Diabetic ketoacidosis (DKA): warning signs and emergency care

Diabetic ketoacidosis, usually shortened to DKA, is one of the most serious short-term problems of diabetes. It needs fast medical care. This article explains what it is, how to spot it and what happens in hospital, based on information from the NHS and NIDDK.

What is DKA?

The NHS explains that in DKA, too little insulin lets substances called ketones build up in the blood. It says DKA can be life threatening and treatment should be sought quickly. The NIDDK also describes DKA as a medical emergency that needs treatment right away.

Who is at risk?

According to the NHS, DKA mainly affects people with type 1 diabetes and people with type 2 diabetes who use insulin. It can also be the first sign of undiagnosed type 1 diabetes, particularly in children.

What can trigger it?

The NHS lists illness, injury, surgery, menstrual periods, and not taking enough insulin as possible causes. People should follow the plan from their own diabetes team.

Warning signs

The NHS lists these symptoms:

• Thirst and passing urine often
• Stomach pain, nausea or vomiting, and diarrhoea
• Deep or fast breathing
• Fruity-smelling breath
• Tiredness, drowsiness or confusion
• Blurred vision

The NHS says symptoms usually develop over about 24 hours but can come on faster. The NIDDK lists very tired feeling, trouble breathing, fruity-smelling breath, fainting from dehydration, and stomach pain, nausea or vomiting.

Ketone checks

For people who test for ketones, the NHS gives this general guide for a blood ketone meter:

• Under 0.6 mmol/L is normal
• 0.6 to 1.5 mmol/L is slightly high, so retest in 2 hours
• 1.6 to 3 mmol/L means you are at risk, so contact your diabetes care team
• Over 3 mmol/L could mean DKA, which needs emergency care

For urine strips, the NHS says a reading of 2+ or higher could mean DKA. The NHS stresses that these levels are a guide and your care team will advise on your own targets.

What to do

The NHS says to seek emergency help if blood ketones are over 3 mmol/L or urine ketones are 2+, if you have symptoms but do not know your ketone level, or if you have symptoms and have not been diagnosed with diabetes. It advises not driving yourself and taking your medicines with you. It also says to contact your care team or the NHS 111 service urgently if your blood glucose stays high despite insulin, or your ketones are slightly high and you feel unwell.

How it is treated

The NHS says treatment is in hospital, with insulin, fluids and nutrients given through a drip. People are monitored for effects on the brain, heart or lungs. They go home once ketones are at a safe level and they can eat and drink normally.

Prevention

The NHS describes these steps, which should be adapted by your own team:

• Follow your treatment plan, including any insulin adjustments
• Check blood glucose regularly and test for ketones when glucose is high or you are unwell
• Follow your sick day rules and never stop insulin, even if you are not eating
• Ask your care team about a continuous or flash glucose monitor

A related emergency

The NHS also warns that high blood glucose in type 2 diabetes can cause a condition called hyperosmolar hyperglycaemic state, which can also be life threatening. It says to seek emergency help if you have frequent urination, intense thirst, nausea, confusion or drowsiness, or shortness of breath.

When to see a doctor

If you have diabetes and feel unwell with high glucose readings, contact your care team the same day. If you or your child has symptoms such as strong thirst, frequent urination and weight loss, and diabetes has not been diagnosed, see a doctor urgently.

Seek emergency help for fruity-smelling breath, fast or deep breathing, confusion, drowsiness, fainting, or severe stomach pain with vomiting. In an emergency, call your local emergency number (112 in India, 911 in the United States).

This article is for education only and does not replace advice from your own doctor.