Diabetic Ketoacidosis (DKA): Early Warning Signs and Emergency Symptoms

What is diabetic ketoacidosis?

Diabetic ketoacidosis occurs when the body does not have enough insulin to use glucose (sugar) for energy. Instead, the body begins breaking down fat, producing substances called ketones. When ketones build up in the blood, they can make it dangerously acidic.

DKA most commonly affects people with type 1 diabetes, but it can also occur in people with type 2 diabetes. It may sometimes be the first sign of diabetes.

What are the warning signs of diabetic ketoacidosis?

Symptoms of diabetic ketoacidosis can develop quickly, sometimes within 24 hours. It helps to know the difference between early warning signs and signs that mean you need emergency care right away.

Early warning signs (monitor closely):

• Excessive thirst and frequent urination
• Nausea and vomiting
• Abdominal pain
• Extreme tiredness or weakness
• Dry mouth and dehydration

Emergency symptoms (seek urgent medical care immediately):

• Fruity-smelling breath
• Fast or deep breathing
• Difficulty concentrating, confusion, or unusual drowsiness

High blood sugar and elevated ketone levels can also be important warning signs. However, DKA can occasionally occur without extremely high blood sugar levels, so symptoms should not be ignored even if a reading looks normal.

What can trigger diabetic ketoacidosis?

Several situations can increase the risk of DKA, including:

• Missing insulin doses or not receiving enough insulin
• Illness or infection
• Problems with an insulin pump
• Physical stress, such as injury or surgery
• Certain medications or medical conditions

During illness, the body may need more insulin than usual, making blood sugar and ketone levels harder to manage.

When should you seek emergency help?

Diabetic ketoacidosis requires urgent medical treatment.

Seek emergency medical care immediately if you have symptoms such as vomiting, difficulty breathing, confusion, or fruity-smelling breath, particularly if your blood sugar or ketone levels are high.

If you have diabetes and feel unwell, check your blood glucose and ketones if you have the appropriate testing equipment. Follow the sick-day guidance provided by your diabetes care team.

Do not wait for symptoms to become severe. DKA can worsen quickly and may lead to serious complications if left untreated.

How can diabetic ketoacidosis be prevented?

Following your diabetes treatment plan, monitoring blood glucose regularly, and knowing how to check ketones during illness can help reduce the risk of DKA.

Speak with your healthcare professional about a personalized sick-day management plan, including when to check ketones and when to seek medical advice.

Your DKA prevention checklist

• Know your personal sick-day plan.
• Know when and how to test ketones.
• Make sure you have ketone testing supplies available.
• Know who to contact when you're ill.
• Be alert to problems with insulin delivery if you use a pump.
• Know the warning symptoms that shouldn't wait until your next appointment.

Frequently asked questions

What is the first warning sign of diabetic ketoacidosis?

.Early symptoms may include excessive thirst, frequent urination, fatigue, nausea, and vomiting. Symptoms can vary between individuals.

Can diabetic ketoacidosis happen with normal blood sugar?

Yes. Although DKA often occurs with high blood sugar, it can occasionally develop with lower-than-expected glucose levels. This is known as euglycemic DKA

Is diabetic ketoacidosis an emergency?

Yes. DKA is a medical emergency requiring urgent treatment in a hospital.

Can people with type 2 diabetes get diabetic ketoacidosis?

Yes. Although more common in type 1 diabetes, DKA can also occur in people with type 2 diabetes, particularly during illness or other physical stress.

How can I reduce the risk of diabetic ketoacidosis?

Follow your diabetes treatment plan, monitor blood glucose and ketones when advised, and contact your healthcare team promptly if you are unwell.

Have you experienced DKA or had to manage high ketone levels?
How did you first realize something was wrong? What advice from your diabetes team has helped you manage sick days? Share your experience with the Carenity community.

Take care!