Reviewed by: HU Medical Review Board | Last reviewed: March 2021.

Diabetic ketoacidosis (DKA) is a very serious complication of diabetes. It can lead to coma or death if not treated quickly. DKA occurs more often in those with type 1 diabetes but can sometimes occur in type 2 diabetes.1

Insulin is a hormone made in your pancreas. Insulin allows glucose (sugar) into the cells of your body to use glucose as energy. When there is not enough insulin, your body cannot use glucose for energy. As a result, your body starts to break down fat for fuel. Ketones are a chemical by-product of this process.1

What is the role of ketones?

Ketones then build up in the blood and are used by the muscles and other tissues to fuel your body. When there is not enough insulin, the fat cells keep releasing fat into the blood. The liver also keeps making more and more ketones and keto acids.2,3

Why are ketones dangerous?

Your body cannot tolerate too many ketones and will try to get rid of them through urinating more. Eventually, ketones build up in the blood when your body cannot keep up when trying to get rid of them. Ketones upset the chemical balance of your blood, making your blood more acidic than normal.3

If left untreated, this acid state can poison your body, making your tissues and organs lose function.2,3

What causes diabetic ketoacidosis?

People can get diabetic ketoacidosis for a few reasons:1,2,4

  • Not getting treated for diabetes
  • Major illnesses or health problems, such as a heart attack or infection
  • Taking certain medicines or illegal drugs
  • Not taking insulin as directed
  • Having an insulin pump that does not work correctly


Diabetic ketoacidosis signs and symptoms usually develop quickly, sometimes within a day. For some people, symptoms of DKA might be how they find out they have diabetes. Some symptoms of DKA include:1,2,4

  • Extreme thirst
  • Urinating a lot
  • Upset stomach (nausea) and throwing up (vomiting)
  • Belly pain
  • Feeling weak and very tired
  • Feeling short of breath
  • Fruity-scented breath
  • Deep, fast breathing
  • Confusion
  • High blood sugar level
  • High ketone levels in your urine


Different tests help determine if a person has ketoacidosis, including:1,2,4

  • Blood sugar (glucose)
  • Electrolytes
  • Urine tests that measure ketones and check for infection

Ketoacidosis can affect how your heart works, so you may need a test to check the electrical activity in your heart. This test is called an electrocardiogram (ECG or EKG).1,2,4

You may need more tests based on your symptoms.


Treatment is done at the hospital and can include intravenous (IV) fluid, including:2

  • Fluids and electrolytes – Your body loses a lot of fluids during ketoacidosis. Electrolytes (substances such as potassium, calcium, and sodium) are important to make the body work. Doctors must replace lost fluids and electrolytes to stop dehydration and restore normal function to the organs.
  • Insulin – Insulin must be given to replace what the body cannot make. Once the body has enough insulin, it can use sugar (glucose) as fuel, and it does not need to break down fat for energy.


You can reduce your chances of getting DKA by:2

  • Taking your insulin exactly as your doctor prescribed
  • Checking your blood sugar often to make sure it is not too high or too low

DKA is a potentially life-threatening complication of diabetes. If you suspect you or your loved one may have DKA, seek immediate medical attention.

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