Diabetes Symptom – Ketoacidosis

The Blood Glucose Level (BGL) you have entered
indicates you may be in a ketoacidotic state.

When to Seek Emergency Care

Seek immediate medical attention if you experience:

Blood ketones of 3 mmol/L or more (the NHS emergency level)
Blood sugar above 16.7 mmol/L (300 mg/dL) on more than one test
Persistent vomiting and inability to keep fluids down
Multiple symptoms of DKA (excessive thirst, frequent urination, nausea, vomiting, abdominal pain, weakness, fruity breath, confusion)
Difficulty breathing
Confusion or unusual drowsiness
Any signs of DKA with inability to contact your healthcare provider

Remember: Untreated DKA can lead to loss of consciousness, coma, and death. Early recognition and treatment are essential.

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes that occurs when your body produces high levels of blood acids called ketones. It develops when your body can’t produce enough insulin, causing a buildup of these acids in the bloodstream. DKA primarily affects people with Type 1 diabetes, but can also occur in those with Type 2 diabetes during severe illness or stress.

Causes

Ketoacidosis develops when insulin levels are too low to allow glucose to enter cells for energy. This triggers the body to break down fat for fuel instead, producing ketones. The primary causes include:

Insufficient insulin due to:

Undiagnosed type 1 diabetes
Missed insulin doses
Incorrect insulin administration
Insulin pump malfunction

Or other triggering factors such as:

Infection or illness (especially pneumonia and urinary tract infections)
Physical or emotional trauma
Heart attack or stroke
Pregnancy
Alcohol or drug misuse, particularly cocaine
Certain medications (corticosteroids, some diuretics)
Pancreatitis

Symptoms

DKA symptoms often develop rapidly, sometimes within 24 hours. They include:

Excessive thirst and dry mouth
Frequent urination
High blood sugar levels (usually 11.1 mmol/L or 200 mg/dL and above, though DKA can occur at lower readings)
High ketone levels in urine
Nausea and vomiting
Abdominal pain
Weakness or fatigue
Shortness of breath
Fruity-scented breath
Confusion or difficulty concentrating

SugarCalc’s ketone warning starts at 11.1 mmol/L (200 mg/dL), in line with the 2024 international consensus on hyperglycaemic crises.

As DKA progresses, symptoms may worsen to include:

Deep, rapid breathing (Kussmaul breathing)
Decreased alertness
Loss of consciousness

Diagnosis

DKA is diagnosed through:

Physical examination
Blood tests measuring:
Blood sugar levels
Ketone levels
Blood acidity (pH)
Additional tests may include:
Blood electrolyte tests
Urinalysis
Chest X-ray
Electrocardiogram (ECG)

Treatment

DKA is a medical emergency requiring immediate hospital treatment, which typically includes:

Fluid replacement: Intravenous fluids to rehydrate the body
Electrolyte replacement: Minerals like sodium, potassium, and chloride to maintain heart, muscle, and nerve function
Insulin therapy: Intravenous insulin to reverse the ketone production process

Treatment complications can include:

Low blood sugar (hypoglycaemia) from insulin treatment
Low potassium (hypokalaemia) affecting heart, muscles, and nerves
Cerebral oedema (brain swelling), particularly in children

Prevention

To prevent DKA:

Take insulin and diabetes medications as prescribed
Monitor blood sugar levels regularly, especially during illness
Test for ketones when blood sugar is consistently high
Follow sick-day management guidelines from your healthcare provider
Never skip insulin doses, even when sick or not eating
Stay hydrated with sugar-free fluids
Seek medical help early when blood sugar is persistently high or ketones are present