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The Dangers of Diabetic Ketoacidosis (DKA)

Nina Ghamrawi, MS, RD, CDE
October 10, 2023
April 30, 2024

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. It usually occurs when glucose readings are critically high for a period of several days or weeks.

DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.

Read on to learn more about DKA, how you can prevent DKA, and how to treat it if needed.

DKA Signs and Symptoms

DKA usually develops slowly. Early symptoms include:

  • Being very thirsty.
  • Urinating a lot more than usual.

If untreated, more severe symptoms can appear quickly, such as:

  • Fast, deep breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity or acetone (nail polish remover) smelling breath
  • Headache
  • Muscle stiffness or aches
  • Being very tired
  • Nausea and vomiting
  • Stomach pain

If you are experiencing any of the above symptoms, and you have medium or high levels of ketones in your blood, or your blood sugars have been above 240 average for at least the recent 2 weeks, or above 400 for 2 days or more, then talk to your doctor immediately. Go to the emergency room or call 911 right away if you can’t get in touch with your doctor. This is a serious condition that requires medical attention to prevent damage to other organs. If you are checking typically less than 4 times per week, check blood sugar daily or multiple times per day to get a more accurate picture.

Causes of DKA

Very high blood sugar and low insulin levels lead to DKA. The three most common causes are:

  • Illness. When you get sick, you may not be able to eat or drink as much as usual, which can make blood sugar levels hard to manage.
  • Missing insulin shots, a clogged insulin pump, or the wrong insulin dose.
  • Significant carbohydrate restriction - such as with the keto diet or fasting.

Other causes of DKA include:

  • Heart attack or stroke
  • Physical injury, such as from a car accident
  • Significant alcohol or drug abuse

Prevent DKA

DKA is a serious condition, but you can take steps to help prevent it:

  • Check your blood sugar often, especially if you’re sick.
  • Keep your blood sugar levels in your target range as much as possible.
  • Take medicines as prescribed, even if you feel fine.
  • Ask your doctor to adjust your insulin based on what you eat, how active you are, if you’re sick, fasting or on a diet.
  • If your blood sugars are rising or high, it may be best to test your ketones with a home test kit.

If you’re concerned about DKA or have questions about how to manage your diabetes, be sure to meet with your doctor and care team, and ask for a referral to iHealth’s Diabetes Self-Management Education and Support (DSMES), or Medical Nutrition Therapy (MNT) services for individual guidance. MNT and DSMES services are a vital tool to help you manage and live well with diabetes while protecting your health, and are covered by most insurances for Diabetes.

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