Diabetic ketoacidosis

Also called DKA

Diabetic ketoacidosis is a serious complication of diabetes. It occurs when your body produces high levels of blood acids called ketones. This happens when your body doesn't have enough insulin.

If you have diabetes, learn the warning signs of diabetic ketoacidosis and know when to seek emergency care (below).

Contact your doctor or diabetes nurse without delay if:
  • your urine ketone levels are high
  • your urine ketone levels are not coming down once you have started treating yourself for ketones
  • you are feeling very unwell (drowsy, rapid breathing, pain in your abdomen or nausea and vomiting)
  • you are unable to look after yourself
  • you don't know how much extra insulin to take
  • you are unable to drink fluids
  • you have a temperature or an obvious sickness that is not improving

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a condition which can affect people with diabetes. It happens when the body does not have enough insulin to help it use sugar for energy. Instead, the body starts burning fats for energy, which releases a chemical called ketones. A build-up of ketones causes the body to become acidic – hence the name 'acidosis'.

Because diabetic ketoacidosis upsets the chemical balance in the body, and can quickly make you sick, it requires immediate medical attention. Left untreated, diabetic ketoacidosis can be fatal. If picked up early, it can be treated with extra insulin, glucose and fluid. 

What causes diabetic ketoacidosis?

Diabetic ketoacidosis is triggered by low insulin levels. This is most commonly caused by:

  • A problem with insulin therapy – low insulin levels could be due to a missed dose of insulin or the dose not being given correctly.
  • An illness or hormonal change – insulin in the body may not work well in the presence of infection, stress/trauma, or pregnancy. This is due to your body producing higher levels of other hormones, such as adrenaline or cortisol, which reduce the effect of insulin.

Other causes include:

  • A heart attack.
  • Alcohol or drug abuse, in particular, cocaine.
  • Certain medications, such as corticosteroids and some diuretics.

What are the warning signs of diabetic ketoacidosis?

If you take insulin to control your diabetes, you should keep an eye out for signs and symptoms of diabetic ketoacidosis. Early signs and symptoms can include:

  • passing large amounts of urine
  • feeling very thirsty
  • feeling sick
  • abdominal (tummy) pain
  • tiredness
  • shortness of breath
  • an increase in your blood sugar and/or ketone levels.

When to test for ketones?

You should test for ketones if:

  • your blood glucose is more than 17mmol/L
  • your blood glucose is climbing and you feel unwell
  • you are injured and your ketone levels are increasing.¹ 

How to test for ketones?

Ketones are very easy to test for. When your body is high in ketones, it tries to get rid of them very quickly. It does this by pushing them out in your urine. Ketones are easily detected by a simple urine test, using strips available on prescription.

At what level of ketones in my urine should I be concerned?

Trace to small amounts of ketones

A small amount of ketones in your urine is usually okay. However, if you are showing small amounts of ketones and you are unwell you should keep a careful eye on whether they are increasing or coming down. Get help if they continue to increase.¹

Moderate or large amount of ketones

If you are showing a moderate or large amount of ketones in your urine you need to act quickly to bring them down. You should ALWAYS contact your doctor or diabetes nurse educator if you have a moderate or large amount of ketones in your urine. If you can't get immediate advice, you should go to the nearest hospital. If your ketones are high and you are feeling unwell this trip to the hospital should be in an ambulance.¹

What can I do if my ketones are raised?

Other things you can do for yourself if your ketones are raised, but not too high, are:

  • Drink water. If your ketone levels are small or moderate AND you are feeling unwell, you need to start drinking large amounts (2-3 litres) of water daily.
  • Take more insulin. You should also take more short-acting insulin. If you have not been taught how to do this (and what dosages to take), you must get help and guidance on this from your diabetes team. Don't take extra insulin unless you know how to dose for sickness.
  • Test your blood and your urine. You should also test both your blood glucose and urine ketone levels every 1–2 hours until the ketones are cleared and your blood glucose levels are coming down.

How to prevent diabetic ketoacidosis?

Diabetic ketoacidosis is usually avoidable. Check your blood glucose levels regularly and more frequently when you are sick and unwell. Avoid missing insulin injections. Read more about blood glucose testing and sick days and diabetes.

Learn more

High blood glucose (hyper) & type 1 diabetes Diabetes New Zealand
Diabetic ketoacidosis NHS choices


  1. High blood glucose (hyper) & type 1 diabetes Diabetes New Zealand
Credits: Health Navigator Editorial Team. Last reviewed: 05 May 2017