Ketoacidosis and Diabetes
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Ketoacidosis in diabetes is commonly known as diabetic ketoacidosis (DKA). It is a condition that arises due to depleted levels of circulating insulin.1 In this condition, ketones, which are harmful substances, start accumulating in the body. The condition can become life-threatening and requires immediate medical attention and treatment.1

Ketoacidosis can be the first sign of type-1 diabetes or people already diagnosed with type-1 diabetes may develop it.2 Although it occurs mostly in people with type-1 diabetes, people with type-2 diabetes can also suffer from ketoacidosis.1 This article focuses on ketoacidosis in people with diabetes and includes its causes, symptoms, and possible treatment.

What happens in ketoacidosis?

When insulin levels drop, glucose is unable to enter the cells as a source of fuel. As a result, the liver begins the breakdown of fat in the body into ketones.2 The process usually takes place when there is a long gap between meals. When the body produces ketones very quickly, they start accumulating in the blood and urine making the blood acidic.2 This condition is known as ketoacidosis. The main causes of ketoacidosis are:2

  • Uncontrolled blood glucose levels
  • Illness, injury, surgery or missing insulin doses in type-1 diabetes
  • Missing the medication in type-2 diabetes

What are the signs and symptoms associated with diabetic ketoacidosis?

The following symptoms are seen in people having DKA:2,3,4

  • Nausea and vomiting
  • Tiredness
  • Headache
  • Increased thirst
  • Dry skin and mouth
  • Dehydration
  • Frequent urination
  • Stomach pain
  • Fruity smelling breath
  • Deep and rapid breathing
  • Disorientation (lack of attention or confusion)

Are children likely to get ketoacidosis?

The fundamental pathophysiology of ketoacidosis in diabetes is similar in both the adults and children, although the characteristics may sometimes differ as discussed below:5

  • Ketoacidosis is often misdiagnosed in toddlers and infants, leading to incorrect treatment that may worsen their condition.
  • Delay in diagnosis is the major cause of DKA in children, while not taking insulin may lead to recurrent DKA in adolescents.
  • Children with DKA are predisposed to cerebral oedema, which is the most common cause of death in these children.
  • Children require greater precision in the delivery of fluids and electrolytes to manage dehydration .

Therefore, careful management is needed in children at risk of or with diabetes. Teaching a child to make healthy lifestyle choices that will shape their health for a lifetime is something every parent can do to help prevent chronic diseases like diabetes.

Is it possible to prevent diabetic ketoacidosis?

You may prevent DKA with the following steps:4

  • Take medication regularly.
  • Check your blood glucose levels regularly, especially during illness.
  • Have a balanced diet and regular meals.
  • Drink plenty of water.
  • Exercise regularly.
  • Contact your doctor immediately if you notice consistent elevated blood glucose levels which isn’t responding to your regular treatment especially if associated with any of the other DKA symptoms mentioned earlier.

How is diabetic ketoacidosis diagnosed and treated?

If your doctor suspects DKA, he/she will advise a test for ketones in your blood and urine. In addition to this, the doctor may advise a test for blood glucose, arterial blood gas, blood pressure, kidney function, sodium and potassium levels in the blood, and osmolality blood test.2

The primary goal of DKA treatment is to maintain normal blood glucose levels. Other goals include fluid replacement and improvement of appetite.2 Hence, the treatment generally includes hospitalisation and giving insulin, fluids and nutrients through a vein.1

Hospitalization is usually necessary for the treatment of DKA as close monitoring is essential to check for any life-threatening problems.1 If DKA is left untreated, complications such as kidney failure, cerebral oedema (build up of fluid in the brain) or cardiac arrest may develop, leading to coma and even death.2,3

Diabetic ketoacidosis is an acute complication in people with diabetes and needs immediate treatment. It may lead to severe consequences if not taken care immediately. If you have diabetes, you should be aware of the risk of DKA.1

Keep your blood glucose in control to keep away ketoacidosis!


  1. NHS. Diabetic ketoacidosis [Internet]. [updated 2017 Apr 24; cited 2019 Dec 13]. Available from:
  2. Medline Plus. Diabetic ketoacidosis [Internet]. [updated 2018 Jan 16; cited 2019 Dec 16]. Available from:
  3. American Diabetes Association. DKA (ketoacidosis and ketones) [Internet]. [cited 2019 Dec 16]. Available from:
  4. Cleveland Clinic. Diabetes: preventing complications [Internet]. [updated 2017 Mar 29; cited 2019 Dec 16]. Available from:
  5. Wolfdorf J, Glaser N, Sperling MA. Diabetic ketoacidosis in infants, children, and adolescents. Diabetes care. 2006;29(5):1150-1159.

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