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What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body.
Ketoacidosis shouldn’t be confused with ketosis, which is harmless. Ketosis can occur as a result of an extremely low carbohydrate diet, known as a ketogenic diet, or from fasting.
DKA only happens when you don’t have enough insulin in your body to process blood sugar into energy. If this happens, your liver starts to process fat into energy, which releases ketones into the blood. High levels of ketones in the blood are dangerous.
It’s less common in people with type 2 diabetes because insulin levels don’t usually drop so low, but it can happen. DKA may be the first sign of type 1 diabetes, as people with this disease can’t make their own insulin.
Diabetic ketoacidosis Symptoms
Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice:
- Excessive thirst
- Frequent urination
- Nausea and vomiting
- Stomach pain
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include:
- High blood sugar level
- High ketone levels in your urine
DKA is a medical emergency. Call your local emergency services immediately if you think you may be experiencing DKA.
If left untreated, DKA can lead to a coma or death. or If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place.
If you have type 1 diabetes and have a blood sugar reading of over 240 milligrams per deciliter (mg/dL), you should test yourself for ketones using a urine or blood test.
You should also test if you are sick or planning on exercising and your blood sugar is 240 mg/dL or higher.
Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.
People with type 2 diabetes are usually at lower risk of DKA. But the risk can increase when your body is under strain due to injury, infection, or surgery.
When to see a doctor
If you feel ill or stressed or you’ve had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit.
Contact your doctor immediately if:
- You’re vomiting and unable to tolerate food or liquid
- Your blood sugar level is higher than your target range and doesn’t respond to home treatment
- Your urine ketone level is moderate or high
Seek emergency care if:
- Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
- You have ketones in your urine and can’t reach your doctor for advice
- You have many signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion
How is diabetic ketoacidosis treated?
The treatment for DKA usually involves a combination of approaches to normalize blood sugar and insulin levels.
If you receive a diagnosis of DKA but haven’t yet received a diagnosis of diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring.
Infection can increase the risk of DKA. If your DKA is a result of an infection or illness, your doctor will treat that as well, usually with antibiotics.
At the hospital, your physician will likely give you intravenous (IV) fluids to help your body rehydrate. During a DKA event, you usually lose a lot of fluids, which can reduce the amount of blood flowing through your body.
Fluid replacement helps restore typical blood flow. It also helps treat dehydration, which can cause even higher blood sugar levels.
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When your insulin levels are too low, your body’s electrolytes can also become atypically low.
Electrolytes are electrically charged minerals that help your body, including the heart and nerves, function properly. Electrolyte replacement is also commonly done through an IV.
Insulin will likely be administered to you through an IV until your blood sugar level falls below 200 to 250 mg/dLTrusted Source. The emergency care team will also monitor several other blood test results that indicate when insulin therapy is no longer needed.