Diabetic Ketoacidosis: All You Need to Know

Dr. Pakhi Sharma (MBBS)
Dr. Pakhi Sharma (MBBS)

General Physician | 6+ years

diabetic ketoacidosis
Living with diabetes, hypertension or any other lifestyle disease is difficult and most often a lonely journey. With Phable, India’s no. 1 BP and Sugar Management Mobile App, you can use technology to take charge of your health. Also Phable’s one-stop-shop is here to help you manage your condition better.
As a diabetic, you must be aware of the numerous complications associated with the condition like cardiovascular disease, stroke, diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, etc. However, have you heard of diabetic ketoacidosis? 

Diabetic ketoacidosis (DKA) is a serious and life-threatening complication of both Type 1 Diabetes and Type 2 Diabetes. Despite the condition being preventable, DKA can still cause hospitalization and death in diabetics due to a lack of awareness. In this article, we discuss everything you need to know about diabetic ketoacidosis – its causes, symptoms, how it is diagnosed, treatment, and how to prevent DKA.
Contents:
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    What is Diabetic Ketoacidosis?
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    What Are the Causes of Diabetic Ketoacidosis?
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    What Are the Symptoms of Diabetic Ketoacidosis?
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    How is Diabetic Ketoacidosis Diagnosed?
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    How is Diabetic Ketoacidosis Treated?
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    What Are Diabetic Ketoacidosis Complications?
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    How Can Diabetic Ketoacidosis be Prevented?
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    When To See A Doctor?
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    Don’t Have Time To Read?
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    FAQs
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What is Diabetic Ketoacidosis?

Diabetic Ketoacidosis or DKA is a condition that occurs in diabetics, when your body produces very little insulin. Due to the lack of sufficient levels of insulin, your cells are unable to use the glucose in your blood to generate energy. Because of this, your body starts breaking down the fat in your body to use it as fuel. Your liver processes these fats and turns them into ketones (acidic, water-soluble molecules used to produce energy). The presence of too many ketones in your blood can turn it acidic, which can cause severe complications. 

DKA is more common in Type 1 Diabetics than Type 2 Diabetics. It is a medical emergency that can result in hospitalization and may prove to be fatal if not treated immediately.

What Are the Causes of Diabetic Ketoacidosis?

Diabetic ketoacidosis is caused by high blood ketone levels, which is a result of too little or no insulin production in your body. Several factors can lead to reduced insulin production in Type 2 Diabetics. They are:
  • Missing doses of insulin shots

DKA occurs due to insufficient levels of insulin in your body. If you are a Type 2 Diabetic taking insulin injections to manage your condition, taking lesser than the prescribed dose of insulin, missing or skipping scheduled insulin doses, or using expired or improperly stored insulin could lead to ketoacidosis.  
  • Skipping meals

When you skip a meal or do not eat enough, your body uses stored fat to produce energy. This results in the release of ketones, which could potentially cause diabetic ketoacidosis.   
  • Prolonged stress

Experiencing stress for long periods of time can elevate the levels of stress hormones (cortisol, catecholamines, growth hormones, etc.) in your body. Stress hormones lower insulin production in your body and increase energy production by breaking down fat and protein (muscle). This can increase ketone levels in your body.  
  • Excessive alcohol consumption

Excessive alcohol consumption, alcohol abuse, or binge drinking can often cause nausea, vomiting, and loss of appetite. When you do not consume any food before or after drinking, your body utilizes the glucose stored in your liver to produce energy. When that fuel source is exhausted (after about 12 hours of eating), your body starts breaking down fat to produce energy. This results in elevated ketone levels and a condition called Alcoholic Ketoacidosis. Having diabetes and being malnourished can increase your chances of developing ketoacidosis after an episode of heavy drinking.   
  • Being ill or having an infection

When you are sick or have an infection, your body produces more cortisol and other stress hormones, which lower insulin levels. You may also experience a loss of appetite when you are ill. Both of these factors can lead to ketoacidosis.  
  • Keto diet

A ketogenic diet that is high in fats and low in carbohydrates is considered a good option for weight loss. However, when you have Type 2 Diabetes, a keto diet can increase the production of ketones in your body, which drastically increases your chances of developing diabetic ketoacidosis.

What are the Symptoms of Diabetic Ketoacidosis?

The symptoms of diabetic ketoacidosis can develop quickly (within 24 hours). Diabetic ketoacidosis symptoms are mostly caused by high blood sugar and ketone levels. 

The following are the warning signs of diabetic ketoacidosis:
  • Extreme thirst and dry mouth
  • Frequent urination
  • Heavy breathing or shortness of breath
  • Blurred vision
  • Dry, hot, or flushed skin
  • Nausea and vomiting
  • Confusion or the appearance of being “drunk”
  • Fruity-smelling breath
Seek immediate medical attention if you are experiencing any of these symptoms.
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How is Diabetic Ketoacidosis Diagnosed?

Your doctor or healthcare provider will perform the following tests to confirm the diagnosis of DKA.
  1. Random Blood Sugar (RBS) test to check for high blood glucose levels.
  2. Serum Ketone test to detect and evaluate the levels of ketones present in your blood.
  3. Arterial Blood Gas (ABG) Analysis which measures the pH levels of your blood (to check for acidosis), blood oxygen levels, and bicarbonate (HCO3) levels.
Your doctor may perform some additional tests and check-ups to monitor your vitals.

