Diabetic Ketoacidosis (DKA)

Topic Overview

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin.

When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine.

Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis.

What causes DKA?

Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high.

What are the symptoms?

Your blood sugar may be quite high before you notice symptoms, which include:

  • Flushed, hot, dry skin.
  • Blurred vision.
  • Feeling thirsty and urinating a lot.
  • Drowsiness or difficulty waking up. Young children may lack interest in their normal activities.
  • Rapid, deep breathing.
  • A strong, fruity breath odor.
  • Loss of appetite, belly pain, and vomiting.
  • Confusion.

How is DKA diagnosed?

Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high.

How is it treated?

When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolytes). The doctors and nurses will watch you closely to be sure that your brain does not swell as the fluids treat your dehydration.

It can take several days for your blood sugar level to return to a target range.

How can I prevent DKA?

The risk for DKA is higher when you are sick. Stress hormones released due to illness can raise your blood sugar. You may be at risk for dehydration if you are vomiting. Or you may not take your diabetes medicine when you don't feel like eating.

To prevent DKA when you are not feeling well, try to drink water, take your diabetes medicine, and eat a little food. Test your blood sugar often. If you are taking insulin, do a test for ketones, especially if your blood sugar is higher than 300 mg/dL.

You and your doctor can make your sick day plan before you get sick so you can prevent a DKA emergency or know when to get help.

References

Other Works Consulted

  • Cooppan R, et al. (2010). Acute complications. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 419–443. Boston: Joslin Diabetes Center.
  • Eisenbarth GS, Buse JB (2011). Type 1 diabetes mellitus. In S Melmed et al., eds., Williams Textbook of Endocrinology, 12th ed., pp. 1436–1461. Philadelphia: Saunders.
  • Masharani U, German MS (2011). Pancreatic hormones and diabetes mellitus. In DG Gardner, D Shoback, eds., Greenspan's Basic and Clinical Endocrinology, 9th ed., pp. 573–655. New York: McGraw-Hill.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Rhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator
Last Revised August 15, 2013

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