Diabetic Ketoacidosis (DKA) is one of the most dangerous complications of diabetes—but also one of the most preventable with the right knowledge and quick action. It mostly affects people with Type 1 diabetes, but those with Type 2—especially during illness, infection, or when insulin is missed—can be at risk, too.
In this article, we’ll break down what DKA is, how to recognize the symptoms early, what you can do at home, when it’s time to get emergency help, and most importantly—how to prevent it from happening in the first place. No medical jargon, just real talk and lifesaving tips.
🚨 What Is Diabetic Ketoacidosis (DKA)?
DKA happens when your body doesn’t have enough insulin to use glucose (sugar) for energy. In response, it starts breaking down fat for fuel—this process produces ketones, a type of acid. When ketones build up too fast, they make your blood dangerously acidic.
If not treated, DKA can lead to coma or death.
⚠️ Common Causes of DKA
- Missed insulin doses
- Illness or infection (like the flu, UTI, or pneumonia)
- Undiagnosed diabetes
- Stress or trauma
- Faulty insulin pump or tubing issues
- Very high blood sugar for an extended time
🧠 Know the Warning Signs: Don’t Wait
DKA doesn’t happen instantly—but the early symptoms are easy to miss or confuse with something else. Here’s what to look for:
Early Signs (Hours to Days Before)
- High blood sugar (usually over 250 mg/dL / 14 mmol/L)
- Excessive thirst or dry mouth
- Frequent urination
- Fatigue or weakness
- Headache
- Muscle aches
Moderate to Severe Symptoms
- Nausea and vomiting
- Stomach pain
- Shortness of breath or rapid, deep breathing (Kussmaul breathing)
- Fruity-smelling breath (like nail polish remover)
- Confusion or difficulty focusing
- Flushed, hot, dry skin
If you notice these symptoms—especially if you’re vomiting or breathing heavily—DKA is likely already underway, and you need medical help immediately.
🏠 At-Home Action Plan: What to Do Right Away
If you suspect DKA but are not yet in severe distress, take these steps while preparing to contact your healthcare provider:
✅ Step 1: Check Blood Sugar and Ketones
- Blood sugar over 250 mg/dL (14 mmol/L)?
- Use a urine ketone strip or a blood ketone meter (blood ketones >1.5 mmol/L are concerning)
✅ Step 2: Stay Hydrated
- Sip water or electrolyte drinks (like Pedialyte or sugar-free rehydration fluids)
- Avoid caffeine, sugary drinks, or alcohol
- Drink small sips every 5–10 minutes if you’re nauseous
✅ Step 3: Take Insulin—But Carefully
- Follow your “sick day plan” if you have one
- You may need a correction dose of rapid-acting insulin
- Do not stop insulin, even if you’re not eating
If vomiting persists or you can’t keep fluids down for more than 4 hours, go to the emergency room immediately.
🏥 When to Go to the ER – Don’t Wait Too Long
Call 911 or go to the nearest ER if:
- You have moderate or large ketones AND high blood sugar
- You are vomiting repeatedly
- You have trouble breathing or very rapid breathing
- You feel confused, very sleepy, or can’t stay awake
- You have severe stomach pain
DKA progresses fast. If you’re unsure, play it safe and get help.
💧 Hydration Protocol for DKA Prevention
When you’re sick or blood sugar is high:
- Drink 1 cup of water or electrolyte fluid every hour
- If blood sugar is >250 mg/dL and ketones are moderate, aim for:
- 8–10 oz of fluid every 30–60 min
- Alternating between plain water and electrolyte drinks
If vomiting, take small sips (1 tablespoon) every 5–10 minutes.
🧭 DKA Emergency Flowchart
Suspect DKA? Follow this:
- Check blood sugar
→ Is it >250 mg/dL?
✔ Yes → Go to Step 2 - Check ketones (urine or blood)
→ Moderate or high?
✔ Yes → Go to Step 3 - Are you vomiting, breathing fast, or very weak/confused?
✔ Yes → Go to ER immediately
❌ No → Go to Step 4 - Hydrate + insulin correction dose
→ Recheck every 2 hours
→ If symptoms worsen or don’t improve in 4–6 hours → Seek medical help
🔁 How to Prevent DKA in the Future
- 💉 Never skip insulin—even if you’re sick or not eating
- 🧪 Test ketones when sick or blood sugar is high (>250)
- 📋 Have a sick day plan from your doctor
- 📱 Use a CGM or glucose tracker to stay in range
- 🛠 Check insulin pump/tubing regularly if you use one
- 👩⚕️ Contact your care team if you’re unsure or need advice
🧷 Final Thoughts
DKA is scary—but with the right information and tools, it doesn’t have to be deadly. Think of it like a fire: it starts small, but if you ignore the smoke, things can spiral quickly. Catch it early, act fast, and you can stop it in its tracks.
Every person with diabetes (and their caregivers) should know the signs, have a plan, and never hesitate to get help. Your life is worth it.
