Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin.

DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected.

Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly.

What is diabetic ketoacidosis?

DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness.

Symptoms of DKA

Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes.

Typical symptoms of diabetic ketoacidosis include:

  • Vomiting
  • Dehydration
  • An unusual smell on the breath –sometimes compared to the smell of pear drops
  • Deep laboured breathing (called kussmaul breathing) or hyperventilation
  • Rapid heartbeat
  • Confusion and disorientation
  • Coma

Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia).

Causes and risk factors for diabetic ketoacidosis

As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy.

This may happen for a number of reasons including:

  • Having blood glucose levels consistently over 15 mmol/l
  • Missing insulin injections
  • If a fault has developed in your insulin pen or insulin pump
  • As a result of illness or infections
  • High or prolonged levels of stress
  • Excessive alcohol consumption
  • Illegal drug use

DKA may also occur prior to a diagnosis of type 1 diabetes.

Ketoacidosis can occasionally occur in pregnancy and this can be very dangerous for both the mother to be and the child.

Euglycemic diabetic ketoacidosis

In most cases, ketoacidosis in people with diabetes will be accompanied by high sugar levels. However, ketoacidosis can also occur at low or normal blood glucose levels. This is referred to as euglycemic diabetic ketoacidosis and may occur if someone who is insulin dependent neither eats nor takes sufficient insulin for a prolonged period of time.

People on insulin pumps should be aware that euglycemic diabetic ketoacidosis could occur during or following exercise if insulin delivery is suspended for too long. Healthcare professionals recommend that insulin delivery is not suspended for more than 1 hour.