Trusted medical advice from the
American Academy of Family Physicians.

Diabetic Ketoacidosis

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death.

DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy).

Symptoms of diabetic ketoacidosis

DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually:

  • excessive thirst
  • dry mouth
  • frequent urination.

The next stage of DKA symptoms include:

  • vomiting (usually more than once)
  • abdominal pain
  • diarrhea
  • trouble breathing
  • confusion or trouble concentrating
  • loss of appetite
  • weakness and fatigue
  • a fruity odor on the breath.

What causes diabetic ketoacidosis?

The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration).

DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes.

How is diabetic ketoacidosis diagnosed?

If you think you may have diabetic ketoacidosis, contact your doctor immediately. He or she will want to run some blood tests before giving you an official diagnosis. These tests include checking your blood sugar and ketone level. Your doctor also may order a urinalysis and chest X-ray.

Can diabetic ketoacidosis be prevented or avoided?

When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels closely when they are more than 250 mg per dL.

When you’re sick or stressed, you should check your blood sugar level more often than normal (sometimes every 3 to 4 hours). If your blood sugar reaches a critical level, check it every 1 to 2 hours. Ask your doctor if you should test your blood sugar level during the night.

You should also test your urine for ketones every few hours if you’re sick, stressed, or if your blood sugar level is more than 250 mg per dL.

You should talk to your doctor to develop a plan if your blood sugar level gets too high. Make sure that you know how to reach your doctor in an emergency.

Diabetic ketoacidosis treatment

DKA causes excessive urination. This means you will urinate more than usual. You can become dehydrated and your body can lose electrolytes (minerals in your blood that help your body function). If you are diagnosed with DKA, your doctor will most likely treat you with fluids (usually through an IV). These fluids will contain electrolytes and insulin. Fluids can help rehydrate you and dilute some of the sugar in your blood. Electrolytes will help your body function normally. Insulin will help lower your blood sugar level.

Living with diabetic ketoacidosis

Keeping the balance between blood sugar and insulin is the key to controlling diabetic ketoacidosis. In most cases, this means sticking to your insulin schedule. But you may need to adjust the amount of insulin you are taking.

You should also try to recognize when you feel stressed or sick. Small adjustments to your eating or drinking can make a big difference.

Should I keep taking insulin when I’m sick?



What else should I do?


If your blood sugar level is more than 250 mg per dL, avoid foods that are high in carbohydrates.

Questions to ask your doctor

  • I’ve never been diagnosed with diabetes, but I have many of the symptoms of diabetic ketoacidosis. Do I have diabetes?
  • I’m having a hard time controlling my blood sugar levels. Am I at risk of diabetic ketoacidosis?
  • Will diet and exercise help me to avoid diabetic ketoacidosis?
  • If I notice I’m having symptoms of diabetic ketoacidosis, what should I do first?
  • Is it safe for me to exercise?
  • What is the best way for me to check the ketone level in my body?
  • I missed a dose of insulin. Should I start testing my blood sugar level and ketone level right away?
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