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Diabetic ketoacidosis is a complication of diabetes in which patients develop high levels of a toxic molecule known as ketones. What do you need to know about it?

Diabetic ketoacidosis is a dangerous complication of diabetes, a disease characterized by high levels of glucose (a type of sugar) in the blood. Diabetic ketoacidosis is most likely to occur in people with type 1 diabetes. In fact, a UK-based study found that nine percent of children with type 1 diabetes experience one episode or more of diabetic ketoacidosis. However, diabetic ketoacidosis can also develop in patients with type 2 diabetes.

Diabetic ketoacidosis is particularly dangerous as it can cause coma and even death, if not identified and treated immediately. In rare cases, diabetic ketoacidosis can occur when a woman is pregnant, which can be dangerous for both the mother and the fetus.

So what is ketoacidosis?

Diabetic ketoacidosis develops when the body does not produce enough insulin, such as in type 1 diabetes. Insulin is a hormone that helps break down glucose, which is used as a source of energy for the body. When there is not enough insulin, the body goes into starvation mode and switches from breaking down sugar to breaking down fat instead. This leads to the production of compounds called ketones, which, at high levels, are toxic.

Symptoms of ketoacidosis

For patients with type 1 diabetes who remain undiagnosed, the development of diabetic ketoacidosis can be a symptom of type 1 diabetes. Sometimes, diabetic ketoacidosis can be diagnosed before type 1 diabetes is. However, the symptoms associated with just diabetic ketoacidosis include:

  • Nausea and vomiting
  • Feeling dehydrated
  • Fruity smell on the breath
  • Deep breathing or hyperventilation
  • Confusion
  • Feeling disoriented
  • In extreme cases, coma

Generally, symptoms of diabetic ketoacidosis are known to develop quickly – over a period of 24 hours if the blood glucose becomes very high, and remains high.

Risk factors for ketoacidosis

Certain risk factors predispose patients with diabetes to diabetic ketoacidosis. The risk factors for diabetic ketoacidosis in patients with diabetes include:

  • Having blood glucose levels that are over 15 mmol/liter over a long period of time
  • Having missed insulin injections
  • If there is some sort of impairment in the patient’s insulin pen or pump
  • Experiencing an illness or an infection
  • Feeling high levels of stress or being stressed for a long time
  • Lots of alcohol consumption
  • Use of illegal drugs

Euglycemic diabetic ketoacidosis

While diabetic ketoacidosis largely occurs in patients with type 1 diabetes who have high blood sugar levels, it can actually also develop in type 1 diabetes patients with either low or normal blood sugar levels. This generally occurs in people dependent on insulin but that stop taking insulin for a long period of time. This is known as euglycemic diabetic ketoacidosis. Additionally, people who receive insulin through insulin pumps are at risk of euglycemic diabetic ketoacidosis if they stop insulin delivery and then exercise. This is why professionals generally recommend that patients don’t stop taking insulin for more than one hour.

How is ketoacidosis diagnosed?

Diagnosis of diabetic ketoacidosis is conducted using both blood and urine tests that measure the levels of ketones in the blood or urine. Furthermore, doctors may also choose to measure the level of potassium as low levels of potassium (a condition called hypokalemia) can occur due to frequent urination and loss of fluids.


Diabetic ketoacidosis is a serious and severe condition that needs to be treated as quickly as possible. The complications of diabetic ketoacidosis can even lead to death if treatment is not promptly provided. Studies have shown that with proper and timely intervention and treatment, the mortality rate associated with diabetic ketoacidosis can be as low as five percent. Therefore, if someone with type 1 diabetes displays signs that are suggestive of diabetic ketoacidosis, you should call 911 and treat the condition as an emergency, as you would with a heart attack.

How is ketoacidosis treated?

Diabetic ketoacidosis is treated using intravenous (IV) fluids in order to replace all the fluids and salts that have been lost as a result of frequent and excessive urination. At the same time, doctors will also treat diabetic ketoacidosis using insulin, as high levels of insulin can instantaneously reduce the amount of ketones that your body produces. Treatment of diabetic ketoacidosis involves keeping a close eye on the patient until their ketone levels stabilize and they are back to eating and functioning normally.

Prevention: Can you avoid ketoacidosis?

Diabetic ketoacidosis can largely be prevented by controlling your blood sugar levels at all times. This means you have to regularly test your blood sugar levels using an at-home glucose testing kit so that you can identify when your blood sugar levels are too high. If you are having an issue with controlling your blood sugar levels, talk to a doctor right away as they can help you. Furthermore, if you don’t feel well then you should test your blood sugar levels as soon as possible, as it could signal diabetic ketoacidosis.

  • Munro, J. F., et al. "Euglycaemic diabetic ketoacidosis." Br Med J 2.5866 (1973): 578-580.
  • Kitabchi, Abbas E., and Barry M. Wall. "Diabetic ketoacidosis." Medical Clinics of North America 79.1 (1995): 9-37.
  • Felig, Philip, et al. "Plasma amino acid levels in diabetic ketoacidosis." Diabetes 19.10 (1970): 727-729.
  • Photo courtesy of SteadyHealth

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