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Published on October 15, 2013

Need to Know: Ketoacidosis

October 15, 2013

What is Diabetic Ketoacidosis?
Diabetic Ketoacidosis (DKA) is a very serious complication of diabetes that can be life-threatening. DKA develops when too little insulin is available in the body. Insulin is responsible for helping sugar (glucose) into your cells.  Without enough insulin, your body can’t get the energy it needs and begins to break down fat for energy instead. This breakdown of fat produces ketones. Ketones are acids that build up in the blood and eventually spill into the urine.  High levels of ketones can poison your body and lead to the development of DKA.

DKA can be a sign that your diabetes is out of control or that you may be getting sick.  DKA primarily occurs in Type 1 diabetes, but can still occur in Type 2 diabetes.

What Are The Symptoms?

Early symptoms include:

  • Feeling extra thirsty
  • Constant trips to the bathroom
  • High blood glucose levels (levels over 250)
  • High levels of ketones in urine

Progressive symptoms include:

  • Constantly feeling tired
  • Dry or flushed skin
  • Nausea, vomiting or stomach pain
  • Difficulty breathing
  • Fruity odor on breath
  • Difficulty paying attention or confusion

How Do I Treat It?

After blood sugar levels have been checked and urinary ketone test is positive:

  • Push fluids – At least a glass of water or sugar-free drink every 30 minutes.
  • Take an injection of insulin, based on your individual correction factor.
  • If you wear an insulin pump, take an injection and change infusion set.
  • Recheck blood sugar and urine ketones every hour for 2 more hours. If blood glucose has not significantly dropped, take more supplemental insulin.
  • Call you doctor.

How Can I Prevent It?
Treatment of DKA usually takes place in a hospital, but prevention can occur through recognizing warning signs and checking urine and blood glucose regularly.

  • Commit to managing your diabetes. Make consistent healthy eating and physical activity a part of your routine.  Take oral diabetes medications or insulin as directed.
  • Know how to manage sick days. See Sick Day Guidelines handout.
  • Monitor your blood glucose levels. Check and record your blood glucose levels several times per day as directed by your treatment team.  Check blood glucose levels more frequently when you are ill or under stress.
  • Adjust your insulin dosage as needed. Talk to your doctor or diabetes educator about how to adjust your insulin based on your correction factor.  If your blood glucose levels begin to rise, follow your diabetes treatment plan to return blood glucose levels to your target range.
  • Check your ketone level. When you are ill or under stress, test your urine for excess ketones with an over-the-counter urine ketone test kit which can be purchased for a minimal cost at any pharmacy.  It is important to follow instructions for use found on the package.  If your ketone level is moderate or high, contact your doctor or seek emergency care.
  • Be prepared to act quickly. If you suspect DKA (your blood glucose level is high and you have excess ketones in your urine) seek emergency care.

When Do I Call the Doctor or Seek Emergency Care?

  • With moderate to large ketones
  • If you have taken two supplemental insulin doses without improvement
  • With vomiting, shortness of breath or abdominal discomfort
  • Any time you are not sure what to do

Melissa Romano, RD, LDN

Certified Diabetes Educator



American Diabetes Association,
The Merck Manuals Online Medical Library,

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