Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when your body produces high levels of acids called ketones in the blood.
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:|
What is diabetic ketoacidosis?
Diabetic ketoacidosis is a condition which can affect people with diabetes, usually type 1 diabetes. It happens when your body does not have enough insulin to help it use sugar for energy. Instead, your body starts burning fat for energy, which releases ketones. A build-up of ketones in your body causes it to become acidic. This is why it is called 'ketoacidosis'.
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 missed dose of insulin
- Insulin therapy not being given correctly which may be because of problems with your insulin pen, insulin cartridge or insulin pump
- 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
- dry mouth
- feeling sick or vomiting
- abdominal (tummy) pain
- tiredness, weakness, fatigue
- shortness of breath
- unusual or fruity-smelling breath
- an increase in your blood sugar and/or ketone levels.
How to test for ketones?
Ketones are very easy to test for. The best way is to use a blood ketone meter. If you have type 1 diabetes you can get a blood ketone meter and two boxes of ketone testing strips on prescription from your doctor. You can also test for ketones in the urine but this is not as accurate because it reflects your ketone levels a few hours ago rather than right away.
Monitoring blood ketone at home allows you to detect oncoming ketoacidosis early, so that you can give yourself insulin therapy and potentially prevent a trip to hospital.
When to test for ketones?
You should test for ketones if:
- your blood glucose is more than 17mmol/L
- you feel unwell and your blood glucose is increasing
- you have any symptoms of ketoacidosis
- you are injured and your ketone levels are increasing
Monitoring blood glucose and ketones levels when you are sick is especially important. During minor illness or injury, blood glucose levels might increase but ketones may remain negative. However during serious illness, such as high temperature or infections, blood glucose levels are often raised and ketones are present. Monitoring blood glucose and ketones during sickness will help you decide if extra insulin is required. Read more about blood glucose testing and diabetes and sick days.
What to do if my ketones are raised?
Whatever your ketone levels, it is important to never stop taking your background insulin.
Negative or small amount of ketones
A small amount of ketones (negative or + on urine testing strip or less than 0.6mmol/L on blood ketone meter) is normal. However, if you feel unwell, test your blood glucose and ketones every 4 to 6 hours and contact your doctor or diabetes nurse educator if they continue to increase. Sip sugar-free fluids, such as water, regularly (at least 100ml per hour). Read about sick day advice for people with diabetes.
Moderate or large amount of ketones
If a moderate or large amount of ketones is showing (more than + on urine testing strip or more than 0.6mmol/L on blood ketone meter), take more background insulin and take short-acting insulin. If you have not been taught how to do this (and what dosages to take), ask your doctor or diabetes nurse educator for guidance. If you feel unwell, also sip sugar-free fluids, such as water, regularly (at least 100ml per hour). Continue monitoring your blood glucose and ketones every 2 hours. Read about sick day advice for people with diabetes.
If your ketones are high, always contact your doctor or diabetes nurse educator. If you can't get advice, go to the nearest hospital.