

To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily.

Your body needs a constant source of energy. When you have plenty of insulin, your body cells can get all the energy they need from glucose. If you don't have enough insulin in your blood, your liver is programmed to manufacture emergency fuels. These fuels, made from fat, are called ketones (or ketoacids). In a pinch, ketones can give you energy. However, if your body stays dependent on ketones for energy for too long, you will become ill.

Ketones are acidic chemicals that are toxic at high concentrations. In diabetic ketoacidosis, ketones accumulate in the blood, seriously altering the normal chemistry of the blood and interfering with the function of multiple organs. They make the blood acidic, which causes vomiting and abdominal pain. If the acid level of the blood becomes extreme, ketoacidosis can cause falling blood pressure, coma and death.

Ketoacidosis is always accompanied by dehydration, which is caused by high levels of glucose in the blood. If there is not enough insulin to move glucose into your cells, it accumulates in the blood. During an episode of ketoacidosis, your blood sugar can rise to a high level (often over 400 milligrams per deciliter). When blood sugar levels are so high, some sugar "overflows" into the urine. When sugar is carried away in the urine, water, salt and potassium are drawn into the urine with each sugar molecule, and your body loses large quantities of your fluid and electrolytes, which are minerals that play a crucial role in cell function. As this happens, you produce much more urine than normal. Usually, you can't drink enough fluids to keep up with amount that you urinate. Vomiting caused by the blood's acidity also contributes to fluid losses and dehydration.