Diabetes-related ketoacidosis (DKA) is a life-threatening condition that affects people with diabetes and those who have undiagnosed diabetes. It happens when your body does not have enough insulin to use sugar for energy. Instead, your body breaks down fat for energy, which causes your body to release ketones. Too many ketones cause your blood to turn acidic.
Diabetes-related ketoacidosis (DKA) is a serious and life-threatening, but treatable, complication that affects people with diabetes and those who have undiagnosed diabetes.
Diabetes-related ketoacidosis occurs when your body doesn't have enough insulin (a hormone that's either produced by your pancreas or injected). Your body needs insulin to turn glucose, your body’s go-to source of fuel, into energy. If there’s no insulin or not enough insulin, your body starts breaking down fat for energy instead. As fat is broken down, ketones are released into the bloodstream.
For a person with diabetes, a high amount of ketones causes their blood to become acidic (the blood pH is too low). This creates an emergency medical situation that requires immediate attention and treatment.
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Diabetes-related ketoacidosis can develop in people of any age who have diabetes or undiagnosed diabetes.
Hyperglycemia (high blood sugar) and diabetes-related ketoacidosis both happen when your body doesn't have enough insulin or isn't using the insulin it has properly.
The difference is that DKA is an acute complication, meaning it has a severe and sudden onset. While very high blood sugar (above 250 mg/dL) is almost always a contributing factor to DKA, other conditions need to be present to have DKA, including ketones in your blood and/or urine. You can have high blood sugar without having ketones in your blood and/or urine.
Untreated high blood sugar can lead to DKA. This is why it’s important to treat high blood sugar with insulin as soon as possible.
Although it’s not as common, you can be in DKA even if your blood sugar is lower than 250 mg/dL. This is known as euglycemic diabetes-related ketoacidosis (euDKA).
Even though they sound alike, diabetes-related ketoacidosis and ketosis are two different things.
Ketosis occurs when you have ketones in your blood and/or urine but not enough to turn your blood acidic. It usually happens if you are eating a low-carbohydrate diet, if you’re fasting or if you’ve drunk too much alcohol. Ketosis isn't harmful.
Diabetes-related ketoacidosis (DKA) affects people with diabetes and people with undiagnosed diabetes. It happens when your blood turns acidic because there are too many ketones in your blood due to a lack of insulin. Diabetes-related ketoacidosis is life-threatening and requires immediate treatment.
It’s important to remember these signs of DKA, especially if you have diabetes or if you or your child are at risk for developing Type 1 diabetes.
Early symptoms of DKA can include:
More severe symptoms of DKA can include:
If you have any of these symptoms, call your healthcare provider immediately or go to the nearest emergency room.
The main cause of DKA is not enough insulin in your body. The following situations can cause a lack of insulin:
The following conditions or situations can also contribute to developing DKA:
Diabetes-related ketoacidosis is considered an acute complication, meaning it has a severe and sudden onset. DKA can develop within 24 hours. If you’re vomiting, it could develop much more quickly. It’s essential to call your healthcare provider or go to the hospital as soon as you experience symptoms to get treatment before the DKA becomes more severe.
Diabetes-related ketoacidosis is generally diagnosed if you have the following four conditions:
In the hospital, healthcare providers may use the following tests to diagnose DKA:
If you have diabetes and call your healthcare provider from home about your symptoms, they can usually determine if you have diabetes-related ketoacidosis based on your history, blood sugar levels and urine and/or blood ketones. They will also determine if you can treat your symptoms from home or if you need to go to the hospital for treatment. There are a few at-home tests you can take to see if you could have DKA, including:
If DKA is caught early enough, people with diabetes can sometimes treat DKA from home with specific instructions from their healthcare provider. If you think you might be developing DKA, call your healthcare provider immediately. They'll determine if you'll be able to treat it from home or if you'll need to go to the hospital.
If you have diabetes and your healthcare provider has determined that you can treat DKA from home, be sure to do the following:
If your symptoms of DKA are severe, you’ll have to go to the hospital for treatment. You may receive the following treatments in a hospital setting:
One of the goals of diabetes-related ketoacidosis treatment is to lower blood sugar levels into an acceptable range. Your body needs insulin to decrease blood sugar levels. Sometimes, too much insulin can cause low blood sugar (hypoglycemia). If this happens and you're treating your DKA from home, you’ll need to treat the low blood sugar by consuming sugar or carbohydrates per your healthcare provider’s instructions. If you are in the hospital for DKA treatment, your healthcare team will give you glucose to treat your low blood sugar.
DKA is fully treated when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. DKA is usually corrected within 24 hours. Depending on the severity of the DKA, it could take multiple days before the DKA is fully treated and you can leave the hospital.
Risk factors for developing DKA include:
If you don't have diabetes but are experiencing symptoms of diabetes-related ketoacidosis, call your healthcare provider immediately or go to the nearest emergency room. The only way to prevent more severe symptoms and side effects of DKA, in this case, is to seek medical attention and treatment.
If you already have diabetes, there are many things you can do to prevent diabetes-related ketoacidosis, including:
Most people recover from treatment for diabetes-related ketoacidosis within a day. Sometimes it takes longer.
If not treated soon enough, diabetes-related ketoacidosis can lead to severe complications including:
Yes, if left untreated, diabetes-related ketoacidosis results in death. Because of this, it’s essential to treat DKA as soon as possible. Call your healthcare provider immediately or go to the nearest emergency room if you experience symptoms.
Diabetes-related ketoacidosis (DKA) is a complication of diabetes that requires immediate treatment. If you experience symptoms such as frequent urination, extreme thirst, high blood sugar, ketones in your urine or blood and vomiting, call your healthcare provider immediately.
A note from Cleveland Clinic:
Diabetes-related ketoacidosis (DKA) is a serious and life-threatening condition, so acting fast if you’re experiencing symptoms is very important. It’s much easier to treat diabetes-related ketoacidosis in its early phase than it is once symptoms become more severe. Be sure to call your healthcare provider if you experience symptoms. Diabetes complications can be scary. Being educated and prepared are crucial to preventing DKA. Don’t be afraid to ask your healthcare provider questions about DKA or your diabetes management.
Last reviewed by a Cleveland Clinic medical professional on 10/14/2021.
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