Diabetes: Ketoacidosis

Diabetic ketoacidosis (DKA) is an emergency condition caused by untreated hyperglycemia. Ketoacidosis can be a life-threatening situation.

A person with type 1 diabetes has the greatest chance of developing ketoacidosis. If you have type 2 diabetes, your risk of developing ketoacidosis is less -- as long as you still make insulin. However, you are still at risk for developing HHNS, a condition that occurs when blood glucose goes very high and you become severely dehydrated.

What Is Ketoacidosis?

When there isn't enough insulin, your body is unable to use glucose for energy. To continue functioning, your body switches to starvation mode and releases fat to use for energy. However, the fat that gets released is converted to ketones which are utilized more slowly than they are made. As a result, ketones in your blood rise and spill over into your urine. To make matters worse, the high glucose that is also leaking into your urine pulls water out of your body causing dehydration.

Remember, ketoacidosis occurs when hyperglycemia is not treated promptly. It usually develops slowly over several hours. By recognizing and treating the early symptoms of hyperglycemia, you can avoid ketoacidosis, a potentially life-threatening condition.

What Are the Symptoms of Ketoacidosis?

The symptoms of hyperglycemia include:

• Dehydration and excess thirst.
• Excess urination, especially weeks or days before the diagnosis of new onset type 1 diabetes.
• Vomiting.
• Abdominal pain.
• Drowsiness.
• Difficulty breathing.
• Fruity smell to the breath.
• Ketones in your urine.

Call your health care provider immediately if you have any of the above listed symptoms.

How Is Ketoacidosis Treated?

Treatment of ketoacidosis requires insulin and fluids as ordered by your doctor. They may suggest that you increase the dose of your insulin or change your insulin type to a more rapid or short acting form. They will also suggest drinking more fluids - sugar free, of course. You will need to check your sugars frequently and repeat the measure of your urine ketones.

Ketoacidosis can result in coma and possibly death if left untreated.

How Can Ketoacidosis Be Prevented?

• Take your medicines as directed. If you are on an insulin pump always check your tube connections for air bubbles and make sure that there are no leaks of insulin. Also, check your insulin to make sure it has not expired and make sure no clumps have formed. Insulin should always be either clear or uniformly cloudy with particles.
• Follow your meal plan closely.
• Follow your exercise program.
• Test your blood glucose on a regular basis.
• Know when to contact your health care provider if you have repeated abnormal blood glucose levels.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.