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Symptoms of Diabetic Ketoacidosis - What is DKA?- Signs of DKA

What exactly is diabetic ketoacidosis and what will happen? - Diabetic Ketoacidosis or DKA is the single most life threatening complication of type 1 diabetes. This is caused by an excessive amount of ketones in the blood.  Ketones, which are acids in the blood, are produced when there is a lack of insulin in the body. The body uses up its own fats, muscle and liver cells (fasting state) in place of glucose to provide essential energy (Fed state). In the fasting state, the fat is broken down into the by product called ketones. The body then attempts to provide more glucose to provide more energy, which increased the acidity.  So basically, the body is short of insulin, the blood glucose levels and ketones are high which can lead to the diabetic ketoacidosis (DKA) 


The blood becomes too acidic, body fluid and salt levels become unbalanced leading to dehydration. The person then can feel nauseous, vomit and become drowsy or sleepy. Excessive urination and excessive thirst are also early warning signs


DKA can happen when a person has not yet been diagnosed as diabetic. It can also happen to a person who is already diagnosed, but their blood sugar levels are running high, due to missing insulin before meals or due to illness. Other causes of DKA can include stress, alcohol and drug abuse. DKA can also occur due to an incorrect dose of insulin, either self administered or by insulin pump, infection, surgery, and heart attack. If you are ill, you should check your ketones every 4 hours or so.


 As glucose levels rise, the liver cannot hold on to these excess sugars so then dump them into the urine, thereby increasing the production of urine and thus dehydrating the body. Excessive urination can lead to significant loss of potassium and other salts in the body as it is drawn out of the cells and enters the blood stream and about 10% of the total body fluids can leave the body during DKA


What are the signs of diabetic ketoacidosis?


Tell tale signs of DKA


  • The breath that smells like fruit, pear drops or nail polish remover (acetone)
  • Hard to breath or gasping for air
  • Extreme thirst
  • Excessive urination
  • Stomach or abdominal pain
  • Nausea or vomiting
  • Flushed complexion
  • DKA often develops over a short time with drowsiness, sickly feeling fluctuating states of consciousness, fatigue and lack of appetite and generally feeling ‘out of sorts’.


If left untreated, the person will start to vomit and lose valuable fluids (approximately a gallon and a half) and become severely dehydrated, which could lead to diabetic coma. It is imperative that the patient gets medical help as soon as possible. While in hospital treatment, they will have insulin administered to reduce the glucose levels and will also receive fluids and electrolytes via a ‘drip’ to increase their body fluids to an acceptable state.


DKA can usually be avoided by checking blood sugars regularly and also test for ketones by using a meter, should the blood sugars rise to 240 mg/dl -13.3 mmol/l or higher.  These days there are meters which can test both glucose and ketones by simply inserting the correct type of test strip into the meter.  The meter does it all and differentiates between the 2 test strips. 


For diagnosed diabetics, a blood glucose diary is highly recommended to monitor your glucose readings.  The ketone readings can also be added in the comments section. Recording your readings gives your diabetes practitioner or diabetes nurse a valuable insight into your overall diabetic control and can therefore suggest any changes that you need to make to your insulin regime or diet. Newly diagnosed diabetics will see a specialised diabetes nurse, dietician and specialist to discuss your diabetes and the appropriate actions to take to make your new life as a diabetic as uncomplicated as possible.  Listen to the professionals’ and you will not go far wrong.

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