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Diabetic Ketoacidosis

What Is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis is when a person with diabetes has too much acid in their blood. This happens when the body uses fat for energy instead of sugar, and creates chemicals called ketones. People with type 1 diabetes or type 2 diabetes can get diabetic ketoacidosis (kee-toe-ah-sih-DOE-sis) if their blood sugar levels are too high for too long and if they don’t have enough insulin in their system.

DKA is an emergency that needs to be treated right away. Fortunately, it usually can be prevented.

What Are the Signs & Symptoms of Diabetic Ketoacidosis (DKA)?

Symptoms that can happen in diabetic ketoacidosis when the blood sugar gets too high (hyperglycemia) include:

  • decreased energy
  • being very thirsty
  • peeing a lot
  • dry mouth and dehydration

If sugar levels stay high, more serious symptoms can happen that need treatment in the ER. These include:

  • nausea or vomiting
  • belly pain
  • breath that smells fruity
  • confusion
  • extreme drowsiness
  • fast, deep breathing

DKA that isn’t treated right away can cause a diabetic coma. The high acid in the blood causes the body not to work well, and can lead to a person becoming unconscious.

What Causes Diabetic Ketoacidosis (DKA)?

Here’s an example of how high blood sugars can lead to DKA:

  1. A person gets sick, is under stress, or doesn’t take insulin according to their care plan.
  2. Without enough insulin, sugar in the blood can’t get into the cells. So blood sugar levels rise above the healthy range (hyperglycemia).
  3. The body uses fat for fuel, which sends ketones into the blood.
  4. The ketones (KEY-tones) in the blood make the blood too acidic.
  5. Too much acid in the blood causes the body’s organs to not work well.

How Is Diabetic Ketoacidosis (DKA) Diagnosed?

When a child comes to the hospital with symptoms of DKA, the health care team will do blood tests and urine tests to know for sure. The tests measure the amount of sugar, ketones, and acid in the blood and the amount of ketones and sugar in the urine (pee).

How Is Diabetic Ketoacidosis (DKA) Treated?

Diabetic ketoacidosis is an emergency and needs to be treated right away. Treatment includes giving insulin and IV fluids. A person with DKA needs to be watched closely in the hospital until their blood sugars and blood acid level are back in a healthy range, and they are feeling better.

How Can Parents Help?

Help prevent diabetic ketoacidosis by following your child’s care plan so blood sugar levels stay in the healthy range. The care plan tells you exactly how to do this and includes specific instructions about:

  • your child’s blood sugar healthy range
  • when and how to test blood sugar 
  • when and how to check blood or urine for ketones
  • when to give insulin and how much
  • eating healthy meals
  • getting plenty of exercise
  • what to do on sick days

Because DKA is serious, you need a plan just in case. Here’s how to prepare:

  • Educate. Tell all adult family members, caregivers, and school staff about DKA. Be sure they know what to do if your child has an emergency, and when to call 911.
  • Get a medical ID. All kids and teens with diabetes should wear a medical identification (like a bracelet or necklace) at all times. Be sure to include your emergency contact information on the ID.
  • Check for ketones. You should check the blood or urine for ketones any time your child is sick, has symptoms of DKA, or their blood sugar is high. The care plan will tell you what blood sugar levels should be followed up with a ketone check. In many plans this is 250 mg/dl or higher.
  • Know when to call the care team. If your child’s blood sugars are high, the blood or urine has ketones, or you have any concerns, contact your child’s diabetes health care team. They’ll answer your questions and teach you how to bring high sugars back into the healthy range.

Anyone with diabetes can have high blood sugar readings from time to time, even if they follow their care plan. What’s most important is that you monitor your child’s blood sugars every day, take action if you get a high reading, and know the signs of DKA. When you’re prepared, you’ll have the confidence to handle any challenges that come your way.

Reviewed by: Chijioke Ikomi, MD
Date Reviewed: 10-02-2022

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