Diabetic Ketoacidosis: Signs, Symptoms, and Treatmentsby 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.
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.
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.
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
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.
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
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
- 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
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.
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
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