Diabetic Ketoacidosis (DKA)

What is Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis is a serious complication of diabetes. This condition develops when there is not enough insulin in the body. Insulin is an hormone that regulates blood sugar levels in the body.

Normally, insulin allows glucose to enter the cells in the body. The cells break down glucose for energy. Without enough insulin, the body cannot break down glucose, so it breaks down fats instead.

This leads to high blood glucose levels in the body and the production of acids that are called ketones. Ketones are poisonous at high levels.

If diabetic ketoacidosis is not treated, it can cause severe dehydration and can lead to a coma or death.

What are the causes?

This condition develops when a lack of insulin causes the body to break down fats instead of glucose. This may be triggered by:

  • Stress on the body. This stress is brought on by an illness.
  • Infection.
  • Medicines that raise blood glucose levels.
  • Not taking diabetes medicine.
  • New onset of type 1 diabetes mellitus.

What are the signs or symptoms?

Symptoms of this condition include:

  • Fatigue.
  • Weight loss.
  • Excessive thirst.
  • Light-headedness.
  • Fruity or sweet-smelling breath.
  • Excessive urination.
  • Vision changes.
  • Confusion or irritability.
  • Nausea.
  • Vomiting.
  • Rapid breathing.
  • Abdominal pain.
  • Feeling flushed.

How is this diagnosed?

This condition is diagnosed based on your medical history, a physical exam, and blood tests. You may also have a urine test to check for ketones.

How is this treated?

This condition may be treated with:

  • Fluid replacement. This may be done to correct dehydration.
  • Insulin injections. These may be given through the skin or through an IV tube.
  • Electrolyte replacement. Electrolytes are minerals in your blood. Electrolytes such as potassium and sodium may be given in pill form or through an IV tube.
  • Antibiotic medicines. These may be prescribed if your condition was caused by an infection.

Diabetic ketoacidosis is a serious medical condition. You may need emergency treatment in the hospital to monitor your condition.

Follow these instructions at home:

Eating and drinking

  • Drink enough fluids to keep your urine clear or pale yellow.
  • If you are not able to eat, drink clear fluids in small amounts as you are able. Clear fluids include water, ice chips, fruit juice with water added (diluted), and low-calorie sports drinks. You may also have sugar-free jello or popsicles.
  • If you are able to eat, follow your usual diet and drink sugar-free liquids, such as water.

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Continue to take insulin and other diabetes medicines as told by your health care provider.
  • If you were prescribed an antibiotic, take it as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.

General instructions

  • Check your urine for ketones when you are ill and as told by your health care provider.
    • If your blood glucose is 240 mg/dL (13.3 mmol/L) or higher, check your urine ketones every 4–6 hours.
  • Check your blood glucose every day, as often as told by your health care provider.
    • If your blood glucose is high, drink plenty of fluids. This helps to flush out ketones.
    • If your blood glucose is above your target for 2 tests in a row, contact your health care provider.
  • Carry a medical alert card or wear medical alert jewelry that says that you have diabetes.
  • Rest and exercise only as told by your health care provider. Do notexercise when your blood glucose is high and you have ketones in your urine.
  • If you get sick, call your health care provider and begin treatment quickly. Your body often needs extra insulin to fight an illness. Check your blood glucose every 4–6 hours when you are sick.

Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your blood glucose level is higher than 240 mg/dL (13.3 mmol/L) for 2 days in a row.
  • You have moderate or large ketones in your urine.
  • You have a fever.
  • You cannot eat or drink without vomiting.
  • You have been vomiting for more than 2 hours.
  • You continue to have symptoms of diabetic ketoacidosis.
  • You develop new symptoms.

Get help right away if:

  • Your blood glucose monitor reads “high” even when you are taking insulin.
  • You faint.
  • You have chest pain.
  • You have trouble breathing.
  • You have sudden trouble speaking or swallowing.
  • You have vomiting or diarrhea that gets worse after 3 hours.
  • You are unable to stay awake.
  • You have trouble thinking.
  • You are severely dehydrated. Symptoms of severe dehydration include:
    • Extreme thirst.
    • Dry mouth.
    • Rapid breathing.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • Diabetic ketoacidosis is a serious complication of diabetes. This condition develops when there is not enough insulin in the body.
  • This condition is diagnosed based on your medical history, a physical exam, and blood tests. You may also have a urine test to check for ketones.
  • Diabetic ketoacidosis is a serious medical condition. You may need emergency treatment in the hospital to monitor your condition.
  • Contact your health care provider if your blood glucose is higher than 240 mg/dl for 2 days in a row or if you have moderate or large ketones in your urine.
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