Science-Based Advice to Treat Diabetic Ketoacidosis

Co-authored by Janice Tieperman | Medically reviewed by Janice Litza, MD

Last Updated: November 8, 2022 References Approved

Are you worried that you might have diabetic ketoacidosis (DKA)? This serious condition occurs when your body breaks down too much fat at once, creating ketones that acidify your blood.^{[1]
X
Trustworthy Source
MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source} While DKA can definitely be tough to think about, you’re not in this alone. We’ve outlined everything you need to know about treating DKA, so you can make a safe and informed decision with your doctor on how to recover.

Section 1 of 8:

What are the symptoms of DKA?

1
Extreme thirst, urination, fatigue, and weakness are common DKA symptoms. Some people also experience bad abdominal pain or even nausea and vomiting. Fruit-scented breath is another really common symptom of DKA, as well as fast breathing, body aches, confusion, and difficulty focusing.^{[2]
X
Trustworthy Source
MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source}
2
Consistently high blood sugar is a standard sign of DKA. High blood sugar on its own doesn’t necessarily mean that you have DKA, but it can be a major red flag. Check your blood sugar levels frequently and see what the results say. If the readings are consistently higher than 240 mg/dL (13.3 mmol/L), you likely have DKA.^{[3]
X
Research source}

Section 2 of 8:

DKA Treatment Plan

1
Confirm that you have DKA with an at-home ketone test. There are 2 types of ketone testing kits: blood-based and urine-based. Some urine-based tests use a numerical scale to rank the number of ketones in your urine—for these tests, a score of 2 or higher means that you have DKA. Blood ketone tests operate on a scale and have different ranges of results.^{[4]
X
Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source}
- Less than 0.6mmol/L (10.81 mg/dL): Normal test result; you don’t have DKA
- 0.6 to 1.5mmol/L (10.81 to 27.03 mg/dL): Slight risk for DKA; take another test in 2 hours to be safe
- 1.6 to 2.9mmol/L (28.83 to 52.25 mg/dL): Moderate/high risk for DKA; call your doctor as soon as you can
- 3mmol/L or higher (54.05 mg/dL): Extremely high risk for DKA; call emergency services for help^{[5]
  X
  Trustworthy Source
  National Health Service (UK)
  Public healthcare system of the UK
  Go to source}
- Urine testing kits are often color-coded—simply use take the test and compare your results to the key provided with the test.^{[6]
  X
  Trustworthy Source
  University of Rochester Medical Center
  Leading academic medical center in the U.S. focused on clinical care and research
  Go to source} If your results say that your ketone levels are moderate or high, be sure to call your doctor.^{[7]
  X
  Trustworthy Source
  American Diabetes Association
  Health-based nonprofit focused on preventing and researching diabetes
  Go to source}
- If your blood sugar is higher than 240 mg/dL (13.3 mmol/L), take these tests once every 4 to 6 hours to monitor your ketone levels.^{[8]
  X
  Trustworthy Source
  American Diabetes Association
  Health-based nonprofit focused on preventing and researching diabetes
  Go to source}
- If you don’t have a ketone test on hand, ask a trusted friend or loved one to pick one up for you as soon as they can.
2
Call your doctor or emergency services if you’re experiencing DKA symptoms. Contact your doctor if you’re at a moderate/high risk for DKA—they can listen to your symptoms and test results and give you their professional opinion on what you should do. If you’re at very high risk for DKA, call emergency services instead of your doctor. DKA symptoms can develop and progress in a day or less, so it’s important to get medical attention right away.^{[9]
X
Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source}
- Always go to the hospital if your blood sugar levels are consistently above 16.7 mmol/L (300 mg/dL), as well as if you’re throwing up, experiencing difficulty breathing, and/or have fruit-scented breath.^{[10]
  X
  Trustworthy Source
  Centers for Disease Control and Prevention
  Main public health institute for the US, run by the Dept. of Health and Human Services
  Go to source}
3
Increase your fluid intake. Extra urination is a common side effect of DKA, so it’s really important to replace all the fluids that your body has lost.^{[11]
X
Trustworthy Source
MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source} At the hospital, doctors will use an IV to rehydrate you with fluids.^{[12]
X
Research source} If your doctor gives you permission to recover at home, drink water or another sugar-free beverage to rehydrate yourself.^{[13]
X
Trustworthy Source
Cleveland Clinic
Educational website from one of the world's leading hospitals
Go to source}
4
Replace your electrolytes. Electrolytes, such as sodium, potassium, and chloride, are important to keep your body functioning properly. When you’re hospitalized, electrolytes are usually given to you through an IV.^{[14]
X
Research source}
- If you aren’t hospitalized, your doctor will likely recommend that you drink plenty of fluids like juice, water, broth, and electrolyte-containing sports drinks. This helps get rid of the extra ketones in your body.^{[15]
  X
  Research source}
- During diabetic ketoacidosis, your body either doesn’t produce enough insulin, or the amount of insulin that your body needs has changed and you aren't giving it enough. Low levels of insulin in the body reduce your electrolyte numbers, which can interfere with your body's functions.^{[16]
  X
  Trustworthy Source
  PubMed Central
  Journal archive from the U.S. National Institutes of Health
  Go to source}
5
Undergo insulin therapy. Insulin helps reverse diabetic ketoacidosis by reducing the acid in your blood and balancing your blood sugar levels. This therapy is usually given intravenously by a medical professional. Talk with your doctor and see if insulin therapy is a good treatment option for you and your DKA.^{[17]
X
Trustworthy Source
Cedars Sinai Hospital
Website of one of the world's leading hospitals
Go to source}
6
Test for a DKA trigger. Many times, diabetic ketoacidosis is triggered by a condition or situation. Your doctor may want to test you after your body has returned to normal to see if they can find a possible cause of the condition.^{[18]
X
Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source}
- For example, you may have a bacterial infection, pneumonia, or a urinary tract infection. Some illnesses or infections can produce hormones like adrenaline and cortisol, which can block the effects of insulin.
- Missing treatments of insulin can also trigger diabetic ketoacidosis.
- Some medications or alcohol and drug abuse may also trigger the condition.

