In short
DKA builds over hours when there isn't enough insulin: the body burns fat, floods the blood with acid ketones and dehydrates fast. Thirst, vomiting, deep breathing and fruity breath are the signs — and never stopping insulin is the prevention.
Emergency if: Vomiting, abdominal pain, deep rapid breathing, fruity-smelling breath, drowsiness or confusion in anyone with diabetes, or blood ketones of 3.0 mmol/L or more — call emergency services.
On your report
Random Blood Glucose, Bicarbonate (CO2), Potassium, Sodium +3 more
On this page
01
What Is Actually Going Wrong
Insulin is the key that lets glucose into cells. Without enough of it, glucose piles up in the blood while the cells effectively starve, so the body switches to burning fat. That releases ketones, which are acidic, and as they accumulate the blood's acid balance tips — this is the 'acidosis' in ketoacidosis.
At the same time, the kidneys dump the excess glucose into urine and drag water and salts out with it. Someone in DKA is therefore acidotic, severely dehydrated and depleted of potassium all at once, which is why it needs hospital treatment rather than simply more insulin at home.
02
Who It Happens To
DKA is most associated with type 1 diabetes and is sometimes how type 1 is first diagnosed, particularly in children and young adults. It can also occur in type 2 diabetes during severe illness, infection or after steroids.
One pattern catches people out: with SGLT2 inhibitor tablets such as dapagliflozin or empagliflozin, DKA can develop while blood glucose looks near normal. If you take one of these and feel unwell with nausea, vomiting or breathlessness, ketones need checking even when the glucose reading is unremarkable.
03
The Warning Signs
It usually builds over a day or so: heavy thirst, passing large amounts of urine, tiredness, then nausea, vomiting and abdominal pain. The abdominal pain can be severe enough to be mistaken for a surgical problem.
Two signs are close to specific. Breathing becomes deep and sighing as the body tries to blow off acid, and the breath takes on a sweet, fruity smell like pear drops or nail-polish remover. Drowsiness or confusion means it is advanced and needs emergency care immediately.
04
What Confirms It, and How It Is Treated
The diagnosis rests on three things together: raised glucose (usually above about 250 mg/dL, though not always), ketones in blood or urine, and acid in the blood shown by a low bicarbonate and low pH. Kidney function, sodium and potassium are checked at the same time and followed closely.
Treatment is intravenous fluids, an insulin infusion and careful potassium replacement — the body's total potassium is depleted even when the first blood result looks normal or high, and it falls further as insulin drives it back into cells. The trigger, most often an infection, is treated alongside.
05
Sick-Day Rules That Prevent It
The single most important rule is never to stop insulin because you are not eating. Illness raises insulin requirements, and stopping is one of the commonest routes into DKA. Check glucose more often than usual, keep drinking fluids, and take small amounts of carbohydrate if you can.
Keep in-date ketone strips or a blood ketone meter and use them when glucose runs high or you feel unwell — blood ketone testing is more reliable than urine strips. Agree a written sick-day plan with your diabetes team in advance, including the ketone level at which you call for help.
When to act
Emergency — act now
Vomiting, abdominal pain, deep rapid breathing, fruity-smelling breath, drowsiness or confusion in anyone with diabetes, or blood ketones of 3.0 mmol/L or more — call emergency services.
Same-day — call promptly
Persistently high glucose with moderate ketones, or being unwell with an infection and unable to keep fluids down — contact your diabetes team or an urgent-care service today.
Routine — see a doctor
Repeated unexplained high readings without ketones — book a review of insulin doses, injection sites and technique before a sick day turns into an emergency.
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