What Is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes. It happens when the liver starts breaking down fat at a dangerously fast rate, processing the fat into a fuel called ketones, which causes a diabetic person's blood to become acidic.

Causes of Ketoacidosis

Cells need glucose to get the energy they require to function. But when that doesn't happen for people with diabetes and their body doesn't have enough insulin to use glucose, it starts to burn fat for energy, producing chemicals known as ketones. But when ketones accumulate in a person's blood, they make it more acidic—potentially to the point of being toxic and poisoning their body. This is known as ketoacidosis.

A person may experience ketoacidosis for one of the following reasons:

• They're not getting enough insulin: Perhaps they didn't inject enough insulin, or their body might need more insulin than usual because of illness.
• They haven't been eating enough food: Prolonged fasting can cause ketoacidosis.
• They are having an insulin reaction—specifically, low blood glucose

Ketoacidosis is far more common in people with type 1 diabetes. In fact, ketoacidosis may be the first indication that they have diabetes if they had not already been diagnosed. People with previous diagnoses of type 1 diabetes may experience ketoacidosis as a result of an infection, injury, a serious illness, missing doses of insulin shots, or the stress of surgery.

Though it's possible for someone with type 2 diabetes to develop ketoacidosis, it is less common and typically not as severe as it is in someone with type 1 diabetes. Triggers for ketoacidosis in people with type 2 diabetes include prolonged uncontrolled blood sugar, missing doses of medicines, medications called SGLT-2s, or a severe illness or infection.

Signs and Symptoms of Ketoacidosis

Though ketoacidosis usually develops slowly, once it reaches a certain point—vomiting, specifically—it can become life-threatening in a matter of a few hours. The first warning signs of ketoacidosis include:

• Thirst or a very dry mouth
• Frequent urination
• High blood glucose (blood sugar) levels
• High levels of ketones in the urine

Gradually, other symptoms will appear, and may include:

• Constantly feeling tired
• Dry or flushed skin
• Nausea, vomiting, or abdominal pain
• Difficulty breathing (including deep, rapid breathing)
• Fruity odor on breath
• A hard time paying attention, or confusion
• Decreased alertness
• Dehydration
• Headache
• Muscle stiffness or aches

There are also certain complications that can arise following ketoacidosis, including health problems like:

• Cerebral edema (fluid buildup in the brain)
• Cardiac arrest (when the heart stops working)
• Kidney failure

Ketoacidosis Diagnosis

If someone without a type 1 diabetes diagnosis is experiencing the symptoms of ketoacidosis, their doctor will likely run a ketone test. More often than not, it's a urine test, but if that comes back positive, it is usually followed by a blood test to measure a specific ketone called beta-hydroxybutyrate in the blood.

For those already diagnosed with diabetes, there are several other ways to test for ketoacidosis, including:

• Arterial blood gas tests
• Basic metabolic panel, (a group of blood tests that measure a person's sodium and potassium levels, kidney function, and other chemicals and functions, including the anion gap)
• Blood glucose test
• Blood pressure measurement
• Osmolality blood test

Ketoacidosis Treatment

Anytime someone with diabetes has symptoms of ketoacidosis, it's important that they seek medical attention as soon as possible. Ketoacidosis typically requires treatment in the ICU and involves:

• Correcting a person's high blood sugar level with insulin
• Replacing fluids lost through urination, loss of appetite, and vomiting 
• Normalizing electrolyte levels

From there, doctors will attempt to determine what caused ketoacidosis in the patient, like some type of an infection. In most cases, a person will respond to treatments for ketoacidosis within 24 hours.

Ketoacidosis Prevention

People with diabetes can help prevent ketoacidosis with a few precautions, including:

• Taking medications as prescribed
• Monitoring blood sugar closely, especially when otherwise ill
• Keeping a balanced diet with regularly scheduled meals
• Staying well-hydrated
• Exercising regularly
• Calling the doctor after noticing symptoms of DKA, and/or when their blood sugar is persistently elevated (above 300), despite correct use of insulin.

A Word From Verywell

Those who have been diagnosed with diabetes are probably used to checking their glucose levels and ketones and have the equipment needed to perform these tests at home. But symptoms of ketoacidosis are frequently used to diagnose diabetes in people without a personal history of the condition. So while it's crucial for people with diabetes to keep an eye on the signs and symptoms of ketoacidosis, it's also important for everyone else to be familiar with them as well.