Diabetic ketoacidosis, also known as DKA, is when there is severe lack of insulin in the body. This means the body can’t use sugar for energy, and starts to use fat instead. When this happens, chemicals called ketones are released. If left unchecked, ketones can build up and make your blood become acidic – hence the name acidosis.
Diabetic Ketoacidosis (DKA) is a serious condition that affects people with type 1 diabetes, and occasionally those with type 2 diabetes (although they are more likely to be affected by Hyperosmolar Hyperglycaemic State (HHS)).
Some children and adults who don’t realise they have type 1 diabetes don’t get diagnosed until they are very unwell with DKA. It is important to be able to spot the signs and symptoms of DKA so that it can be treated quickly.
DKA is serious if it is not treated fast so these are some of the warning signs to look out for. Share this information with friends, relatives or anyone who looks after children, like teachers and childminders. This is so that they will be able to spot the symptoms of DKA, too.
Here Kate tells us about when her son Llewis became seriously ill with DKA and was diagnosed with type 1 diabetes soon after.
The signs of DKA include:
- high blood sugar levels
- being very thirsty
- needing to pee more often
- feeling tired and sleepy
- blurred vision
- stomach pain
- feeling or being sick
- sweet or fruity-smelling breath (like nail polish remover or pear drop sweets)
- passing out.
Although most common in people with type 1 diabetes, people with type 2 diabetes can sometimes develop DKA. If you notice high blood sugar levels and spot any of the signs below it’s very important to get urgent medical help.
In her video Kate mentions the 4Ts which are the four most common signs of type 1 diabetes. They are:
- Toilet - Going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.
- Thirsty - Being really thirsty and not being able to quench the thirst.
- Tired - Feeling more tired than usual.
- Thinner - Losing weight or looking thinner than usual.
The early signs of DKA can often be treated with extra insulin and fluids if it is picked up quickly. But if it isn’t, DKA needs hospital treatment and can be life-threatening.
These symptoms are sometimes referred to as a 'diabetic attack', but this can also refer to other things, such as hypoglycaemia. You might notice these signs developing over 24 hours but they can come on faster, especially in children or if you use a pump. If you spot any of these symptoms it is a sign that you need to get some medical help quickly.
Checking ketones and blood sugar
Check your blood sugar straight away if you have any of the signs of DKA.
If your blood sugar is high, check for ketones. You can check your blood or your urine for ketones. A blood test will show your ketone levels in real time but a urine test will show what they were a few hours ago.
If you have type 1 diabetes you should get either a blood ketone monitor or urine testing strips for free from the NHS. If you have high ketone levels in your blood and suspect DKA, you should get medical help straight away.
When to get help with DKA
DKA is serious and must be treated in hospital quickly. Left untreated, it could lead to a life-threatening situation.
Treatment of DKA includes:
- Being given insulin through a vein
- Being given fluids through a vein to rehydrate your body
- Being given nutrients through a vein to replace any you've lost
You'll also be closely monitored to make sure there are no serious problems with your brain, kidneys or lungs.
You'll be able to leave hospital when you're well enough to eat and drink and tests show a safe level of ketones in your body.
What can you do to avoid DKA?
You can help avoid DKA by monitoring your blood sugar levels regularly and altering your insulin dose in response to your blood sugar levels and what you eat.
Your blood sugar levels could be higher than normal when you are unwell. So, it’s a good idea to work with your healthcare team to come up with some sick day rules for when you are ill. You may need to drink more fluids, take more insulin and check your blood sugars more than you would usually. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you (or your child).
It is still a good idea to contact your GP or diabetes team if:
- You feel fine but are getting higher than usual readings for blood glucose and ketones.
- You feel unwell but your blood glucose and ketones are only slightly higher than normal.
"The experience [of having DKA] has taught me that it’s so important to listen to your body. No matter how many HCPs you visit, whether they’re a GP or a diabetes specialist or a family friend who works in the field, you know your body and you know what feels right and what doesn’t feel right. When it comes to diabetes, it’s so important to trust your instincts."
Amber, 21, had DKA
What causes DKA?
For some people, becoming suddenly very ill with DKA can be what leads them to finding out they have type 1 diabetes in the first place.
If you have already been diagnosed with diabetes, the causes of DKA can include:
- being ill with a chest infection, flu, Urinary Tract Infection (UTI) for example
- high blood sugar levels caused by a growth spurt or puberty
- not taking your insulin or missing doses
- surgery or an injury
- high blood sugar caused by having your period.
Sometimes, there isn’t always an obvious trigger for DKA which can be worrying and confusing. But if you suspect you or your child has DKA it is important to get medical help straight away.
If you are concerned about any aspect of managing diabetes, you can always call our helpline for support on 0345 123 2399. Alternatively, you can head over to our forum where there are many people willing to offer support and share their experiences of diabetes.