Diabetic Ketoacidosis (DKA)

A serious diabetes complication where the body produces excess blood acids (ketones).

In type 1 diabetes

It is a life-threatening emergency usually affecting people with type 1 diabetes.

In type 2 diabetes

Although less common, it also can happen with type 2 diabetes. DKA is rare in type 2 diabetes – but can develop if someone with type 2 diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in type 2 diabetes are severe infections, acute pancreatitis, and treatment with steroids.

How DKA starts?

DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours.

As we know, without enough insulin, the body cannot burn glucose properly so it builds up, resulting in high blood sugar levels. In its response, the body starts breaking down fat into a useable fuel to give energy that doesn't require insulin. As a consequence, the excess fat goes to the liver which makes ketoacids (also known as ketones) out of the fat. When too many ketones build up, your blood becomes acidic and slowly, the body is literally poisoning itself with excess glucose and ketoacids.

What causes DKA?

A lack of insulin usually due to:

  • Unknown or newly diagnosed cases of type 1 diabetes
  • Missed or inadequate doses of insulin, or spoiled insulin
  • Not taking enough food
  • Infection
  • Steroid medications
  • An extremely stressful medical condition


Early symptoms include the following:

  • Thirst or a very dry mouth
  • Frequent urination
  • High blood glucose (blood sugar) levels
  • High levels of ketones in the urine

Late symptoms include the following:

  • Constantly feeling tired
  • Dry or flushed skin
  • Nausea, vomiting, or abdominal pain
  • Difficulty breathing
  • Fruity odour on breath
  • A hard time paying attention, or confusion

How do you know if you have DKA?

  • Check your blood or urine for ketones.
  • Generally, when you are ill or your blood sugar is more than 240 mg/dl, check for ketones every 4 to 6 hours.
  • Also, check for ketones when you have any symptoms of DKA.
  • Under 0.6 mmol/L – a normal blood ketone value

Call your doctor at once if you experience the following conditions:

  • Your urine tests show high levels of ketones.
  • Your urine tests show high levels of ketones and your blood glucose level is high.
  • Your urine tests show high levels of ketones and you have vomited more than twice in four hours.
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