Section 3 of 8:

Can DKA be treated at home?

Yes, but only with your doctor’s permission. DKA is a life-threatening condition that often needs immediate medical attention and hospitalization. Still, every case of DKA is different—call your doctor and see what they recommend for you. If they give you the green light to recover at home, make sure that you:
- Stay hydrated (with water and sugar-free drinks)
- Monitor your blood sugar once per hour
- Eat structured meals as usual
- Relax and stay immobile
- Make sure to do exactly what your doctor suggests as you rest and recover at home. If your symptoms don’t seem to be getting any better (or seem to be getting worse), call emergency services.^{[19]
  X
  Trustworthy Source
  Cleveland Clinic
  Educational website from one of the world's leading hospitals
  Go to source}

Section 4 of 8:

What are the side effects of DKA treatment?

Low blood sugar is a possible side effect. Many treatments of DKA involve insulin therapy, where doctors give you lots of insulin through an IV. The insulin helps balance the high blood sugar levels caused by the DKA; however, it might cause your blood sugar to dip a little low. If your blood sugar drops too much when you’re at the hospital, your doctors will counterbalance the effects with glucose.^{[20]
X
Trustworthy Source
Cleveland Clinic
Educational website from one of the world's leading hospitals
Go to source}
- If you’re recovering at home, ask your doctor for suggestions on how to raise your blood sugar. They’ll likely encourage you to eat something sweet and/or carb-rich to help boost your levels.

Section 5 of 8:

Causes of DKA

1
Inconsistent insulin therapy can lead to DKA. Regular, structured insulin doses are a key part of managing your diabetes and keeping you at your happiest and healthiest. If you miss an insulin dose or frequently skip doses, you could develop DKA as a result.^{[21]
X
Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source}
2
A sickness or infection can trigger DKA. Minor infections, like UTIs, can cause DKA to develop. Minor respiratory illnesses, such as the flu, can also lead to DKA.^{[22]
X
Research source}
3
Certain long-term health conditions can contribute to DKA. Health issues like pancreatitis, alcohol abuse, stroke, and heart attack are all connected with DKA. Other factors, like pregnancy, can also cause you to develop DKA.^{[23]
X
Research source}
- Certain medications can also put you at a higher risk for DKA, like dexamethasone, prednisone, and SGLT-2 inhibitors.^{[24]
  X
  Trustworthy Source
  Cedars Sinai Hospital
  Website of one of the world's leading hospitals
  Go to source}

Section 6 of 8:

Who is at risk for diabetic ketoacidosis?

Type 1 diabetics are at the highest risk of developing DKA. DKA almost always affects people with type 1 diabetes, but people with type 2 diabetes can occasionally develop it as well.^{[25]
X
Research source} Typically, individuals with type 2 diabetes experience milder cases of DKA.^{[26]
X
Trustworthy Source
American Diabetes Association
Health-based nonprofit focused on preventing and researching diabetes
Go to source}

Section 7 of 8:

Prognosis

Many people fully recover from DKA in 24 hours or less. As serious as DKA may be, it doesn’t take long to recover from whatsoever. Most people are feeling better within a day or so.^{[27]
X
Research source}
- Some people may take more than 1 day to recover from DKA, but most people recover very quickly.

Section 8 of 8:

Prevention

1
Follow your diabetic management plan. Take the correct dosage of insulin each day, as often as your doctor advises. Poor diabetes management is a common cause of DKA, so it’s really important to stay on top of your daily dosages.^{[28]
X
Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source}
- Talk with your doctor about how to adjust your insulin based on your blood sugar level, the foods you eat, your health, and your activity level.
2
Monitor your blood sugar frequently. Regular monitoring helps ensure that your blood sugar levels are within your target range. This way, any abnormalities can be treated before they turn into DKA.^{[29]
X
Trustworthy Source
Centers for Disease Control and Prevention
Main public health institute for the US, run by the Dept. of Health and Human Services
Go to source}
- You may need to check your blood sugar multiple times a day to get an accurate picture.
- If your blood sugar range varies a lot, get a sliding scale for dosing insulin based on your current glucose level. This scale might need to be adjusted when you are sick or your activity or appetite levels change.
3
Monitor your ketone levels when you feel sick or have high blood sugar. Your ketones often increase when you’re feeling sick or under a lot of stress. During these times, monitor the ketone levels in your urine to make sure they’re not at a moderate or high level. If they are, seek immediate medical care.^{[30]
X
Research source}

Warnings

It’s always better to be safe than sorry when it comes to DKA! This condition can lead to kidney failure and cardiac arrest when it’s not treated quickly, so be sure to call your doctor right away if you start noticing any symptoms.^{[32]
X
Research source}

⧼thumbs_response⧽
Helpful 0 Not Helpful 0
You could still have DKA even if you haven’t officially been diagnosed with diabetes. For some people, DKA is the first sign that they have the condition.^{[33]
X
Trustworthy Source
MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source}

⧼thumbs_response⧽
Helpful 0 Not Helpful 0