Diabetic Ketoacidosis: Causes, Risk Factors, Symptoms, Diagnosis, Treatment and Complications

It is a serious health problem that occurs when chemicals called ketones build up in the blood.

Normally, the cells of the body absorb and use glucose as an energy source. Glucose moves through the body in the bloodstream.

Insulin is a hormone that helps cells absorb glucose from the blood. When a patient has diabetes, the cells cannot absorb and use this glucose normally.

Glucose accumulates in the bloodstream and does not reach the cells. In search of an alternative source of fuel, the body’s cells burn fat and break it down.

A by-product of this process is ketones. If ketones are not controlled, they will cause the body to become acidic, hence the name ‘acidosis’.

Ketoacidosis also changes the levels of other substances in the blood. These include electrolytes, such as sodium, potassium, and bicarbonate.

Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes.

This is a condition where the body does not produce enough insulin.

Diabetic ketoacidosis can occur when patients are under high levels of stress , or when they have taken certain medications that change the way their bodies handle glucose.

Causes of diabetic ketoacidosis

Insulin deficiency

Diabetic ketoacidosis is a complication of diabetes that can occur if the body begins to run out of insulin (the hormone that regulates blood sugar).

Lack of insulin can send the body’s metabolism into a destructive downward spiral.

Metabolism is the complex process of chemical reactions that the body uses to break down food into energy.

Insulin allows the body to use blood sugar (glucose). If insulin is lacking, or if it cannot be used properly, the body will break down fat.

The breakdown of fat releases acidic chemicals (ketones). High glucose and ketone levels make you pass large amounts of urine. This can lead to severe dehydration.

Therefore, there are a number of interrelated problems with the body’s metabolism that can make a person sick quickly.

These are:

  • High blood glucose levels (hyperglycemia) due to a lack of insulin.
  • High levels of acid in the blood due to the accumulation of ketones.
  • Decreasing levels of the mineral, potassium, which is essential for good health, vomiting and treatment for diabetic ketoacidosis can cause a decrease in potassium levels ( hypokalemia ).


The body’s response to infection is to make more glucose.

Too much glucose can make insulin treatment ineffective, triggering diabetic ketoacidosis.

The most common infections are:

  • Urinary tract infection, including bladder and kidney infections.
  • Pneumonia – a lung infection.
  • Gastroenteritis: an infection of the digestive system.
  • Gripe.

Undiagnosed diabetes

Symptoms of type 1 diabetes often develop rapidly, and a delay in diagnosing the disease can sometimes progress to diabetic ketoacidosis.

However, this only occurs in a small number of people with type 1 diabetes, suggesting that they have a particularly severe form of the disease compared to other people.

Missed treatment

There are a number of reasons why a person with diabetes may miss recommended treatment, including:

  • Psychological stress, often a common cause in teens with type 1 diabetes.
  • Frequent injections that alter daily activity.
  • Find frequent injections painful.
  • Concern about weight gain.

Other diseases

An underlying disease is the most common reason that people with type 1 diabetes develop diabetic ketoacidosis.

So the following tips should be followed:

  • Some cough mixes and cold remedies contain sugar. The unsweetened variety should always be used.
  • Drink lots of fluids without sugar.
  • Continue your insulin treatment even if you cannot eat your usual amounts of food.
  • Insulin injections may need to be increased when you have an underlying disease.
  • Blood glucose levels will also need to be checked more frequently (usually at least four times a day).

Other triggers

Less common triggers for diabetic ketoacidosis include:

  • Use of illegal drugs, such as cocaine, ecstasy, and ketamine.
  • Excessive alcohol consumption.
  • In some cases, it can also be triggered by another disease, such as a stroke or heart attack.
  • The use of certain medications (such as prednisone, dexamethasone, or other glucocorticoid medications or a certain class of diabetes medications called SGLT-2 inhibitors).

Risk factor’s

Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes.

Children under the age of four are considered to be most at risk.

In about 1 out of 4 cases, diabetic ketoacidosis develops in people who previously did not know they had type 1 diabetes.

Diabetic ketoacidosis accounts for about half of all diabetes-related hospital admissions in people with type 1 diabetes.

Diabetic ketoacidosis is more common in women, they suffer from it more often than men.


Symptoms generally appear quickly over a 24-hour period.

They can vary depending on the severity of ketoacidosis and how long you’ve had it. Symptoms can include:

  • High blood glucose levels – Diabetic ketoacidosis is often accompanied by high blood glucose levels. If your levels are consistently above 15 mmol per liter, you should check for ketones.
  • Ketones in the blood and urine. Ketones are easily detected by a simple urine or blood test.
  • Feeling tired and lethargic
  • Blurry vision.
  • Abdominal pain, nausea, vomiting.
  • Changes in breathing (deep breaths).
  • Odor of ketones in the breath (“fruity-flavored” breath).
  • Collapse or unconsciousness.
  • Feeling very thirsty and drinking lots of water.
  • Urinate a lot more than normal.
  • Fatigue and lethargy that can progress to coma.

