Overview

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin.

When this happens, harmful substances called ketones build up in the body, which can be life-threatening if it's not found and treated quickly.

DKA mainly affects people with type 1 diabetes but can sometimes affect  people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if you get DKA.

Symptoms of diabetic ketoacidosis

Signs of DKA include:

• needing to pee more than usual
• feeling very thirsty
• being sick
• tummy pain
• breath that smells fruity (like pear drop sweets or nail vanish)
• deep or fast breathing
• feeling very tired or sleepy
• confusion
• passing out

You can get DKA if you have high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine.  You can check for using home-testing kits.

Symptoms usually develop over 24 hours, but they can happen faster.

Check your blood sugar and ketone levels

Check your blood sugar level if you have symptoms of DKA.

If your blood sugars is 11mmol/L or over and you have a blood urine ketone testing kit, check your ketone level.

If you do a blood ketone test:

• lower than 0.6mmol/L is a normal reading
• 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in 2 hours
• 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
• 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately

If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA and you should get medical help immediately.

When to get medical help

Go to your nearest A&E immediately if you think your have DKA, especially if you have a high level of ketones in your blood or urine.

DKA is an emergency and needs to be treated in hospital immediately.

Call your diabetic nurse or GP as soon as possible if you're not sure if you need emergency help - for example:

• your blood sugar or ketone levels are high or getting higher over time but you do not feel unwell
• you feel unwell but your blood sugar or ketone levels are normal or are only a little bit higher than usual

If you are unable to contact your GP surgery/PCS call 111 to speak to a nurse. 111 is available 24 hours a day, every day. For patients' safety, all calls are recorded. 111 is free to call.

Causes of diabetic ketoacidosis

DKA is caused by a lack of insulin in the body, which results in the body  breaking down fat for energy. Ketones are released into the body as the fat is broken down.

If you have diabetes, certain things can make this more likely to happen, including:

• having an infection, such as flu or a urinary tract infection (UTI)
• not following your treatment plan, such as missing doses of insulin
• an injury or surgery
• taking certain medicines, such as steroids
• binge drinking
• using illegal drugs
• pregnancy
• having your period

In some cases there's no obvious trigger.

Preventing diabetic ketoacidosis

The following tips can help reduce your chances of getting DKA:

• check your blood sugar regularly so you can notice and treat an increase quickly
• follow your treatment plan - do not stop taking insulin unless you're told to by a healthcare professional
• take extra care when you're ill - your diabetes team can give you some "sick day rules" to follow, which include things like checking your blood sugar more often and checking your ketone level
• be careful taking new medicines - check with a doctor or pharmacist first, as some medicines can increase the risk of DKA

Contact your diabetes team or GP for advice if you find it hard to keep your blood sugar level down.

Treatments for diabetic ketoacidosis

DKA is usually treated in hospital.

Treatments for DKA include:

• insulin, usually given into a vein (intravenously)
• fluids given into a vein to rehydrate your body
• nutrients given into a vein to replace any you've lost

You'll also be closely monitored for any life-threatening problems that can occur, such as problems with the brain, kidneys or lungs.

You can leave hospital when you're well enough to eat and drink and tests show a safe level of ketones in your body. It's normal to stay in hospital for around 2 days.

Before leaving hospital, ask to speak to a diabetic nurse about why DKA occurred and what you can do to stop it happening again.