What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a medical emergency. It's a life-threatening complication of diabetes.

If you have diabetes and not enough insulin, your body can start burning fat for energy instead of glucose. This process makes by-products called ketones. Together with very high blood sugar levels, this can lead to DKA.

DKA happens most often in people with type 1 diabetes. But it can sometimes affect people with type 2 diabetes.

In some people, diabetic ketoacidosis (DKA) may be the first sign of type 1 diabetes.

What are the symptoms of diabetic ketoacidosis?

Symptoms and signs of DKA can include:

• feeling very thirsty
• urinating (doing a wee) often
• recent weight loss
• feeling very tired
• nausea and vomiting
• dehydration
• abdominal (tummy) pain

Other symptoms and signs of DKA are:

• fast breathing and heart rate
• flushed cheeks
• breath that smells like acetone (like nail polish remover)
• drowsiness, confusion or reduced consciousness

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When should I call an ambulance of go to the emergency department?

Diabetic ketoacidosis (DKA) is a medical emergency. If you have symptoms of DKA, call triple zero (000) for an ambulance or go to the emergency department.

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What causes diabetic ketoacidosis?

Normally your cells use glucose for energy. If you don't have enough insulin, the glucose can't move from your blood into your cells. This causes hyperglycaemia (high blood glucose levels). Your body can also start burning fat for energy, making ketones.

Hyperglycaemia and ketones make your blood more acidic, which can lead to DKA.

The most common triggers for DKA in people with diabetes are:

• having an infection (such as a urinary tract infection or pneumonia)
• missing insulin doses
• not taking the correct amount of insulin

You may not get the correct amount of insulin if:

• your insulin pen or pump is not working properly
• you use insulin that is past its expiry date
• your insulin was not stored properly

In some people, DKA may be the first sign of diabetes.

If you already have diabetes, DKA can be triggered by:

• a new illness
• surgery
• some medicines

DKA is also a rare side effect of a type of diabetes medicine called sodium-glucose co-transporter 2 (SGLT2) inhibitors. The risk of DKA from SGLT2 inhibitors may be higher if you:

• are sick (for example with an infection)
• are dehydrated
• have been on a very low carbohydrate diet, such as a ketogenic diet
• do lots of exercise
• are fasting (not eating) before surgery or a procedure
• drink a lot of alcohol
• forget to take your insulin or take much less insulin than normal

How is diabetic ketoacidosis diagnosed?

Your doctor will ask about your symptoms and whether you have diabetes. If you have diabetes, they will want to know about your recent blood glucose control.

Your doctor may ask if you have had a recent illness or infection, and what medicines you are taking.

Your doctor will examine you and organise tests including:

• a finger-prick blood test to quickly check your blood glucose and ketone levels
• blood tests, including blood glucose and ketone tests
• a urine test for glucose and ketones

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How is diabetic ketoacidosis treated?

Most people with DKA need hospital treatment in an intensive care unit (ICU). A specialist diabetes team will look after you.

You will need treatment with fluids and medicines via a drip. This includes insulin treatment.

You will be closely watched and checked for complications. Your blood glucose and ketone levels will be regularly checked.

If you have an infection or another illness that may have triggered the DKA, this will be treated.

What are the complications of diabetic ketoacidosis?

DKA is a serious condition. The treatment is complex, and you will need to be watched carefully to reduce your risk of complications, such as:

• low potassium levels in your blood
• hypoglycaemia (low blood glucose levels)
• cerebral oedema (brain swelling)
• pulmonary oedema (fluid in your lungs)

Can diabetic ketoacidosis be prevented?

It's important to control your blood glucose levels when you have diabetes. This helps prevent complications, including DKA.

Take your insulin or medicines as advised by your doctor and diabetes educator.

Regular monitoring of your blood glucose levels is also important. If your blood sugar level is higher than it should be, follow the advice from your doctor or diabetes educator.

Make sure to regularly check that your diabetes equipment is working and that your insulin is stored correctly. Your diabetes educator can help with this.

'Sick day' planning

It's important to have a plan for managing your diabetes when you are unwell with another illness. This is called a 'sick-day management plan'.

Your plan will have instructions on what to do with your diabetes monitoring and medicines when you are unwell. This may involve temporarily stopping your diabetes medicines or changing your insulin doses.

Your plan should also include emergency contact numbers and directions for when to go to hospital.

Talk to your doctor or diabetes educator if you do not have a sick day plan.

SGLT2 inhibitor medicines

You doctor may advise you to avoid SGLT2 inhibitor medicines if you are on a very low carbohydrate diet.

They may tell you to withhold your SGLT2 inhibitor medicine if you are unwell or having a procedure or surgery.

Resources and support

Visit Diabetes Australia for more information and resources. You can also call Diabetes Australia on 1800 177 055.

Diabetes Australia has resources for:

• Aboriginal and/or Torres Strait Islander people
• people from multicultural backgrounds

The National Diabetes Services Scheme (NDSS) has a range of resources, support services and subsidised diabetes products. The NDSS website also has diabetes information in languages other than English.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.