Diabetic Ketoacidosis: Signs, Symptoms, and Treatments

by Mary Shomon Patient Advocate

Diabetic ketoacidosis (DKA) is a potentially dangerous complication for people with diabetes. If you have diabetes, you should know the triggers and risk factors for DKA, as well as signs, symptoms, and treatments for this potentially life-threatening condition.

Glucometers on desk with doctor using laptop in background

What is Diabetic Ketoacidosis (DKA)?

DKA is a condition that involves high levels of ketones in your blood. Without treatment, DKA can be fatal.

The cause of DKA is a blood sugar level that is too high – typically above 250 mg/dl -- for too long. The elevated blood sugar is due to a lack of insulin. Without enough insulin, cells can’t use the sugar in your blood as fuel. The cells turn to fat instead. When fat is burned, it makes acids called ketones. Over time, the buildup of ketones can have serious effects.

child with type 1 diabetes

Who is at Risk of DKA?

DKA occurs primarily in people with type 1 diabetes, who make little or no insulin.

As many as a third of people hospitalized for DKA, however, were previously unaware that they had developed type 1 diabetes.

Around one in four DKA cases are in people with type 2 diabetes.

woman with the flu

Who is More Likely to Develop DKA?

You are more likely to develop DKA if:

  • You frequently miss your prescribed doses of insulin
  • You stop taking your prescribed insulin
  • You skip meals regularly
  • You are sick with an infection, like pneumonia, the flu, or a urinary tract infection, or have an acute illness, such as sepsis, pancreatitis, or have had a heart attack
woman looking at stats on tablet

DKA Statistics

DKA is fatal in about 2 to 5 percent of cases, and is the leading cause of death in people under age 24 who have diabetes.

Among all DKA cases:

  • 30 to 36 percent are under age 30
  • 27 percent are between 30 and 50
  • 23 percent are between 51 and 70
  • 14 percent are over 70

It’s estimated that around 27 percent of people admitted to the hospital for DKA have a new diagnosis of diabetes.

bottle of insulin

Causes of DKA

The causes of DKA include:

  • Insulin deficiency from new-onset diabetes
  • Insulin deficiency due to noncompliance, insulin pump failure, or inability to pay for insulin
  • An increased need for insulin because of infectious illness
  • Certain prescription drugs, including antipsychotics like olanzapine (Zyprexa) and risperidone (Risperdal), and steroids, among others
  • Illicit drug use, especially cocaine
  • Alcohol abuse
Little boy drinking tap water

Symptoms of DKA

Diabetic ketoacidosis signs and symptoms can develop quickly, sometimes in as little as 24 hours. They include:

  • Excessive and unquenchable thirst
  • Dry mouth, “cotton-mouth”
  • Dry skin
  • Hunger
  • Dehydration
  • Weight loss
  • Frequent urination, and high urinary volume
  • Nausea and vomiting
  • Stomach pain
  • Fatigue, lethargy
  • Shortness of breath
  • Fruity-scented breath
  • Mental confusion
  • Difficulty breathing
Laboratory Urine analysis on blurred background

Testing Your Ketones

If your blood sugar is above 250 mg/dl or you have any DKA symptoms, you should do a home urine test with a ketone test strip.

  • Urinary ketone levels above 5 mmol/L with blood sugar above 250 mg/dL put you at high risk for DKA. Call your doctor.
  • If elevated blood sugar and ketones don’t quickly respond to insulin treatment and oral rehydration, go to an emergency room right away.
  • A level above 10 mmol/L is considered indicative of DKA and requires immediate emergency medical treatment.
emergency room exterior

DKA Treatment

DKA treatment typically requires an emergency room visit or hospitalization, with treatment that includes:

  • Intravenous insulin to lower your blood sugar
  • Intravenous (or oral) fluids to rehydrate you and restore your electrolyte balance
  • Supplemental electrolytes when needed, including potassium, sodium, and chloride
testing blood sugar while sitting on a yoga mat

How Can You Prevent DKA?

Without treatment, over time DKA can make you pass out, go into a coma, cause brain swelling, or even death. This means that it is important to people with diabetes know how to prevent DKA from developing.

Careful management of your blood sugar can help you avoid DKA.

woman wearing insulin pump on arm

Other Important DKA Prevention Tips

To help prevent DKA, you should also make sure that you:

  • Take your diabetes medicines as directed by your physician
  • Regularly test and monitor your blood sugar
  • Test ketones when blood sugar and symptoms indicate
  • Have a management plan for diabetes treatment for when you get sick
  • If you wear an insulin pump, learn how to inspect it for leaks or defects, and have a backup plan in the event that your pump fails
Mary Shomon
Meet Our Writer
Mary Shomon

Mary Shomon is a patient advocate and New York Times bestselling author who empowers readers with information on thyroid and autoimmune disease, diabetes, weight loss and hormonal health from an integrative perspective. Mary has been a leading force advocating for more effective, patient-centered hormonal healthcare. Mary also co-stars in PBS’ Healthy Hormones TV series. Mary also serves on HealthCentral’s Health Advocates Advisory Board.