Diabetic Ketoacidosis: Symptoms, Causes & Treatment

Diabetic ketoacidosis is a serious emergency that occurs as a complication of diabetes, especially type 1, and sometimes type 2 under severe stress. It arises when the insulin level in the body is very low, so cells cannot use glucose (sugar) as an energy source despite its high level in the blood.

As a result, the body resorts to burning fat instead of sugar for energy, and this burning produces acidic substances called ketones that build up in the blood and make it acidic. This is accompanied by a severe rise in blood sugar and loss of large amounts of fluids and salts through urination, so the patient enters a state of dehydration and salt and acid disturbance that may threaten life. Ketoacidosis is often the first sign revealing type 1 diabetes in a child or young person, or results from missing insulin doses or a severe illness or infection.

Ketoacidosis symptoms develop over hours to a day and include severe thirst, heavy urination, nausea, vomiting, abdominal pain, and severe fatigue, then rapid deep breathing and a breath odor resembling fruit or acetone, and may deteriorate to confusion and coma if untreated. This is a true medical emergency requiring immediate hospital care, where the patient is treated with intravenous fluids, insulin, and salt replacement under close monitoring. Prevention relies on adhering to insulin doses, monitoring sugar and ketones during illness, and never stopping insulin even with loss of appetite.

• Severe thirst and heavy urination.
• Nausea, vomiting, and abdominal pain.
• Severe fatigue and rapid, deep breathing.
• Breath odor resembling fruit or acetone.
• Confusion and coma in late cases.

• Severe insulin deficiency (missing or insufficient doses).
• Illness and severe infection that raise the body's insulin need.
• First-time onset of type 1 diabetes.

• Measuring the very high blood sugar.
• Measuring ketones in the blood or urine.
• Blood-gas and salt tests to assess acidity and severity.

Emergency hospital treatment

• Intravenous fluids to correct dehydration.
• Intravenous insulin to lower sugar and stop ketone production.
• Salt replacement (especially potassium) under close monitoring.

Treating the trigger

• Treating the triggering infection or illness.

Ketoacidosis is an emergency not treated at home. This content is educational and does not replace urgent medical care.

• Circulatory collapse and kidney failure.
• Potassium disturbance and risk to the heart.
• Brain swelling (especially in children) and coma.

• Never stopping insulin and adhering to doses.
• Monitoring sugar and ketones during illness (sick-day rules).
• Treating infection early and increasing water intake.
• Educating the patient and family on early signs.