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When Blood Sugar Turns Dangerous: Signs of Diabetic Ketoacidosis (DKA) You Need to Know

By: Alexis Kozma


Type 1 diabetes is an autoimmune disease that can develop at any age. Often, diagnosis is

without clear warning, genetic predisposition, or identifiable risk factors. As rates of autoimmune conditions continue to rise, it’s important to stay aware of subtle but serious symptoms. One of the most dangerous complications is diabetic ketoacidosis (DKA), which can develop rapidly. This condition starts when insulin is lacking. Recognizing early warning signs is key to preventing a medical emergency. DKA is a life-threatening complication of untreated diabetes, most commonly occurring in type 1 diabetes (T1D), less commonly in type 2 diabetes (T2D).


Main Symptoms:

• Urinating more often than usual

• Extreme thirst that doesn’t go away, even with fluids

• Unintentional weight loss

• Blurry vision

• Feeling very tired or weak (lethargy)


If you have diabetes, checking your urine for ketones when you’re feeling unwell can help catch problems early and may help prevent diabetic ketoacidosis (DKA). Please contact your

healthcare provider if you notice any of the above. Unintentional weight loss and extreme

thirst, that is unrelieved by drinking adequate fluids, should always be monitored and evaluated by a medical professional in-person.


Additional Warning Signs:

• Dry or flushed skin

• Nausea, vomiting, or stomach pain

• Fruity-smelling breath

• Confusion or difficulty thinking clearly (1)


What Happens in the Body (Understanding DKA)

Simply put, Diabetic Ketoacidosis (DKA) happens when the body does not have enough

insulin. This is most common in people with Type 1 diabetes, because their body no longer

produces insulin. However, it can also happen in people with Type 2 diabetes, especially before they are diagnosed. Without insulin, the body cannot use glucose (sugar) for energy. Instead, it begins to break down fat for fuel. When this happens, ketones are released into the bloodstream (2).


Ketosis vs. Ketoacidosis: What’s the Difference?

You may have heard of “keto” diets, which are designed to help the body burn fat by limiting

carbohydrates.

• In people without diabetes, the body still produces enough insulin to safely manage this

process. This is called ketosis, and it is a normal metabolic state.

• In people with diabetes, especially when insulin is too low, ketones can build up to

dangerous levels.


This leads to ketoacidosis, where:

• Ketones become very high

• Blood sugar is often very high

• The blood becomes too acidic (3)


In someone without diabetes, the body continues to produce enough insulin, even when eating very few carbohydrates. DKA develops when there isn’t enough insulin available to properly manage blood sugar and ketones.


How DKA is Diagnosed

There are three main features of DKA:

1. High blood sugar (hyperglycemia)

2. High ketone levels (ketosis)


3. Acidic blood (metabolic acidosis) (4)

Most patients arrive at the emergency room with high blood sugar, but not always. In some

cases, a person can be in DKA with normal or only slightly elevated blood sugar. This can

happen due to:

• Certain medications

• Chronic alcohol use

• Pregnancy

• Prolonged fasting (5)

Because of this, healthcare providers look at multiple lab values, not just blood sugar, to make the diagnosis


Testing for Ketones at Home

Ketones can be checked using a urine ketone test strip, which can be commonly used by people with diabetes.

• The strip can be dipped into a urine sample or held in the urine stream

• The color on the strip is then compared to a chart on the bottle

Results may show:

• Trace (around 0.5–0.6 mmol/L)

• Low, moderate, or high levels of ketones


Lighter colors usually indicate lower ketone levels, while darker colors indicate higher levels.

In some cases, trace or small amounts of ketones may be managed at home with additional

insulin and increased fluid intake, sugar-free of course! However, moderate to high ketones or worsening symptoms definitely require seeking medical advice and may likely require hospital care (6).


Why does talking about DKA matter?

One important and sometimes overlooked cause is new-onset Type 1 diabetes in adults. Type 1 diabetes occurs more commonly in adolescents and babies. Some adults develop a slower form called Latent Autoimmune Diabetes in Adults (LADA), which can initially look like Type 2 diabetes. Because of this, diagnosis may be delayed and insulin treatment may not be started right away, increasing the risk of developing DKA. In fact, research shows that a significant portion of Type 1 diabetes cases occur in adulthood and are sometimes misdiagnosed early on (7). In addition to new or undiagnosed diabetes, common triggers of DKA include:

• Infection (most common), such as flu, COVID-19

• Missed insulin doses, skipping insulin, running out of medication, or issues with insulin delivery can quickly lead to DKA.

• Medical events, any physical trauma placing stress on the body

• Medications

• Steroids (can raise blood sugar)

• SGLT2 inhibitors (can rarely cause DKA even with normal blood sugar, known

as euglycemic DKA)

• Dehydration, from not drinking enough fluids, or from vomiting and diarrhea

• Alcohol use or prolonged fasting


Which can disrupt normal blood sugar and ketone balance (8)


References

1) Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention [Internet]. [cited 2026

2) Beyond Type 1 [Internet]. [cited 2026 May 2]. All About Diabetic Ketoacidosis (DKA).

3) Healthline [Internet]. 2018 [cited 2026 May 2]. Ketosis vs. Ketoacidosis: What’s the

4) Feingold KR, Dhatariya K. Diabetic Ketoacidosis. In: Feingold KR, Adler RA, Ahmed SF,

Anawalt B, Blackman MR, Chrousos G, et al., editors. Endotext [Internet]. South Dartmouth

(MA): MDText.com, Inc.; 2000 [cited 2026 May 2]. Available from:

5) Chandrasekara H, Fernando P, Danjuma M, Jayawarna C. Ketoacidosis is not always due to diabetes. BMJ Case Rep. 2014 Feb 25;2014:bcr2013203263. doi:10.1136/bcr-2013-203263 PubMed PMID: 24569261; PubMed Central PMCID: PMC3939410.

6) Cervoni B. Ketone levels: where should I be and how can I check? Verywell Health [Internet]. New York (NY): Dotdash Meredith; 2026 Feb 24 [cited 2026 May 2]. Available from:

7) Cleveland Clinic [Internet]. [cited 2026 May 2]. What Is LADA Diabetes? Available from:

8) Lizzo JM, Goyal A, Kaur J. Adult Diabetic Ketoacidosis. In: StatPearls [Internet]. Treasure

Island (FL): StatPearls Publishing; 2026 [cited 2026 May 2]. Available from:


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