Ketoacidosis: an introduction

Diabetic ketoacidosis is a dangerous short-term complication of diabetes that results from uncontrolled high blood glucose. A rare complication in people with type 2 diabetes, ketoacidosis occurs when elevated blood glucose persists and is uncorrected, resulting in chemicals called ketones accumulating in the blood. Because a person with diabetes is unable to use glucose for energy, if they are not being treated properly, their body may burn fat instead to get energy. Burning fat causes the production of ketones, which can be toxic if they build up in the blood. While ketoacidosis is a complication that mostly affects people with type 1 diabetes, it can sometimes occur in people with type 2 diabetes.1

What causes ketoacidosis?

Ketoacidosis can affect someone with type 2 or type 1 diabetes who is not taking insulin as directed (in some cases, their insulin pump may not be working properly), or someone who is not getting a sufficient amount of insulin, or someone who is taking certain medications or illegal drugs that affect how insulin works. Additionally, a person with type 1 diabetes who has a major health problem, such as a heart attack or infection, is at risk for ketoacidosis. Ketoacidosis may also occur in a person with undiagnosed type 2 diabetes.1

Causes of ketoacidosis

Untreated diabetes
  • Body unable to use glucose, burns fat instead causing a build-up of ketones in blood
Major illness
  • Certain major illnesses (eg, heart attack, kidney disease, pancreatitis, stroke, infections)
Medications or illict drugs
  • Certain medications (eg, glucocorticoids, high-dose thiazide diuretics) or illegal drugs (cocaine) may interfere with carbohydrate metabolism
Insulin not taken as directed
  • Failure to take insulin as directed or faulty insulin pump operation can interfere with body’s ability to use glucose
Fasting or alcohol abuse
  • Both fasting and consumption of large amounts of alcohol may affect blood glucose levels

What are the symptoms of ketoacidosis?

There are several signs and symptoms of ketoacidosis including1,2:

In extreme cases, ketoacidosis can cause a person to go into a coma. Ketoacidosis should be treated as a medical emergency. If you experience any of the symptoms listed above, you should consult your doctor or nurse immediately.1,2

How is ketoacidosis detected?

A variety of tests are useful in determining if a person has ketoacidosis, including serum glucose, serum electrolytes, and urinalysis and urine ketones. Blood glucose levels in people with ketoacidosis are typically less than 800 mg/dL, but may be greater than 1000 mg/dL. Urine analysis will be done to determine levels of ketones in your urine. Ketoacidosis can affect how your heart operates, so your doctor may have you undergo an electrocardiogram to check the electrical activity in your heart.1,2

How is ketoacidosis treated?

If you have ketoacidosis, your body has lost fluids and important chemicals that your body requires to function normally. Treatment for ketoacidosis requires replacing lost fluids and electrolytes (chemicals including potassium and sodium) and re-establishing the normal healthy balance of these components in your blood. This is done with an intravenous infusion of fluids and electrolytes. Treatment for ketoacidosis also requires making sure that your body has the insulin it needs to use glucose for energy.1

How can I prevent ketoacidosis?

As with many complications of diabetes, ketoacidosis can be prevented by closely monitoring your blood sugar and maintaining it at the right level and taking your insulin, as directed.1

Written by: Jonathan Simmons | Last reviewed: May 2014.