Diagnosis of diabetic ketoacidosis

Blood tests can be used to monitor your glucose levels and any chemical imbalances, such as low potassium levels.

Urinalysis can be used to estimate the number of ketones in your body.

Blood and urine tests can also be used to detect an underlying infection, which could be a trigger.

You may also have blood tests to check:

  • The amount of dissolved particles in your blood (plasma osmolarity).
  • The concentration of certain electrolytes in the blood, such as sodium and potassium, and bicarbonate.
  • The number of red and white blood cells in the blood.
  • Kidney function
  • After diabetic ketoacidosis has been diagnosed, regular blood and urine tests will likely be required to check how well you are responding to treatment.

An EKG may also be needed to monitor your heart rhythm.

This is because altered levels of electrolytes in the blood can cause heart problems.


Diabetic ketoacidosis should be treated right away in the hospital.

Diabetic ketoacidosis is treated with a combination of:

  • Insulin (usually pumped into a vein). This will allow your cells to start using more glucose. This will help lower ketone and blood sugar levels.
  • Fluids pumped directly into a vein to rehydrate the body.
  • Replacement of minerals, such as potassium, that may have been lost through vomiting and other diabetic ketoacidosis treatments.

If a patient with diabetic ketoacidosis is unconscious, a feeding tube can be used to remove stomach contents and prevent breathing in vomit.

Urine can be drained out of the bladder using a catheter. If you have a disease that caused your ketoacidosis, your doctor will prescribe treatment after diagnosis. For example, you may be given antibiotics for an infection.

You will need to have more blood tests during treatment. This is so the doctor can observe the condition and change treatment as needed.

Complications of diabetic ketoacidosis

Diabetic ketoacidosis is potentially very serious. High levels of ketones in the blood disrupt the normal function of many parts of the body.

If left untreated, diabetic ketoacidosis can cause life-threatening complications, such as:

Brain edema

Swelling of the brain is a very serious complication of diabetic ketoacidosis. It occurs when excess water accumulates within the brain.

The medical term for this is cerebral edema. Brain edema is generally seen in children and occurs in about 1 in 150 cases of diabetic ketoacidosis.

It is not known why water accumulates in the brain in this way.

Symptoms of brain edema include:

  • Headache.
  • Drowsiness.
  • Restlessness and irritability.
  • Seizures

Brain edema is very serious and can cause severe brain damage. In about 1 in 4 cases, this can be fatal.

The patient with cerebral edema should be admitted to an intensive care unit and administered with mannitol, to help reduce the swelling of the brain.

Acute kidney failure

Severe dehydration can cause the kidneys to stop working.

The kidneys remove waste products from your blood, so if they stop working you may experience a variety of symptoms such as:

  • Swelling in the arms and legs due to a build-up of fluid (edema).
  • Feeling sick.
  • Feeling very tired
  • Confusion.

Until your dehydration has been successfully treated, you may need dialysis, as a treatment to filter waste products from your blood.

Once your fluid levels have returned to normal, your kidneys should begin to recover.

Adult respiratory distress syndrome

The rapid and unpredictable changes in fluid levels that can occur in diabetic ketoacidosis can occasionally cause the lungs to fill with fluid.

This is known as adult respiratory distress syndrome and can cause severe breathing difficulties.

If you develop adult respiratory distress syndrome, a machine called a ventilator may be used to help you breathe until your condition stabilizes from severe dehydration.

Low levels of potassium (hypokalemia), very low levels of potassium can cause serious problems such as muscle weakness and heart rhythm problems.

This can cause death, coma, and swelling of the brain.

The most likely times for the occurrence are:

  • At the time of diagnosis (some people who do not realize they have type 1 diabetes are not diagnosed until they feel well with diabetic ketoacidosis).
  • During accelerated growth and puberty.
  • If you have not taken your insulin for any reason.

Diabetic ketoacidosis usually develops over 24 hours, but it can develop more quickly, especially in young children.

Hospitalization and treatment are essential to correct life-threatening acidosis.

Treatment involves closely monitored intravenous fluids, insulin, and glucose.

Measures when suffering from diabetic ketoacidosis

If you have high blood glucose levels and signs of diabetic ketoacidosis, you should contact your diabetes team immediately. If left untreated, diabetic ketoacidosis can be fatal.

If treated early, it can be treated with extra insulin, glucose, and fluid.

  • Be sure to do ketone lab tests if your blood glucose level is above 15 mmol per liter.
  • Additional insulin may be required.
  • You may need to test your blood glucose and ketone levels frequently (for example, every two hours).
  • Drink plenty of fluids without sugar.

If you cannot eat, replace meals with snacks and drinks that contain carbohydrates to provide energy (for example, sips sugary drinks, suck on cooked sweets).

It is normal to feel tired for a few days after an episode of diabetic ketoacidosis.

You should check your blood sugar level and call your doctor if you are not comfortable with your numbers.

A laboratory test should be performed any time your blood sugar level exceeds 240 mg / dl or 13 mmol.

The key to avoiding diabetic ketoacidosis is giving ketones at the onset of symptoms.