| Critical glucose threshold | >250 mg/dL |
| Urgent ketone level | >1.5 mmol/L (blood) |
| Emergency ketone level | >3.0 mmol/L |
| Blood pH in severe DKA | <7.00 |
| Most common trigger | Infection or illness |
| Highest risk group | Type 1 diabetes |
Key Takeaways
- DKA is a medical emergency requiring immediate hospital treatment
- Early warning signs include excessive thirst, frequent urination, nausea, and fruity breath
- Most DKA episodes are preventable with consistent monitoring and sick-day management
- Type 1 diabetes carries the highest risk, but Type 2 can also develop DKA
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis (DKA) occurs when the body lacks sufficient insulin to use glucose for energy. Instead, it breaks down fat rapidly, producing acidic ketone bodies that accumulate in the blood, lowering its pH to dangerous levels. Without prompt treatment, DKA can be fatal.
Warning Signs and Symptoms
Early Warning Signs
- Excessive thirst (polydipsia)
- Frequent urination (polyuria)
- Blood glucose above 250 mg/dL
- Elevated ketones in urine or blood
- Fatigue and weakness
Advanced Symptoms
- Fruity or acetone-like breath odor
- Nausea, vomiting, and abdominal pain
- Rapid, deep breathing (Kussmaul respirations)
- Confusion or difficulty concentrating
- Loss of consciousness (severe cases)
DKA Severity Classification
| Severity | Blood pH | Bicarbonate | Mental Status |
|---|---|---|---|
| Mild | 7.25β7.30 | 15β18 mEq/L | Alert |
| Moderate | 7.00β7.24 | 10β14 mEq/L | Drowsy |
| Severe | <7.00 | <10 mEq/L | Stupor/Coma |
Common Triggers
- Missed or insufficient insulin doses
- Illness or infection (most common trigger)
- Newly diagnosed or undiagnosed Type 1 diabetes
- Insulin pump failure or site occlusion
- Certain medications (corticosteroids, SGLT2 inhibitors)
- Physical or emotional stress
Prevention Strategies
Daily Monitoring
Consistent blood glucose monitoring is your first line of defense. Check glucose at least 4 times daily if on insulin. MDS Diabetes offers a range of blood glucose meters and continuous glucose monitors (CGMs) at mdsdiabetes.com to help you stay ahead of dangerous spikes.
Ketone Testing
Test blood or urine ketones whenever blood glucose exceeds 250 mg/dL, during illness, or if you feel unwell. Blood ketone meters provide faster and more accurate results than urine strips. Ketones above 1.5 mmol/L require urgent medical attention.
Sick-Day Rules
- Never stop taking insulin during illness, even if not eating
- Check glucose and ketones every 2β4 hours
- Stay well hydrated with water or sugar-free fluids
- Contact your diabetes care team early if symptoms worsen
Insulin Management
Ensure you always have an adequate insulin supply. Store insulin correctly (2β8Β°C refrigerated, avoid freezing). Check expiry dates regularly. MDS Diabetes stocks insulin storage cases, cooling wallets, and pen needles to support safe insulin management.
When to Seek Emergency Care
Call emergency services or go to the nearest emergency department immediately if you experience vomiting that prevents fluid intake, ketones above 3.0 mmol/L, blood glucose that won't come down despite correction doses, or any loss of consciousness.