Diabetic ketoacidosis (DKA)

When your body does not have enough insulin, it cannot move glucose (sugar) into your cells, and they become starved of energy. Your body then burns fat to get energy.

Burning fat releases chemicals called ketones. This process is called ketosis. Ketones are acidic and if the level of ketones in your blood gets too high, they can be toxic.

Your kidneys can clear small amounts of ketones, but they cannot cope with large amounts.

If you have type 1 diabetes, the levels of ketones in your blood can get very high. This is called diabetic ketoacidosis (DKA). DKA can be life threatening if not treated quickly.

DKA usually affects people with type 1 diabetes, but it can also happen in people with type 2 diabetes who need insulin.

It can happen when:

• you have missed insulin doses
• you are unwell and unable to eat or drink normally
• your insulin pump is not working properly
• you are having a heart attack or a stroke
• you are having a growth spurt.

If you use an insulin pump, you can develop ketosis more quickly than people using injections. 

If your body is producing ketones, you may have some of the following symptoms:

• tiredness and low energy
• dry mouth and thirst
• feeling sick (nausea) or throwing up (vomiting)
• headache
• sore stomach
• rapid breathing or breathing difficulties
• breath that smells like nail polish remover, alcohol, fermenting fruit or a fruity odour.

For some people, these symptoms may be the first sign of having diabetes.

DKA can be very serious and even life threatening.

It can cause:

• vomiting
• dehydration
• imbalance of other chemicals in the blood
• loss of consciousness
• brain damage
• death.

Many people with type 1 diabetes have a ketone testing meter. If you are not sure if you should have a meter, ask your diabetes care team.

You should test for ketones if your blood glucose level is persistently higher than 14 mmol/l or if you have an infection.

You can get a ketone meter and test strips on prescription from your healthcare provider. You can also buy them from most pharmacies.

Ketone test results and what to do

If your ketone level is more than 1.5 mmol/l

• If your blood glucose is below 8 mmol/l, try to eat some extra carbohydrate, such as a sandwich, yoghurt or a banana.
• If your blood glucose levels are high (persistently above 14 mmol/l) you will need extra insulin — follow the recommendations you have been given for managing sick days.
• Test your blood glucose and ketones every hour. You may need to have several extra doses of insulin.
• If your ketones are decreasing, this is reassuring. You can stop extra monitoring and ketone tests once your ketones are below 1.4 mmol/l.

If your ketone level is 1 to 1.4 mmol/l

• This is slightly high. You should adjust your insulin according to the recommendations you have been given for managing sick days.

If your ketone level is less than 1 mmol/l

• Your ketone levels are reassuring. But if your glucose is high you may need to adjust your insulin according to the recommendations you have been given for managing sick days.

If you have type 1 diabetes, it is important to manage your diabetes well. This will help prevent any of the complications of diabetes including DKA.

You need to:

• eat well
• keep physically active
• keep hydrated by drinking plenty of fluids
• take your insulin as prescribed.

Living well with diabetes