Diabetic Ketoacidosis (DKA)

jenhrn98
38 minutes ago
3 min read

Diabetic Ketoacidosis is a potentially life-threatening complication of diabetes mellitus. DKA develops when your body doesn't have enough insulin to allow blood sugar to enter your cells for use as energy. It is most common among people with Type 1 diabetes.

What is Diabetic Ketoacidosis?

Diabetic Ketoacidosis (DKA) is a serious, sometimes life-threatening complication of Type 1 or 2 diabetes. When your body doesn't produce enough insulin to push sugar from your blood into your cells, your liver breaks down fat instead for fuel and produces acids called ketones. When these ketones are produced too quickly, they can rise to dangerous levels. Sometimes DKA can be the first sign of diabetes in someone who has yet to be diagnosed. The process of DKA can develop slowly, but you need to know the warning signs.

Warning Signs!

The symptoms of high blood sugar are as follows.

Extreme thirst
Frequent urination
Quick and deep breathing
Dry mouth (and sometimes skin)
Flushed face
Fruity breath
Headache
Muscle aches
Extreme fatigue
Nausea and vomiting
Stomach pain

If blood sugar levels are left high for extended periods, DKA can develop. However, there are other causes.

Causes:

The two most common causes of DKA are illness and missing insulin dosing. When you are sick, you tend not to eat or drink enough causing your blood sugar to be difficult to manage. Not taking your insulin routinely as prescribed, taking the incorrect dose (too low a dose), or an insulin pump that is blocked over time can also lead to DKA. Other causes can be a stroke, a heart attack, a physical injury, drugs or alcohol use, or some medications. If you suspect DKA, you should get medical help immediately.

Diagnosis:

The first part of the diagnosis is the presence of the symptoms, clinical presentation. Lab findings would show hyperglycemia (very high blood sugar levels), metabolic acidosis (a low blood pH and/or low bicarbonate), ketosis (ketones in the blood and/or urine), and an elevated anion gap, which indicates acid buildup. Other testing may include ECG (electrocardiogram), a chest x-ray, and fluid balance checks.

Treatment:

The main treatment will be fluid resuscitation. Rehydrating the individual and diluting their blood sugar by using IV fluids. Insulin will also be administered intravenously to stop ketone production. And finally, electrolyte replacement is a necessity, most commonly potassium. Of course, treating the underlying cause of the DKA is also important.

My Story!

Although DKA is very dangerous, it actually saved my life this year. I was starting to feel unwell, basically unable to keep any food/fluid down. I suspected that I was going into DKA, so I got myself to my local emergency department. I was in fact, in the early stages of DKA. It was an atypical presentation as my blood sugar was only 12. However, further blood testing showed a low pH and an open anion gap. The doctor on call that day decided to do a battery of tests to figure out what was the trigger causing me to have DKA. It was discovered that my troponin was extremely high, I had in fact, had a heart attack. I was in disbelief, I hadn't felt any chest pain. However, being a female with diabetes causes the symptoms to be very different. I was able to get the proper care and am slowly recovering.

Jennifer Hoar, RN

References:

July 2025. The Mayo Clinic Staff. Diabetic Ketoacidosis. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/diagnosis-treatment/drc-20371555

November 2025. The Cleveland Clinic. Diabetes-Related Ketoacidosis. https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

May 2024. CDC-Diabetes. Diabetic Ketoacidosis. https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html