Diabetic Ketoacidosis

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a serious, life-threatening complication of high blood sugar. It usually occurs in type 1 (insulin-dependent) diabetics. It must be treated immediately. If you have ketoacidosis, you may go into a diabetic coma.

How does it occur?

If you have diabetes and don't have proper treatment for it, you may develop this very dangerous complication called ketoacidosis. At first your blood sugar (glucose) level may rise above normal. This condition is called hyperglycemia. Hyperglycemia happens when you do not have enough insulin to get sugar out of your blood and into your cells. When the cells of the body can't use sugar for energy, they break down fat for energy. The fat byproducts (ketones) and high sugar level can cause ketoacidosis, a life-threatening chemical imbalance.

Reasons why your blood sugar may increase, even if you are being appropriately treated, include:

  • not getting enough insulin
  • eating the wrong amounts or types of food
  • not testing your blood sugar levels properly or regularly.

Usually, however, ketoacidosis results from changes in your life such as illness, dehydration, infection, trauma, heart attack, surgery, pregnancy, or other types of stress.

If you have not yet been diagnosed with diabetes, ketoacidosis may be the first sign that you have type 1 diabetes (insulin-dependent diabetes).

What are the symptoms?

Symptoms of hyperglycemia include:

  • increased thirst
  • increased hunger
  • dry mouth
  • increased urination.

If you have ketoacidosis you may also have these symptoms:

  • excessive urination
  • excessive thirstiness
  • fruity-smelling breath
  • nausea
  • vomiting
  • confusion
  • tiredness.

The onset of a diabetic coma is usually gradual, producing the symptoms of ketoacidosis first.

How is it diagnosed?

To diagnose ketoacidosis, your health care provider will ask about your medical history, review your symptoms, and give you a physical exam. Your provider will pay special attention to:

  • possible infection
  • the amount of fluids in your body
  • how clearly you are thinking
  • breathing difficulty
  • your heart and kidneys.

Your health care provider will do some tests to check the levels of sugar and other chemicals in your blood and urine. If needed, your provider will also order other lab tests, a chest x-ray, or ECG.

How is it treated?
  • You will be given diabetes treatment as soon as ketoacidosis is diagnosed.
  • Your blood will be checked often for sugar levels and chemical balances.
  • You will be given fluids, possibly intravenously (IV).
  • Your treatment will include antibacterial medication if you have an infection.
How long will the effects last?

Ketoacidosis will continue until enough insulin is available to the body to achieve a normal blood sugar level and restore chemical balance. If this condition is not treated, it can be fatal. With treatment, you may recover in hours to days.

What can be done to help prevent diabetic ketoacidosis?

To help take care of yourself and prevent ketoacidosis, follow these guidelines:

  • Keep your blood sugar level under control.
  • Eat a healthy diet.
  • Follow the physical activity or exercise plan your health care provider has recommended.
  • Check your blood sugar level as often as you and your health care provider have discussed.
  • Test for ketones in your urine, if your blood sugar level is high or you are ill or under more stress than usual.
  • Never take extra diabetes medicine until you are sure that your blood sugar level is too high. The symptoms of low blood sugar can be similar to those of high blood sugar.
  • Know the early signs and symptoms of ketoacidosis.
  • Keep extra diabetes medication with you.
  • Teach a family member or friend how to give you an injection if necessary.
  • Wear a medical ID bracelet for diabetes.

Call your health care provider if:

  • Your fasting blood sugar is 240 mg/dl or more for 2 days.
  • You have vomiting or other symptoms of ketoacidosis.

Developed by Phyllis G. Cooper, R.N., M.N., and iMcKesson Clinical Reference Products.
Published by iMcKesson Clinical Reference Products.
Copyright 1991-2000 iMcKesson LLC. All rights reserved.

Adapted from content provided by iMcKesson, LLC
Review Date: 6/9/2001