Diabetic ketoacidosis [ dahy-uhbet-ik kee-toh-as-i-doh-sis ] is a life-threatening complication of diabetes, and it is characterized by what is known as the three Ps: Polydipsia—thirst Polyuria—urination Polyphagia—appetite.

When knowledgeable type 1 diabetics experience these symptoms, they usually fight back with haste to correct the problem.

Diabetic ketoacidosis (DK) can occur with insulin deficiency, resulting in the body’s inability for needed glucose to penetrate cells for use as energy. The body of a non-diabetic produces insulin naturally to make glucose for energy. In contrast, when a diabetic who is dependent on administering insulin doesn’t make the glucose needed to produce energy, the liver breaks down fat. The fat is used to produce ketones as a fuel substitute; it is the body’s way of somehow finding fuel. This switching from glucose to fat happens if the diabetic fails to administer enough insulin to offset calories. DK can also occur in diabetics who are not yet diagnosed, usually because they are in the early stages of the disease.

Some people might think that using fat to produce fuel is a smart move on the part of the diabetic body. It is not good at all. That’s because ketones, particularly at high levels, are toxic. Note that there is a difference in nutritional ketosis vs. diabetic ketoacidosis.

Nutritional ketosis below 5 mmol/L

Nutritional ketosis below 5 mmol/L

As ketones build up in the blood, both the blood and the urine become more acidic. High levels of ketones in the body are like ingesting poison. Luckily, this comes with warning signs that a diabetic’s disease is out of control. This is why it’s smart to know the symptoms of DK; if the symptoms aren’t recognized, the uncontrolled nature of DK can be a major debilitation with deadly results over time. 

Who Is Diagnosed With Diabetic Ketoacidosis?

Those who are Type-1 (and some Type-2 diabetics), as well as youth and adults who have not yet been identified as diabetic, can suffer from the effects of DK. For Type-1 diabetics who are insulin-dependent, the body’s lack of insulin can impair the patient quickly, as quickly as a matter of days, even hours. 

Symptoms of Diabetic Ketoacidosis

Signs of ketoacidosis include:

  • Weakness and/or fatigue
  • Nausea/vomiting that may be associated with radiating abdominal pain, decreased appetite, and/or anorexia
  • Rapid weight loss in patients newly diagnosed with type 1 diabetes
  • Fruity breath
  • Pain in stomach
  • Confusion

Recognizing these signs makes a quick response possible

Indications of DK onset among undiagnosed diabetics include thirst, urination, and changes in appetite. DK onset can also bring rapid weight loss. 

Parents should know and recognize these symptoms, particularly in young children. So, too, should anybody who suspects or has been recently diagnosed with diabetes. 

Recognizing these symptoms makes a quick response possible Causes of Diabetic Ketoacidosis 

Two common causes of DK in diagnosed diabetics are illness and missing an injection. When diabetics get sick with a cold or flu, blood sugar levels become more difficult to manage. As the diabetic’s body works to fight illness, adverse hormones are released. The hormones not only interfere with insulin, decreasing its effects but also increasing blood sugar. 

DK can also be the result of

  • Device malfunctions (it is always helpful to calibrate devices)***
  • Very high blood sugar and low insulin levels
  • An infection or other illness 
  • Pneumonia and urinary tract infections 
  • Missed insulin treatments or an insulin therapy problem
  • Vomiting
  • Physical or emotional trauma
  • Heart attack or stroke
  • Pancreatitis
  • Pregnancy
  • Alcohol or drug abuse, especially cocaine
  • Medications such as corticosteroids and some diuretics

Treatment For Diabetic Ketoacidosis

Woman tests her blood sugar using glucose meter

First, know the symptoms and check blood sugar levels frequently. Test ketones with an over-the-counter urine ketones testing kit. 

Treatment for DK typically occurs at a hospital or emergency room. Doctors treat DK with insulin and electrolytes sodium, potassium and chloride). Perhaps surprisingly, some common complications of diabetic ketoacidosis are related to electrolytes, a reason why professionals should administer them.

Contact a doctor immediately if:

  • Vomiting occurs and food or liquid won’t stay down
  • The blood sugar level is above the target range accompanied by a lack of response to home treatment
  • The urine ketone level is moderate to high

Seek emergency care if blood sugar levels are consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L). Though it might seem logical to burn calories to combat DK, exercise isn’t beneficial because stress can elevate glucose.

Ketoacidosis Prevention

Glucometer with healthy food and dumbells

There are ways that diabetics can prevent diabetic ketoacidosis.

It is important to meet each day with healthy eating and exercise, monitor blood sugar levels, and take medications as directed. Learn about how to manage diabetes and about possible problems such as DK. Prevention involves checking and recording one’s blood sugar level a minimum of 3-4 times each day, more often if feeling stressed, tired, or ill. 

Learn how to adjust dosage(s) as required, then make adjustments as needed. Successful adjustment requires learning the relationships between wellness/illness, caloric intake, and physical activity. 

Adjusting insulin assumes that diabetic patients have no problem affording insulin and supplies. This is far from true in some households. However, it is possible for residents in some countries to safely purchase a 3-month supply of insulin online, assuming they have a prescription from a reputable physician. This is a boon for many diabetics.

Diabetics should also check their ketone levels, particularly when suspecting illness or signs of DK. It is a simple process because the urine testing kits are available OTC. Knowing that levels are within limits is powerful; recognizing problems is life-saving.

Blood sugar reading devices should be calibrated often to ensure that they remain accurate over time. The Mayo Clinic suggests

Check your blood sugar level with your meter at the same time that blood is drawn for lab tests, being sure to use a fingerstick sample, not blood from the blood draw. Then compare your meter’s reading with the lab results. Any result that is within 15% of the lab reading is considered accurate.