Diabetic Ketoacidosis (DKA): Causes, Symptoms, Treatments

Diabetes is a disease with many complications, but few are more serious than diabetic ketoacidosis or DKA.

DKA is a life-threating condition that requires immediate hospitalization to treat.

Despite its seriousness, DKA can be prevented with the right diabetes treatment.

In this article, the basics of DKA will be explained.

What is DKA?

Diabetic ketoacidosis is a disease where there is too much of an acid known as ketones (or ketone bodies) in the blood.

This occurs when blood sugars rise to very high levels due to a lack of insulin.

Insulin is the key that allows the body to use up blood glucose (blood sugar). If insulin levels are extremely low or nonexistent, blood sugar can continue to rise and rise, reaching dangerous levels.

As this is happening, the body is unable to use glucose for energy and is literally starving from the inside. With glucose trapped in the bloodstream, the body begins to create its own energy source using fatty acids known as ketones.

Small amounts of ketones are normal, and they can appear after an extended fast or a very low carb diet.

However, the ketone level in someone with DKA is over 6 times the normal level. This amount is too much for the body to handle and begins to acidify the bloodstream.

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What are the risk factors for DKA?

DKA is caused by an insulin deficiency and very high blood sugars, but what causes this to happen in the first place?

DKA is more common in type 1 diabetes because the body cannot make its own insulin.

Although less common, DKA can happen in type 2 diabetes, as well. The following are risk factors of developing DKA:

  • Undiagnosed type 1 diabetes.

  • Not taking diabetes medications.

  • Age under 19.

  • Increases in stress.

  • Illness and infection.

  • Recent surgery.

  • Excessive alcohol intake.

For example, a person with type 1 diabetes that is not taking insulin medication and is experiencing the stress from a flu infection would be at high risk for developing DKA.

Symptoms and complications of DKA

Classic symptoms of DKA also mimic the signs of very high blood sugars; they can develop quickly and include:

  • Extreme thirst.

  • Dry mouth.

  • Nausea.

  • Vomiting.

  • Excessive urination.

  • Tiredness and fatigue.

  • Fruity breath.

  • Abdominal pain.

  • Confusion.

  • Loss of appetite.

Left untreated, the complications of DKA are serious and can include:

  • Cerebral edema (brain swelling).

  • Dehydration.

  • Shock.

  • Kidney failure.

  • Respiratory failure.

  • Death.

How is DKA diagnosed?

DKA is diagnosed when high blood sugars are combined with acidic blood and the presence of ketones in the blood or urine.

Blood sugar levels typically need to be 250 mg/dl (13.9 mmol/L) or higher, and the pH of the blood needs to be less than 7.30, where normal is 7.35-7.45 (a lower pH is more acidic).

Blood gases such as serum bicarbonate will also be checked to assess the acid level of the blood.

A medical provider will use these laboratory parameters along with clinical symptoms to make the diagnosis of DKA.

Treating DKA

The quick treatment of DKA is essential to reduce dangerous complications. The main treatment strategies are summarized below.

  • Rehydrate and restore electrolytes. IV fluid solutions will be used to quickly rehydrate the bloodstream and correct low levels of electrolytes such as potassium and magnesium.

  • Correct blood sugar. Insulin will also be given via an IV and will help to reduce blood sugars quickly.

  • Correct the acidosis. Many times, the above strategies are enough to resolve the acidosis, but sometimes patients are given additional agents such as sodium bicarbonate are used to neutralize the acids.

Preventing DKA

If corrected in time, DKA can usually be managed without complications.

However, preventing DKA in the first place will always be the best treatment.

There are a few strategies that can help ensure blood sugars stay within safe levels:

  • Take insulin as prescribed. If insulin therapy is prescribed, this means there is some level of insulin deficiency present, and this must be corrected to avoid high blood sugars.

  • Monitor blood sugar levels. Frequent checking of blood sugars, at varying times of the day, is an important strategy to prevent things from getting too far out of control. Alert a medical provider if levels are persistently elevated more than normal.

  • Manage sick days. Illness can cause blood sugars to rise to high levels. It is recommended to continue taking diabetes medications as normal but to check blood sugar more often, and to stay hydrated with sugar-free beverages. Alert a medical provider if there are ketones present or blood sugars remain above 250 mg/dl (13.9 mmol/L). Urine strips are available to test for ketones.

  • Keep nutrition in check. Continuing to eat healthily and monitor portion sizes, especially of carbohydrates, will help to keep blood sugar levels in normal ranges.


Diabetes ketoacidosis is a severe complication of diabetes. It occurs when an insulin deficiency is met with uncontrolled blood sugar levels.

DKA occurs more often in people with type 1 diabetes. Treating DKA involves hospitalization and IV fluids. Keeping blood sugar controlled and staying on top of diabetes management is the key to preventing DKA.

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  1. Diabetic ketoacidosis. (2018, June 12). Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551.Gosmanov, A. R. (2018, May 17).
  2. Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK279052/.Trachtenbarg, D. E. (2005, May 1).
  3. Diabetic Ketoacidosis. Retrieved from https://www.aafp.org/afp/2005/0501/p1705.html.

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