Short-term high blood sugars are rarely lethal. However, for people with type 1 diabetes, and some with type 2 who are not producing enough insulin, periods of high blood sugars can lead to diabetic ketoacidosis (DKA). DKA is extremely dangerous, and if untreated it is deadly.

The absence of insulin allows your blood to slowly become acidic. The body’s cells cannot survive under acidic conditions, so the liver will try to help the cells that are starved for glucose and secrete glucose. When combined with dehydration, this process accelerates into a poisonous cocktail that undermines the heart, impairs the brain, and can lead to death in days.

Diabetic ketoacidosis is always ultimately caused by a lack of insulin, and usually occurs in patients with undiagnosed type 1 diabetes. It can also happen when patients miss insulin doses (or don’t realize that their insulin pumps have failed). Other health issues, such as the flu, dehydration, or physical exhaustion can also cause DKA to develop more quickly.

Who Can Develop Diabetic Ketoacidosis (DKA)?

People with type 1 diabetes and type 2 diabetes can develop DKA. Those with type 1 diabetes are at a much higher risk, because they naturally make little or no insulin. Most people with type 2 diabetes secrete enough insulin to prevent diabetic ketoacidosis, even if blood sugars are chronically elevated.

Most often, DKA develops in people who have not yet been diagnosed with diabetes. Type 1 diabetes is frequently diagnosed only after DKA has sent an unsuspecting patient to the hospital. Once diagnosed, people with diabetes can avoid DKA if they learn to recognize the beginning symptoms.

How Do I Know If I Have Diabetic Ketoacidosis (DKA)?

DKA can develop slowly or quickly. At first, it is characterized by the symptoms of very high blood sugar:

• thirstiness
• dry mouth
• frequent urination
• blurry vision
• fruity bad breath

At this point, you will likely have high blood sugars and ketones in your urine (more on this below).

If your body still doesn’t get the insulin it needs, your blood becomes more acidic. You will likely feel tired, and your body might start to feel very achy, as if with a high fever. When any of the following symptoms occur, your condition is very serious, and may develop into DKA, if it hasn’t already:

• nausea, vomiting, or abdominal pain
• confusion and trouble concentrating
• dizziness
• deep and labored breathing

DKA is a potentially life-threatening condition and requires immediate treatment at a medical center. If you think that you may have it, call your doctor immediately or go to the emergency room.

What Are Ketones?

Diabetic ketoacidosis involves the dangerous overproduction of ketones.

Ketones are a byproduct of your body burning fat for fuel. Most of the time, there’s nothing unsafe about ketones — the body safely produces ketones when fasting or when you’ve eaten few carbohydrates. Your body may even create ketones overnight, between breakfast and dinner. Many people enjoying low-carbohydrate diets, both with and without diabetes, have consistent low levels of ketones circulating. But in excessive concentrations, ketones become very dangerous.

If you do not have enough insulin and are experiencing prolonged high blood sugars, your body will begin to harvest fat for energy. Eventually, it will consume your muscles and organs. This will cause ketones to build up in your blood, making it more acidic. Your kidneys will eventually try to help filter out the extra glucose in the blood by secreting the glucose along with your urine. You can detect DKA by checking for ketones.

How to Check for Ketones

Many experts recommend checking for ketones if you have had prolonged high blood sugars. The American Diabetes Association suggests testing for ketones every four to six hours when blood sugar remains elevated above 240 mg/dL.

It is also wise to check for ketones during illness, especially any dehydrating illness — one that causes vomiting or diarrhea, or makes it difficult to eat or drink. These conditions can greatly accelerate the development of DKA.

There are test kits for ketones that use blood or urine. Those that use urine are less expensive and more common, though blood meters may be more accurate and easier to interpret.

Checking Urine for Ketones

A ketone urine test works by dipping a ketone test strip into a sample or fresh stream of urine. You wait for a little while (see instructions on the test kit) and the strip will change color. You then match the color with the color strip on the side of the bottle to determine your level of ketones. Typically, the darker the strip, the more ketones you have.

Checking Blood for Ketones

There are now a few devices on the market that can check your blood for ketones. These devices work the same way as a typical blood glucose meter. You apply a drop of blood to the strip and the meter will tell you your level of ketones.

How to Treat Diabetic Ketoacidosis (DKA)

You always should treat DKA by trusting to the supervision of a qualified medical professional. This is not a health condition to handle at home! Typically, the treatment will include:

• Intravenous (IV) fluids to restore proper levels of hydration
• Insulin to lower the high blood sugars
• Electrolytes to restore the imbalance caused by dehydration
• Treatment of any illness or infection that may be contributing to DKA

If you suspect you have DKA, seek emergency medical care. In the meantime, be sure to drink plenty of water and treat the high blood sugars as your doctor has advised you.

If you need to go to the ER, let the paramedics know that you think you have diabetic ketoacidosis. If you can remember, let them know how much insulin you used recently and when.

How to Treat Slightly Elevated Ketones

If you only have mild symptoms of high blood sugar and a ketone test does not indicate that you’re in immediate danger of DKA, then you need to know what to do so your situation doesn’t worsen. Don’t hesitate to contact your healthcare provider so they can help you monitor your situation closely.

The most important thing to do is to bring your blood sugar back down to healthy levels. If you’re an insulin user, the usual prescription is to administer a correction dose of insulin.

Gary Scheiner, a CDE, author, and person living with type 1 diabetes, shares his insight on the quantity of insulin that should be given: “When elevated ketones are present, it is generally safe to administer the usual ‘correction dose’ based on one’s target blood glucose and insulin sensitivity.  Often, there is an insulin deficit since the body is either insulin-resistant or has received very little working insulin for the past several hours, so a bit more than the standard amount may be warranted.  However, the standard dose will at least start the process toward recovery.”

Be sure to drink plenty of water and if you are alone, try to find someone who can be with you while you continue to monitor your blood sugar and ketone levels, to make sure the situation does not get worse.

After Diabetic Ketoacidosis (DKA)

It is normal to feel tired for a few days after a DKA episode. Check your blood sugars and call your doctor if you are uncomfortable with your numbers. If you don’t already own a blood ketone meter or urine ketone strips, consider the small investment and remember to use it anytime blood sugars go over 240mg/dL or 13mmol. The key to avoiding DKA is to manage ketones at their earliest onset.