How is Diabetic Ketoacidosis Treated?

Diabetic ketoacidosis can only be treated in clinical or hospital settings. DKA treatment goals include: 
  • Lowering blood glucose levels by administering insulin.
  • Rehydration by administering oral or intravenous (IV) fluids.
  • Eliminating ketones from your body through urine (achieved with insulin therapy and fluid replacement).
  • Improving blood circulation by restoring blood volume.
  • Restoring electrolyte balance by administering sodium and potassium.
  • Normalizing blood pH value by administering bicarbonate infusion.

What are Diabetic Ketoacidosis Complications?

Diabetic ketoacidosis can decrease blood volume, resulting in low blood pressure and poor circulation. It can also cause the following complications:
  • Elevated blood potassium levels (hyperkalemia)
  • Hypovolemic shock (organ failure caused by poor circulation and low blood volume)
  • Blood clots which could lead to stroke or heart attack
  • Difficulty breathing or respiratory distress
  • Accumulation of fluid in lungs (pulmonary edema)
  • Kidney damage
The treatment of diabetic ketoacidosis can also cause complications like:
  • Low blood sugar levels, caused by high dose or rapid insulin administration. 
  • Decreased blood potassium levels, caused by potassium entering your cells after insulin administration.
  • Edema or swelling in the brain, caused by a rapid drop in blood sugar levels.

How can Diabetic Ketoacidosis be Prevented?

The core principle of diabetic ketoacidosis prevention is effective diabetes management. The following tips may help in the successful prevention of DKA:

  • Eating well-balanced, diabetic-friendly meals.
  • Regular home monitoring of your blood glucose levels using a glucometer.
  • Taking the appropriate and prescribed doses of insulin and other hypoglycemic medication consistently.
  • Eating on time and not skipping meals.
  • Frequent monitoring of blood glucose and urine ketone levels when you are ill or have an infection. 

When to See a Doctor?

If you experience any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
  • You are vomiting and cannot eat or drink anything.
  • Your blood glucose levels are over the target range, and are not responding to treatment at home.
  • The level of ketones in your urine is moderate or high.

Don’t Have Time To Read?

  • Diabetic ketoacidosis (DKA) occurs in diabetes, when your body does not have enough insulin to convert blood glucose into energy. As a result your body uses stored fat for fuel, releasing ketones into your blood.
  • When ketones accumulate in your blood, it can become acidic and lead to DKA
  • Diabetic ketoacidosis can be caused by missing insulin shots, skipping meals, illness or infections, prolonged stress levels, excessive alcohol consumption, or eating a keto diet, all of which affect blood glucose levels.
  • Symptoms of DKA include but are not limited to frequent urination, extreme thirst, stomach ache, headache, fatigue, persistent dry mouth, fruity-scented breath, and nausea.
  • DKA can be diagnosed using a blood sugar level test, blood or serum ketone level test, and arterial blood gas test.
  • DKA is treated using insulin therapy, IV fluids, and electrolytes.
  • DKA can cause complications like poor blood circulation, hypovolemic shock, blood clots, kidney damage or failure, respiratory problems, high blood potassium levels, etc.
  • You can prevent DKA by sticking to a diabetic-friendly meal plan, monitoring your blood sugar and ketone levels, taking your insulin injections as prescribed, and managing your diabetes effectively.
  • Use the Phable Care App to consult India’s leading diabetologists, order medicines, book lab tests, integrate blood sugar monitoring and other devices to get real-time remote care from the comfort of your home. Also, check out our Diabetes Management program which provides ‎360º care. Let’s treat diabetes together.

Frequently Asked Questions

In diabetic ketoacidosis, the blood sugar levels are usually above 250 mg/dL. However, ketoacidosis can occur even when your blood sugar levels are below 250 mg/dL. This condition is called euglycemic ketoacidosis.

Diabetic ketoacidosis is a serious condition that can be fatal if left untreated.

Insulin  can be used to treat diabetic ketoacidosis by reversing the processes that cause it. Insulin helps your body use the glucose present in your blood for fuel. This stops your body from using stored fat as an energy source, thus preventing further ketone production.

DKA is a serious but treatable condition if prompt medical assistance is provided. A majority of people recover from diabetic ketoacidosis within a day. However, it may take a little longer in some cases.

With insulin therapy and timely medical intervention, most people recover from diabetic ketoacidosis within a day. However, the longer it takes you to seek treatment, the more likely you are to develop DKA-related complications..

You can test for diabetic ketoacidosis at home by checking your blood sugar levels using a glucometer and by checking your ketone levels using a urine ketone test.

Dr. Pakhi Sharma
Dr. Pakhi Sharma, MBBS
(General physician, 6+ years)
An expert in obstetrics and medical emergencies, Dr. Pakhi Sharma, an alumni of Sri Devaraj Urs University of Higher Education and Research Centre, is a general physician working at Phablecare. She has 6+ years of work experience spread across gynaecology and obstetrics, family medicine, and medical emergencies at renowned hospitals and clinics.

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