What Is Diabetic Ketoacidosis?

Written by Dr. Kulyk Alexander Petrovich on Mon, 20 November 2023

Key Highlights

  • Diabetic Ketoacidosis (DKA) is a life-threatening complication of diabetes caused by severe insulin deficiency, leading to high blood sugar and the release of ketones.
  • DKA can occur when there is low insulin in the body, leading to glucose not being utilized, overproduction of glucose by the liver, accelerated breakdown of fat, and the conversion of fat into ketones, making the blood acidic.
  • Symptoms include extreme thirst, frequent urination, headache, high blood sugar levels, and, in severe cases, abdominal pain, nausea, shortness of breath, fatigue, and confusion.
  • Treatment for DKA involves insulin administration, electrolyte replacement, fluid replenishment, and addressing any underlying illnesses or triggers, such as infection.
  • Regularly monitor blood sugar and ketone levels, adhere to insulin and medication schedules, evaluate insulin pumps for issues, establish a plan for sick days, attend regular healthcare provider visits, and seek clarity from your healthcare team to prevent or identify DKA. 

Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes characterised by low insulin levels, high blood sugar, and the release of ketones. Prompt medical intervention is necessary to address the condition and prevent potential life-threatening consequences.

A Diabetes Complication

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes, which occurs when there is a severe shortage of insulin in the body, leading to high blood sugar levels and the production of ketones. In this high-stakes battle against diabetes, the body's insulin deficiency becomes a catalyst for chaos, unleashing a cascade of dangerous symptoms. Let us go on a journey through the intricacies of this condition, where understanding and intervention hold the key to managing it.

What Is Diabetic Ketoacidosis?

DKA develops when the body has decreased insulin levels. It can occur when insufficient insulin is produced or used by the body or it is given in inadequate quantity to a person with diabetes. Insulin is crucial for converting glucose (the body's primary fuel source) into energy. When insulin levels decrease, glucose cannot be converted into fuel. This causes the body to break down fat to generate energy, which releases ketones into the bloodstream.

Elevated levels of ketones lead to acidification of the blood, which results in a critical medical condition with symptoms like tiredness, headache, urinating more, and vomiting that demands prompt medical intervention and treatment.

Diabetes-induced ketoacidosis is an acute complication due to its severity and rapid onset. DKA can manifest within a span of 24 hours, with an even faster progression if accompanied by vomiting. It is necessary to contact your doctor immediately in case you suspect DKA, and receive timely treatment to prevent the escalation of the condition. If this is not prevented, it may be life-threatening.

What Causes Diabetic Ketoacidosis?

What Causes Diabetic Ketoacidosis

DKA starts when the body has low insulin levels, resulting in several consequences:

  • Glucose, the body's energy source, cannot absorbed from the blood into the cells of the body for utilisation.
  • The liver overproduces glucose, leading to high blood sugar levels.
  • Fat is broken down at an accelerated rate, exceeding the body's capacity to process it.
  • The liver converts the broken-down fat into ketones, a fuel source typically generated during prolonged fasting. Under normal circumstances, the muscles and the heart use these ketones. However, if ketone levels increase abnormally, they may lead to toxicity as the blood becomes acidic.

DKA can be an early sign of type 1 diabetes or occur in individuals diagnosed with diabetes due to factors like infection, injury, missed insulin doses, or stress. Type 2 diabetes can also trigger DKA through prolonged uncontrolled blood sugar, missed medications, or severe illness/infection. But this condition is rare in type 2 diabetes.

What Are the Symptoms of Diabetic Ketoacidosis?

Some early symptoms of DKA include:

  • Extreme thirst
  • Peeing more often than usual (frequent urination)
  • Headache
  • Increased blood glucose (blood sugar) levels (over 250 mg/dL).

Your doctor may also notice increased levels of ketones during your routine blood and urine tests.

Some more severe symptoms of DKA include:

  • Abdominal pain
  • Nausea and vomiting
  • Shortness of breath
  • Profound fatigue or weakness
  • Reduced alertness
  • Disorientation or confusion.

How to Treat Diabetic Ketoacidosis?

If you are diagnosed with DKA, you will receive medical treatment either in the emergency room or you will be admitted to the hospital. Some treatment options include:

  • You will receive insulin as part of your treatment, as it effectively reverses the underlying conditions that allowed the onset of DKA.
  • Electrolytes, essential minerals for the proper functioning of your heart, brain, nerves, and muscles, will be replaced since insufficient insulin levels can lead to electrolyte depletion.
  • Your treatment plan will likely involve replenishing the fluids lost due to frequent urination, which can also dilute the excessive sugar in your bloodstream.
  • Treating an underlying illness, if any, with appropriate medications. For example, an underlying infection will be treated with antibiotics.

Tips To Prevent Diabetic Ketoacidosis

Tips To Prevent Diabetic Ketoacidosis

Let us look at ways to prevent ketoacidosis:

  • Monitor your blood sugar regularly: It is vital to check your blood sugar levels using a glucometer or continuous glucose monitor to effectively manage diabetes and prevent complications.
  • Assess ketone levels: If you experience continuous high blood sugar levels, use blood or urine tests to check for ketones.
  • Take your insulin and/or prescribed medication: Never ever skip a dose of insulin. Follow the instructions provided by your doctor for taking insulin and medications. Skipping doses can increase the risk of DKA.
  • Evaluate your insulin pump: If you rely on an insulin pump to manage diabetes and are noticing elevated blood sugar levels, examine the pump for potential issues that may be hindering insulin delivery.
  • Establish a plan for sick days: Discuss with your doctor how to care for yourself and manage diabetes when you are sick. Since illness can trigger the onset of DKA, it is necessary to be prepared and aware of what actions to take.
  • Attend regular healthcare provider visits: Regular appointments with your healthcare provider are crucial to ensure the effectiveness of your diabetes management plan.

Diabetes management can be challenging and confusing. Do not hesitate to seek clarity about DKA from your healthcare team. The more you understand about DKA and managing your diabetes, the better equipped you will be to prevent or identify it in its early stages.


DKA is a critical and potentially life-threatening complication of diabetes. It arises from a severe insulin deficiency, leading to high blood sugar levels and the release of ketones.

Prompt medical attention, including fluid replacement, insulin therapy, and addressing underlying causes, is crucial for the effective management and prevention of DKA.

Regular monitoring, adherence to treatment plans, and ongoing education are essential in mitigating the risks associated with DKA.


Dr. Kulyk Alexander Petrovich

Dr. Kulyk Alexander Petrovich is a Ukraine-based gynecologist, with extensive experience in women's health. In 1995, he graduated from the Kyiv Medical University, and specialized in gynecology. He then went on to work as a gynecologist in the Institute of Pediatric, Obstetrics and Gynecology in Kyiv, where he worked until the year 2000.

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