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Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) happens when the body does not have enough insulin and can’t get the sugar it needs for energy. When the body can’t use sugar for energy, it starts to use fat for energy. This process makes fatty acids called ketones. The ketones build up in the blood and change the chemical balance in your body.

This problem can be very dangerous and needs to be treated. Without treatment, it can lead to a coma or death.

DKA occurs most often in people with type 1 diabetes. But people with type 2 diabetes also can get it. DKA can be caused by many things. It can happen if you don’t take enough insulin. It can also happen if you have an infection or illness like the flu. Sometimes it happens if you are very dehydrated.

DKA can only be treated with insulin and fluids. These are often given in a vein (IV).

  • Symptoms

    What are the symptoms of diabetic ketoacidosis?

    Symptoms of diabetic ketoacidosis include blurred vision, trouble staying awake or being woken up, fast and deep breathing, breath that smells fruity, belly pain, not feeling hungry, vomiting, and feeling confused. Anyone who has these symptoms needs emergency treatment.

  • Causes

    What causes diabetic ketoacidosis?

    If you have type 1 diabetes, sometimes your blood sugar level may get high before you know something is wrong. Without enough insulin, the cells in the body can't get the sugar (glucose) they need for energy. So the body starts to break down fat and muscle for energy. This produces ketones, or fatty acids. The ketones enter the bloodstream and cause the chemical imbalance called diabetic ketoacidosis. It can be life-threatening.

  • Treatment

    How is diabetic ketoacidosis treated?

    If the symptoms of diabetic ketoacidosis are severe, you may need to be treated in an intensive care unit. Treatment includes fluids given through a vein (intravenous, or IV) and insulin. IV fluids treat dehydration and balance electrolytes. Insulin lowers blood sugar and keeps the body from producing ketones.

  • When to call

    Diabetic ketoacidosis (DKA): When to call

    Call 911 anytime you think you may need emergency care. For example, call if:

    • You passed out (lost consciousness).
    • You are confused or cannot think clearly.
    • Your blood sugar is very high or very low.

    Watch closely for changes in your health, and be sure to contact your doctor if:

    • Your blood sugar stays outside the level your doctor set for you.
    • You have any problems.
  • Care

    How can you care for diabetic ketoacidosis (DKA)?

    To reduce your chance of ketoacidosis:

    • Take your insulin and other diabetes medicines on time and in the right dose.
      • If an infection caused your DKA and your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
    • Test your blood sugar before meals and at bedtime or as often as your doctor advises. This is the best way to know when your blood sugar is high so you can treat it early. Watching for symptoms is not as helpful. This is because you may not have symptoms until your blood sugar is very high. Or you may not notice them.
    • Teach others at work and at home how to check your blood sugar. Make sure that someone else knows how do it in case you can’t.
    • Wear or carry medical identification at all times. This is very important in case you are too sick or injured to speak for yourself.
    • Talk to your doctor about when you can start to exercise again.
    • Eat regular meals that spread your calories and carbohydrate throughout the day. This will help keep your blood sugar steady.
    • When you are sick:
      • Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. Talk with your doctor about a plan when you are well. Then you will know what to do when you are sick.
      • Drink extra fluids to prevent dehydration. These include water, broth, and sugar-free drinks. If you don’t drink enough, the insulin from your shot may not get into your blood. So your blood sugar may go up.
      • Try to eat as you normally do, with a focus on healthy food choices.
      • Check your blood sugar at least every 3 to 4 hours. Check it more often if it’s rising fast. If your doctor has told you to take an extra insulin dose for high blood sugar levels (for example, above 240 mg/dL) be sure to take the right amount. If you’re not sure how much to take, call your doctor.
      • Check your temperature and pulse often. If your temperature goes up, call your doctor. You may be getting worse.
      • If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 240 mg/dL). Call your doctor if your ketone level is moderate or high.

    If you know your blood sugar is high, treat it before it gets worse.

    • If you missed your usual dose of insulin or other diabetes medicine, take the missed dose or take the amount your doctor told you to take if this happens.
    • If you and your doctor decide on a dose of extra-fast-acting insulin, give yourself the right dose. If you take insulin and your doctor has not told you how much fast-acting insulin to take based on your blood sugar level, call your doctor.
    • Drink extra water or sugar-free drinks to prevent dehydration.
    • Wait 30 minutes after you take extra insulin or missed medicines. Then check your blood sugar again.
    • If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor. If you start to feel sleepy or confused, call 911.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.