Diabetic Ketoacidosis

Medically Reviewed by Michael Dansinger, MD on November 06, 2022
4 min read

Diabetic ketoacidosis, also known as DKA, is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. DKA is a serious complication of diabetes and could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too.

Diabetic ketoacidosis symptoms can appear quickly and may even be your first warning sign that you have diabetes. Symptoms include:

Call your doctor or go to the emergency room right away if you have any of the symptoms below and your ketones are moderate to high when you test them using a home kit, or if you have more than one symptom:

  • You've been throwing up for more than 2 hours.
  • You feel queasy or your belly hurts.
  • Your breath smells fruity.
  • You're tired, confused, or woozy.
  • You're having a hard time breathing.


Diabetic ketoacidosis usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones. If the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system.

People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you:

  • Miss a meal
  • Are sick or stressed
  • Have an insulin reaction
  • Haven’t injected enough insulin

DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration.

Risk factors for DKA include:


Test your ketones when your blood sugar is over 250 mg/dL (milligrams per deciliter) or you have any of the above symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot.

You can check your sugar levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes.

Your doctor can give you a physical exam, ask about your symptoms, and discuss your medical history. They can order these tests to diagnose DKA too:

  • Bloodwork, including metabolic panel and electrolytes
  • Urinalysis
  • Arterial blood gas
  • Blood pressure
  • Tests for signs of infection
  • Chest X-ray
  • Electrocardiogram


If you don't treat ketoacidosis, you could pass out, go into a coma, and possibly die. You should go to the hospital to treat DKA. There, you will receive emergency treatments like:

  • Insulin through an IV to bring your ketones down
  • Fluids to get you hydrated and bring your blood chemistry back into balance
  • Electrolyte replacement through an IV to replace key minerals like sodium, potassium, and chloride to keep your heart, muscles, and nerves working properly
  • If you have any infection, antibiotics
  • If your doctor suspects you’re at risk for a heart attack, a further heart evaluation


DKA complications are possible if you don’t have emergency treatments like electrolyte replacement and insulin. They include:


Your doctor may change your insulin dose, or the kind you use, to prevent DKA from happening again.

Good blood sugar control will help you avoid ketoacidosis in the future. Make sure you manage your diabetes through your diet, exercise, medications, and self-care.

Follow these steps to help prevent DKA:

  • Drink lots of water or sugar-free, nonalcoholic beverages.
  • Take your medicines as directed.
  • Follow your meal plan closely.
  • Keep up with your exercise program.
  • Test your blood sugar regularly.
  • Check for expired insulin.
  • Don't use your insulin dose if it has clumps. Insulin should either be clear or evenly cloudy with small flecks.
  • If you're on an insulin pump, look closely for insulin leaks, and check your tube connections for air bubbles.
  • Talk to your doctor if your blood sugar levels are often out of your target range.
  • Manage your insulin dose with help from your doctor or diabetes coach. Make adjustments based on your blood sugar levels, what you eat, activity levels, or during any illness.
  • Create a DKA emergency plan. If your blood sugar levels are too high or your urine has too many ketones, make a plan to go to the hospital.


Show Sources


American Diabetes Association: "DKA (Ketoacidosis) & Ketones," "Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)."

Mayo Clinic: "Diabetic Ketoacidosis."

Beth Israel Lahey Health Winchester Hospital: “Diabetic Ketoacidosis.”

American Association for Clinical Chemistry: “Comprehensive Metabolic Panel (CMP).”

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