How to Prevent Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes (diabetes mellitus). It develops when there is not enough of a hormone called insulin in the body.

If the body does not have enough insulin, it cannot divide (break down) sugar (glucose) into usable cells, so it breaks down fats instead. This leads to the production of acids (ketones), which can cause the blood to have too much acid in it (acidosis). DKA is a medical emergency that must be treated at the hospital.

You may be more likely to develop DKA if you have type 1 diabetes and you take insulin. You can prevent DKA by working closely with your health care provider to manage your diabetes.

What nutrition changes can be made?

• Follow your meal plan, as directed by your health care provider or diet and nutrition specialist (dietitian).
• Eat healthy meals at about the same time every day. Have healthy snacks between meals.
• Avoid not eating for long periods of time. Do not skip meals, especially if you are ill.
• Avoid regularly eating foods that contain a lot of sugar. Also avoid drinking alcohol. Sugary food and alcohol increase your risk of high blood glucose (hyperglycemia), which increases your risk for DKA.
• Drink enough fluid to keep your urine pale yellow. Dehydration increases your risk for DKA.

What actions can I take to lower my risk?

To lower your risk for diabetic ketoacidosis, manage your diabetes as directed by your health care provider:

• Take insulin and other diabetes medicines as directed.
• Check your blood glucose every day, as often as directed.
• Follow your sick day plan whenever you cannot eat or drink as usual. Make this plan in advance with your health care provider.
• Check your urine for ketones as often as directed.
  • During times when you are sick, check your ketones every 4–6 hours.
  • If you develop symptoms of DKA, check your ketones right away.
• If you have ketones in your urine:
  • Contact your health care provider right away.
  • Do not exercise.
• Know the symptoms of DKA so that you can get treatment as soon as possible.
• Make sure that people at work, home, and school know how to check your blood glucose, in case you are not able to do it yourself.
• Carry a medical alert card or wear medical alert jewelry that says that you have diabetes.

Why are these changes important?

DKA is a warning sign that your diabetes is not being well-controlled. You may need to work with your health care provider to adjust your diabetes management plan. DKA can lead to a serious medical emergency that can be life-threatening.

Where to find support

For more support with preventing DKA:

• Talk with your health care provider.
• Consider joining a support group. The American Diabetes Association has an online support community at: community.diabetes.org/home  

Where to find more information

Learn more about preventing DKA from:

• American Diabetes Association: www.diabetes.org  
• American Heart Association: www.heart.org  

Contact a health care provider if:

You develop symptoms of DKA, such as:

• Fatigue.
• Weight loss.
• Excessive thirst.
• Light-headedness.
• Fruity or sweet-smelling breath.
• Excessive urination.
• Vision changes.
• Confusion or irritability.
• Nausea.
• Vomiting.
• Rapid breathing.
• Pain in the abdomen.
• Feeling warm in your face (flushed). This may or may not include a reddish color coming to your face.

If you develop any of these symptoms, 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

• DKA may be a warning sign that your diabetes is not being well-controlled. You may need to work with your health care provider to adjust your diabetes management plan.
• Preventing high blood glucose and dehydration helps prevent DKA.
• Check your urine for ketones as often as directed. You may need to check more often when your blood glucose level is high and when you are ill.
• DKA is a medical emergency. Make sure you know the symptoms so that you can recognize and get treatment right away.