Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2005;71(9):1721-1722

What is diabetic ketoacidosis?

Diabetic ketoacidosis (say: key-toe-acid-OH-sis), or DKA for short, happens when your body has high blood sugar (also called glucose) and a build-up of acid. If it isn’t treated, it can lead to coma and even death. It mainly affects persons with type 1 diabetes. But, it can happen with other types of diabetes, including type 2 diabetes and diabetes during pregnancy.

What causes DKA?

The main cause of DKA is not having enough insulin. This raises the blood glucose levels, but stops the body from using the glucose for energy. To get calories, the body starts to burn fat. This causes a build-up of acid in the body. A high level of blood glucose can cause excessive urination, which leads to a lack of fluids in the body (dehydration).

What are triggering factors?

The most common triggering factors are “skipping” insulin doses and illnesses, especially infections that raise your body’s need for insulin.

How can I prevent DKA?

You should work with your doctor to have a plan if your blood glucose level gets too high. Make sure that you know how to reach your doctor in an emergency. Careful monitoring is needed, especially if you are sick.

What should I do?

Check your blood glucose level at least every three to four hours if you are sick. Check your glucose level every one to two hours if you have critical blood glucose values. Ask your doctor what your critical level should be. Most patients should watch their glucose levels closely when they are higher than 250 mg per dL. Keep testing at least every four hours during the night.

Test your urine for ketones or your blood for beta-hydroxybutyrate every four hours or if your blood glucose is over 250 mg per dL.

If you are not eating, do NOT stop your insulin completely. Your body needs insulin even if you are not eating. Call your doctor if you do not know how to change your insulin dose.

If your blood glucose is high, take extra insulin to control it. Call your doctor if you do not have an extra insulin dose or if the extra dose is not working.

Drink lots of sugar-free, caffeine-free liquids. Sip small amounts every few minutes if you are feeling sick to your stomach.

If your blood glucose is more than 250 mg per dL, do not eat or drink foods that are high in carbohydrates.

Contact your doctor if you have:

  • Vomiting more than once

  • Stomach pain

  • Diarrhea five or more times in six hours

  • Two blood glucose level tests higher than 300 mg per dL

  • A blood glucose level less than 70 mg per dL more than once or symptoms of low blood sugar

  • Trouble breathing

  • Moderate or large ketones if you are using urine test strips

  • High beta-hydroxybutyrate levels if you are using blood test strips

If you have signs of infection, including fever, cough, sore throat, or pain when you go to the bathroom, see your doctor to make sure you are getting the right treatment.

If you are on an insulin pump, make sure that you have short-acting insulin, long-acting insulin, and needles in case your pump is not working right. You also should have an emergency phone number to call for help with your pump.

Where can I get more information?

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