Diabetic ketoacidosis (DKA) – symptoms and treatment

Diabetic ketoacidosis (DKA) is a life-threatening health problem that’s caused by a lack of the hormone insulin. It usually affects people with type 1 diabetes, but it can also happen if you have type 2 diabetes.

When your body doesn’t have enough insulin, it can’t use sugar (glucose) for energy. So it starts to break down body fat instead. This breakdown of fat releases acidic chemicals called ‘ketones’, which build up in your blood. High levels of ketones make your blood too acidic, leading to severe dehydration.

If you have symptoms of DKA you need emergency treatment. So read on to learn the symptoms and how it’s managed – and what you can do to prevent it.

What are the symptoms?

The symptoms of diabetic ketoacidosis (DKA) usually come on quickly, sometimes in less than 24 hours.

They can include:

• feeling very thirsty
• dry mouth, headache, and flushed skin (signs of dehydration)
• needing to pee a lot more than usual
• feeling tired or confused
• having breath that smells fruity (like pear drop sweets)
• nausea
• vomiting
• belly pain
• shortness of breath.
• loss of consciousness (coma).

When to get emergency medical help

Diabetic ketoacidosis (DKA) can be life-threatening, so it’s important to get help right away.
Get emergency help if:

• you have a high level of ketones in your blood (over 3mmol/L) or pee (over 2+) – as shown in home tests for diabetes
• you have symptoms of DKA – even if you haven’t been diagnosed with diabetes.

Speak to a doctor immediately if you have diabetes and you:

• have high blood glucose but your insulin treatment isn’t helping to lower it, even if your ketones are normal
• have slightly high levels of ketones (0.6 to 1.5mmol/L) and you don’t feel well
• have ketones of 1.6 to 3mmol/L – even if you have not got symptoms.

What is the cause and who is affected?

The most common causes of DKA include:

• illness – When you’re sick, your body makes different hormones to help fight the infection – and these hormones can interfere with insulin and stop it from doing its job properly. This can be due to the flu (influenza) or urinary tract infections (UTIs), for example
• a problem with your diabetes treatment – such as missed insulin doses – which leads to you not having enough insulin
• undiagnosed – and therefore untreated – diabetes (usually type 1). Sometimes DKA can be the first sign of diabetes, especially in children.

Other things that can lead to DKA when you have diabetes include:

• drug or alcohol misuse
• surgery or injury
• stroke or heart attack
• inflammation of the pancreas (pancreatitis)
• stress/trauma
• high blood sugar caused by having your period.

About 1 in 4 people who gets diabetic ketoacidosis (DKA) haven’t yet been diagnosed with diabetes.

Diagnosing and treating DKA

Tests to diagnose diabetic ketoacidosis (DKA) include:

• blood tests – to check your blood sugar (glucose) and ketone levels, and whether your blood is acidic
• pee (urine) tests – to check for ketones
• other tests – to check for health conditions that may have caused DKA, and any health problems as a result.

If DKA is detected early, extra insulin and fluids might be enough to treat it. But you’ll typically need to be admitted to hospital for treatment.
DKA is usually treated with:

• insulin – given through a drip into a vein (known as intravenous, or IV) to reverse DKA
• fluids – again given into vein, to rehydrate your body
• mineral (electrolyte) replacement – such as potassium and sodium – given intravenously to restore the balance lost due to little insulin, as well as vomiting and other effects of DKA.

You’ll also be checked and monitored for complications. DKA can sometimes affect your lungs, heart, kidneys, or brain. These complications can be serious, and need urgent treatment.

If DKA is treated right away, you’ll usually recover quickly. You’ll be able to leave the hospital when your ketones have returned to safe levels, and you’re well enough to eat and drink normally. Patients with DKA usually stay in hospital for around 3 or 4 days.

Can you prevent DKA?

If you have diabetes, it’s important to stick to your management plan – such as taking your insulin, following a balanced diet, and regularly checking your blood sugar levels.

Talk to your healthcare team about how to check your ketone levels at home using a pee or blood test. You can then test for ketones if:

• you have high blood sugar
• you’re sick
• you have symptoms of DKA.

When you’re sick, you may need to increase your insulin, as part of ‘sick day rules’ agreed with your healthcare team. You should also:
continue taking your insulin, even if you're unable to eat your usual amounts of food

• stay hydrated with sugar-free drinks
• try soups or liquid carbohydrates if you’re struggling to eat – and see your doctor if you can’t keep these down
• use sugar-free cough mixtures and cold remedies
• check your blood sugar more often – usually at least four times a day, including at night if necessary
• get advice from your healthcare team if you’re unsure about what to do.