Diabetic ketoacidosis is a serious complication of diabetes that needs urgent treatment. It develops when your body does not have enough insulin to use glucose properly for energy. Instead, it starts breaking down fat, producing chemicals called ketones. If ketones build up, they make the blood acidic and can quickly make you very unwell. Knowing the main DKA symptoms and diabetic ketoacidosis causes can help you act quickly.
What is diabetic ketoacidosis?
Diabetic ketoacidosis, usually shortened to DKA, happens when there is a severe shortage of insulin. Insulin allows glucose to move from your blood into your cells, where it is used for energy. Without enough insulin, your body turns to fat for fuel instead, producing acidic chemicals called ketones.
High ketone levels can change the chemical balance of your blood and cause severe dehydration. The NHS guidance on diabetic ketoacidosis explains that DKA can be life threatening and requires urgent hospital treatment.
Who is most at risk of DKA?
DKA is most common in people with type 1 diabetes because they depend on insulin treatment. It can also affect some people with type 2 diabetes, particularly those who use insulin. In some cases, diabetic ketoacidosis is the first clear sign that someone has type 1 diabetes.
Although it is more common in type 1 diabetes, nobody should ignore possible DKA symptoms because their diabetes type, treatment or usual readings seem different. Follow your care plan and seek medical help when advised.
What are the main diabetic ketoacidosis causes?
The most common diabetic ketoacidosis causes involve having too little insulin for your body’s needs. This might happen because an insulin dose has been missed, too little insulin has been taken or an insulin pump has failed or become disconnected.
Illness is another trigger. Infections such as flu, a chest infection or a urinary tract infection can increase the amount of insulin your body needs. Surgery, injury and other physical stress can also raise blood glucose and contribute to DKA. Sometimes there is no obvious trigger.
Understanding diabetic ketoacidosis causes matters because DKA can sometimes be prevented if rising blood glucose or ketone levels are spotted early. Never stop taking insulin because you are unwell or not eating normally unless your diabetes team has specifically told you to do so.
What DKA symptoms should you look for?
Early DKA symptoms can resemble ordinary high blood glucose. You may feel extremely thirsty, need to urinate more often and feel unusually tired. As ketones rise, you may develop stomach pain, nausea, vomiting, blurred vision or deeper breathing than usual. Other DKA symptoms include fruity smelling breath, drowsiness, confusion or difficulty staying awake. Symptoms often develop within about 24 hours, but they can appear more quickly.
The Diabetes UK guide to DKA also explains the warning signs and why prompt treatment matters. If you have not been diagnosed with diabetes but develop symptoms suggesting DKA, you still need urgent medical assessment.
When should you check your ketones?
If you have diabetes and your blood glucose is high, particularly when you are unwell, you may need to test your blood or urine for ketones. Your diabetes team should tell you when to test and what action to take.
As a general NHS guide, a blood ketone level below 0.6 mmol/L is normal. A result from 0.6 to 1.5 mmol/L is slightly high, while 1.6 to 3 mmol/L means there is a risk of DKA and you should contact your diabetes care team. A reading above 3 mmol/L may indicate diabetic ketoacidosis and needs emergency medical attention.
When is diabetic ketoacidosis an emergency?
Diabetic ketoacidosis is a medical emergency when ketones are very high or serious symptoms are present. According to current NHS advice on high blood sugar, you should call 999 or go to A&E if you have high blood sugar with vomiting, stomach pain, faster breathing, severe drowsiness, confusion or fruity-smelling breath, or if you have a high level of ketones.
You should also seek emergency help if you have DKA symptoms and have not previously been diagnosed with diabetes. Do not wait to see whether the symptoms pass. DKA can worsen rapidly.
How is DKA treated?
DKA is treated in hospital. Treatment usually includes insulin given into a vein, intravenous fluids to correct dehydration and replacement of important salts and nutrients. Your blood glucose, ketones and other measurements will be monitored closely.
Can you reduce the risk of DKA?
You cannot prevent every episode, but understanding diabetic ketoacidosis causes can lower your risk. Take your insulin as prescribed, check your blood glucose as advised and follow your diabetes team’s sick day rules when you are ill. These may include checking glucose and ketones more often and adjusting insulin using the guidance you have been given.
FAQs
Can you have diabetic ketoacidosis without knowing you have diabetes?
Yes. Diabetic ketoacidosis can sometimes be the first sign of type 1 diabetes, particularly in children and younger people. If you have extreme thirst, frequent urination, vomiting, fruity smelling breath, deep breathing, drowsiness or confusion and have never been diagnosed with diabetes, seek urgent medical help because DKA needs hospital assessment and treatment.
Can DKA happen even if blood sugar is not extremely high?
Yes. In some circumstances, DKA can occur without the very high blood glucose levels people often associate with it. If you have DKA symptoms and feel seriously unwell, do not dismiss them because one glucose reading seems lower than expected. Your symptoms and ketone levels can still indicate that urgent medical assessment is needed.
How quickly can diabetic ketoacidosis develop?
Diabetic ketoacidosis can develop over roughly 24 hours, but sometimes it progresses much faster. This is why you should respond promptly to rising ketones, persistent high blood glucose or worsening illness. If you use insulin, follow your sick day guidance, check ketones when advised and seek urgent help if your readings or symptoms suggest DKA.
