Diabetic Ketoacidosis

Consistently high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, will cause the body to become acidic – hence the name ‘acidosis’.

DKA is a life-threatening emergency

Although most common in people with Type1 diabetes, anyone who depends on insulin could develop diabetic ketoacidosis. In exceptionally rare cases, people controlling their diabetes with diet or tablets have been known to develop DKA when severely ill.

The most likely times for DKA to occur are:

  • At diagnosis. (Some people who do not realise they have Type 1 diabetes do not get diagnosed until they are very unwell with DKA.)
  • When you are ill.
  • During a growth spurt/puberty.
  • If you have not taken your insulin for any reason.
  • DKA usually develops over 24 hours but can develop faster particularly in young children.

Hospital admission and treatment is essential to correct the life-threatening acidosis. Treatment involves closely monitored intravenous fluids, insulin and glucose.

How to recognise DKA
  • High blood glucose levels: DKA is often (but not always) accompanied by high blood glucose levels. If your levels are consistently above 15mmol/l you should check for ketones.
  • Ketones in the blood/urine. Ketones are easily detected by a simple urine or blood test, using strips available on prescription.
  • Frequently passing urine
  • Thirst
  • Feeling tired and lethargic
  • Blurry vision
  • Abdominal pain, nausea, vomiting
  • Breathing changes (deep sighing breaths)
  • Smell of ketones on breath (likened to smell of pear drops)
  • Collapse/unconsciousness.
What to do if you have symptoms of DKA

If you have high blood glucose levels and any signs of DKA you must contact your diabetes team immediately. Left untreated, DKA can be fatal. If picked up early, it can be treated with extra insulin, glucose and fluid.

  • Make sure you check for ketones if your blood glucose is over 15mmol/l.
  • You may need to take extra insulin.
  • You may need to test your blood glucose and ketone levels frequently (e.g. every two hours).
  • Drink plenty of unsweetened fluid.
  • If you are unable to eat, replace meals with snacks and drinks containing carbohydrate to provide energy (e.g. sips of sugary drinks, sucking boiled sweets).
DKA prevention

DKA is usually avoidable. Making sure you always take your insulin in the right amounts for your food and activity patterns, keeping a good check on your blood glucose levels and consulting your healthcare team appropriately will help you to avoid episodes which are both life-disrupting and life-threatening.