Diabetic ketoacidosis (DKA) is a serious complication of diabetes that develops when the body lacks sufficient insulin. Without enough insulin, the body cannot effectively use glucose for energy, leading it to break down fat for fuel instead. This process produces acidic substances called ketones, which accumulate in the blood and can make it dangerously acidic. If left unaddressed, this buildup of ketones can significantly disrupt the body’s normal functions and become life-threatening.
Recognizing the Symptoms
Symptoms of diabetic ketoacidosis can appear quickly, often within 24 hours. Early signs include increased thirst and frequent urination, as the body attempts to flush out excess sugar and ketones. Individuals may also experience a dry mouth and general fatigue. High blood sugar levels, typically above 250 mg/dL, and elevated ketone levels in urine or blood are also early indicators.
As DKA progresses, more pronounced symptoms develop. These include nausea, vomiting, and abdominal pain. The body’s attempt to correct blood acidity can lead to rapid, deep breathing, sometimes called Kussmaul respirations. A distinct sweet or fruity odor on the breath, similar to nail polish remover, is another sign caused by acetone, a type of ketone.
Further progression of DKA can affect neurological function, leading to confusion, disorientation, or decreased alertness. Headache or muscle stiffness may also occur. These symptoms signal a severe metabolic imbalance and require prompt medical evaluation.
Who is at Risk?
Diabetic ketoacidosis primarily affects individuals with type 1 diabetes, where the body produces little to no insulin. DKA can even be the first indication of undiagnosed type 1 diabetes, especially in children. For those already diagnosed, missing insulin doses or issues with insulin pumps can lead to insufficient insulin levels and trigger DKA.
Physical stress on the body can also increase the risk. Severe illness or infection are common triggers because they can lead to increased insulin resistance. Surgery, significant physical injury, heart attack, or stroke can also precipitate DKA. Certain medications, including some diuretics and corticosteroids, may also contribute to the risk. While less common, people with type 2 diabetes can also develop DKA, especially under severe stress or prolonged uncontrolled blood sugar.
When to Seek Immediate Medical Help
Diabetic ketoacidosis is a medical emergency. If you experience a combination of key symptoms, especially if you have diabetes, seek emergency medical care immediately. Call emergency services or go to the nearest emergency room.
Seek medical evaluation if your blood sugar level is consistently high, above 300 mg/dL, and does not decrease with home treatment. Also seek help if you have moderate to high ketone levels in your urine or blood, particularly with persistent vomiting or difficulty breathing. Prompt action can prevent DKA from progressing to severe complications.
Ketoacidosis Versus Ketosis
The terms “ketosis” and “ketoacidosis” sound similar, but describe distinct metabolic states. Nutritional ketosis is a normal physiological process where the body, lacking sufficient carbohydrates, switches to burning fat for energy. This state is often induced by very low-carbohydrate diets or fasting. In nutritional ketosis, ketones are present in the blood, but their levels remain relatively low and do not make the blood acidic. This is generally safe for healthy individuals.
In contrast, diabetic ketoacidosis (DKA) is a dangerous complication characterized by dangerously high levels of ketones that make the blood excessively acidic. This condition arises from a severe lack of insulin, which prevents cells from using glucose and forces the body to break down fat at an uncontrolled rate. Unlike nutritional ketosis, where ketone levels might be around 0.5-3 mmol/L, DKA involves ketone levels that can be ten times higher, leading to a critical imbalance in the body’s acid-base regulation. The presence of high blood sugar alongside high ketones is a hallmark of DKA, distinguishing it from nutritional ketosis where blood sugar levels usually remain stable or low.