Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria.It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. The overproduction of ketones ensues, causing them to accumulate in the blood and urine and turn the blood acidic. DKA occurs mainly in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes.

Signs and symptoms of diabetic ketoacidosis

The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA:

• Malaise, generalized weakness, and fatigability

• Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia

• Rapid weight loss in patients newly diagnosed with type 1 diabetes

• History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump

• Decreased perspiration

• Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis

Signs and symptoms of DKA associated with possible intercurrent infection are as follows:

• Fever

• Coughing

• Chills

• Chest pain

• Dyspnea

• Arthralgia

Diagnosis and Tests

You can take a few at-home tests to see if you could have DKA, including:

• Urine ketone test: This measures the number of ketones in your pee. It’s usually a strip that’ll turn a certain color depending on the ketone levels in your pee. You can buy urine ketone tests at your local pharmacy without a prescription. Follow the instructions on the packaging to be sure you’re doing the test properly.
• Blood ketone test: Some at-home blood glucose meters can check blood ketones as well as blood sugar levels with a drop of blood. Some meters just check ketones in your blood.
• Blood sugar checks: High blood sugar (above 250 mg/dL) is a sign that you could have DKA. Checking your blood sugar with a blood glucose meter or using a continuous glucose monitor (CGM) are the only ways to know for sure if you have high blood sugar.

Prevention

DKA is a serious condition, but you can take steps to help prevent it:

• Check your blood sugar often, especially if you’re sick.
• Keep your blood sugar levels in your target range as much as possible.
• Take medicines as prescribed, even if you feel fine.
• Talk to your doctor about how to adjust your insulin based on what you eat, how active you are, or if you’re sick.

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