Diabetic Ketoacidosis

What to Know and What to Expect

By, Carly Berlon

What is DKA?
According to the CDC, “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” (Centers for Disease Control and
Prevention, 2021).

Who does it effect?

 Mainly type 1 diabetics
 Also effects Type 2 diabetics
 More common in women, young adults, and children
Why is this important?
 200,000 cases in the US every year
 DKA can develop in a few hours
 In 20% of cases, DKA is the first sign of type 1 diabetes
 If left untreated, can be life threatening

Signs and Symptoms

 Dry mouth
 Abnormal heart rate
 Increased breathing
 Fruity-smelling breath
 Extreme thirst
 Extreme hunger
 Increased urination
 Lethargy
 Seizures

Causes of DKA
 Most common:
o Illness: blood sugars are often mismanaged on sick days
o Missing doses of insulin or malfunction of insulin pump
o Using expired or spoiled insulin
o Undiagnosed Diabetic
 Other causes:
o Pregnancy
o Emotional trauma
o Heart attack
o Physical injury
 o Alcohol/drug use (esp. cocaine)
o Certain medications such as corticosteroids which increases blood
sugar levels in the body

What to do if DKA is expected?

 Check your blood sugar
 If over 240, use an over-the-counter ketone test every 4-6 hours

I have Ketones in my urine, now what?

Make an appointment with your PCP immediately. If they are unable to get you in
or you are experiencing the following symptoms, go to the emergency room:
 Blood glucose >300
 Vomiting
 Shortness of breath

How is DKA diagnosed?

 Blood glucose >250 mg/dL
 Blood pH <7.3 (acidosis)
 Ketones in urine or blood
 Serum bicarbonate level <18 mEq/L

How is DKA treated?

 Fluids- helps to dilute blood sugar levels
 Electrolytes- DKA can affect electrolyte levels such as potassium, which can
alter your heart rhythm if levels are too low. Blood work is completed often
to monitor and replace such electrolytes.
 Insulin- many times DKA will be treated with an IV insulin drip in either the
ER or ICU. This medication will reverse DKA.
 Other Medicines- In cases such as infection, antibiotics may also be used
How is DKA prevented?
 Check blood sugars often and at regular intervals
 Take medications based on prescribed dosing, even if you feel fine
 Check your insulin pump regularly
 Have a plan for sick days
 See your PCP on a regular basis
 Stay educated!

References:
Centers for Disease Control and Prevention. (2021, March 25). Diabetic ketoacidosis. Centers
for Disease Control and Prevention. Retrieved June 17, 2022, from
https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html 

Cleveland Clinic. (2021, October 14). Diabetes-related ketoacidosis (DKA): Symptoms,

treatment & causes. Diabetes-Related Ketoacidosis (DKA). Retrieved June 17, 2022, from
https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka 

John Hopkins. (2019, February 24). Diabetic ketoacidosis (DKA). The Johns Hopkins Patient
Guide to Diabetes. Retrieved June 17, 2022, from https://hopkinsdiabetesinfo.org/diabetic-
emergencies-ketoacidosis/