Everything you need to know about Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) can be life-threatening: Here’s what you need to know.

DKA is a serious and life-threatening complication that affects people with diabetes and those who have undiagnosed diabetes. The good news? It’s treatable. So it’s really important to understand it and know the warning signs.

What is diabetic ketoacidosis (DKA)?

DKA occurs when the body starts running out of insulin. It develops when there isn’t 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. 

What are the signs and symptoms?

DKA symptoms often come on fairly quickly, sometimes within 24 hours.

Symptoms include:

  • Being very thirsty
  • Urinating often
  • Feeling nauseous, and vomiting
  • Having stomach pain
  • Being weak or tired
  • Being short of breath
  • Having fruity-scented breath
  •  Being confused

Keep in mind that the symptoms are similar to flu and gastro.

More certain signs of DKA (which can show up in home blood and urine test kits) include:

  • High blood sugar level
  • High ketone levels in your urine

How to test and treat DKA?

If you have Type 1 diabetes, you’re sick, and your blood glucose is higher than 15mmol/l, you should check your ketone levels every 4 to 6 hours. The easiest way to test is with a glucometer that also tests for ketones, or with a urine strip test. 

The ketone test will show you have either no ketones, small amounts of ketones, moderate amounts of ketones or large amounts. Slightly high levels could mean that ketones have started to build up in your body. Call your doctor, and take the insulin dose prescribed. Then:

  • Drink 250ml liquid per hour (1 teaspoon/minute). Sugar-free if blood glucose is over 15mmol/l, sugar containing if it’s below.
  • If stomach cramps get worse and you can’t keep fluids down, go to a hospital.
  • If you start feeling better, continue with treatment.

Seek emergency care immediately if:

  • You can’t keep fluids down after 1 hour and you’re testing positive for ketones.
  • You have symptoms of DKA: excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-smelling breath, and confusion.

How is DKA treated in hospital?

In hospital, you’ll be given insulin through an IV to bring your ketones down. You might also get IV fluids to rehydrate you and balance your electrolytes. If you have any infection, you’ll be given antibiotics.

DKA is fully treated when your blood sugar is less than 10mmol/l, and your blood pH is higher than 7.3. This usually takes about 24 hours, although you can expect to stay in hospital for 2-3 days.

If left untreated, DKA results in coma or death. Because of this, you need to treat DKA as soon as possible.

What causes diabetic ketoacidosis?

Very high blood sugar and low insulin levels lead to DKA. The 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. Sometimes being sick can cause your body to release higher amounts of certain hormones like cortisol (stress hormone) and adrenaline. These hormones make it more difficult for your body to use insulin properly. Vomiting from an illness can also trigger DKA.
  • Missing insulin shots, a clogged insulin pump, or the wrong insulin dose.

“Diabetic ketoacidosis happens when you do not have enough insulin, either because your needs have increased (with an infection) or you have skipped doses. Infection, stress, and menstruation are common triggers, but sometimes it’s not clear what the trigger is at all.”

Dr CLaudine Lee, GP with a special interest in diabetes

Other causes of diabetic ketoacidosis (DKA) include:

  • Heart attack or stroke.
  • Physical injury, such as from a car accident.
  • Emotional trauma, due to the high amounts of cortisol (stress hormone) produced by the body, which makes it difficult for your body to use insulin properly.
  • Menstruation, as a result of increased hormone levels.
  • Pregnancy, due to insulin resistance.
  • Alcohol or drug use, as hormone levels increase, and a person is more likely to miss their insulin dose under the influence.
  • Certain medicines, such as some diuretics and corticosteroids (used to treat inflammation in the body).

Who does DKA affect?

DKA can develop in people of any age who have diabetes or undiagnosed diabetes.

  • If you have Type 1 diabetes, you could develop DKA at any time in your life if your body does not get as much insulin as it needs.
  • For some people, DKA is how they find out that they have Type 1 diabetes. 
  • Although it’s not as common, if you have Type 2 diabetes you can develop DKA. Talk to your doctor or clinic nurse about your risk factors to make sure you have the right treatment plan in place.
  • In Type 1 diabetes it’s more common in young children and teenagers due to an increase in growth hormones and sex hormones.

How to prevent DKA?

Early recognition and treatment of the signs can prevent DKA. Here’s what to do, and look out for:

  • Check your blood sugar often, especially if you’re sick. As much as possible, keep your blood sugar within your target range.
  • Take medicines as prescribed, even if you feel fine. Missed doses of insulin can lead to DKA.
  • Check for ketones if you have ongoing high blood sugar, to make sure you’re not close to developing DKA.
  • Have a sick day plan. Since illness can trigger DKA, it’s important to know what to do if you get sick before it happens so that you’re prepared. Chat to your doctor or clinic nurse.
  • See your doctor regularly. The more you know about DKA and your diabetes management, the more likely you will be able to prevent DKA or catch it early.

We know diabetes complications can feel scary, but knowledge is power! The more you understand, the better you can manage your condition.

For encouragement and advice from other people living with diabetes, join our South Africans with Diabetes community.

What to read next?

Symptoms of high blood sugar: Here are the symptoms of high blood sugar so you can tell if you need to speak to your doctor about adjusting your medication.

Less common side-effects of diabetes: While diabetes has some common symptoms – particularly before you are diagnosed – there are also some less common side-effects of diabetes, when you live with the condition every day.

The Diabetes Dawn Phenomenon / Dawn Effect: The Dawn phenomenon is defined as an “abnormal early-morning increase in blood sugar, usually between 3am and 8am.

Photo by Etactics Inc and Yuris Alhumaydy on Unsplash

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