Signs and Symptoms of Diabetic Ketoacidosis (DKA)
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Medically reviewed by Kelly Wood, MD
Diabetic ketoacidosis (DKA) is a dangerous buildup of acids called ketones in your blood. Ketones are produced when your body doesn’t have enough insulin to convert sugar into energy. As a result, your liver begins breaking down fat cells instead. This breakdown of fat often happens much too quickly, turning your blood acidic and making you feel sick.
DKA is common in people with type 1 diabetes. It can also occur with type 2 diabetes, but it’s not as common and is usually not as severe. Early symptoms include extreme thirst and frequent urination. Symptoms can quickly progress to more serious, potentially life-threatening symptoms like rapid breathing, dehydration, and vomiting.
It’s important to be aware of diabetic ketoacidosis symptoms if you have diabetes so you can seek prompt medical attention. Most people who receive treatment recover from DKA, but it can be fatal if left untreated.
Early Symptoms
Diabetic ketoacidosis occurs when your body doesn’t make enough insulin to process the glucose in your blood. This leads to very high blood glucose levels, which can cause many complications.
DKA sometimes leads people with previously undiagnosed type 1 diabetes to get medical care: they seek treatment for their symptoms and are diagnosed with diabetes. DKA can also develop if a person with type 1 diabetes isn’t managing their condition well or becomes sick with another infection.
Polyuria and polydipsia are two physical symptoms that may occur in the early stages of DKA:
Polyuria: High blood glucose levels can cause glucose to build up in your urine, forcing your kidneys to produce more urine to flush it out. This results in polyuria, or frequent urination.
Polydipsia: It’s easy to become dehydrated during or before DKA due to increased urination. One of the most obvious signs of dehydration is extreme thirst, or an increased urge to keep drinking, also known as polydipsia. You may also have an excessively dry mouth.
Testing Blood Glucose and Ketones at Home
If you have already been diagnosed with diabetes, you may be able to test your blood glucose levels and even your ketones at home. One or both levels will likely be elevated if you have diabetic ketoacidosis.
You can use a blood sugar monitor or meter to check your glucose levels if you think you may have DKA. Your healthcare provider can tell you your optimal glucose range. You should generally check for ketones if your blood sugar level is greater than 240 milligrams per deciliter (mg/dL). You can use a simple urine test strip kit.
Related: Do You Pee a Lot at Night? This Might Be Why
Progressive Symptoms
Without prompt medical attention, diabetic ketoacidosis can cause additional symptoms that may become severe. These symptoms include:
Gastrointestinal illness: Nausea, vomiting, and stomach pain are common symptoms of DKA. This is due to your sodium levels becoming depleted with frequent urination as well as the buildup of ketones in your blood.
Respiratory problems: Difficulty breathing or deep, rapid breathing are signs of DKA. Decreasing electrolytes (minerals your body needs to function) can cause severe muscle weakness that affects breathing. This deep, rapid breathing—similar to hyperventilation—is usually called Kussmaul breathing or Kussmaul respiration. It's common in conditions that cause high blood acid levels.
Flu-like symptoms: You may feel generally unwell as your body tries to get rid of excess ketones. Possible symptoms include fatigue, weakness, muscle aches, headache, and flushed skin.
Confusion: Symptoms like dehydration and difficulty breathing can cause you to feel less alert or have difficulty concentrating. Extreme confusion, or delirium, could be a sign of cerebral edema (brain swelling)—a rare but often fatal complication of DKA.
Fruity-smelling breath: Acetone is one of the ketones produced by the body during DKA. It can give your breath a fruity smell.
Symptoms in Children
Diabetic ketoacidosis symptoms in children are the same as symptoms in adults. However, it can be harder to differentiate between DKA and other common childhood illnesses (like the flu or a stomach virus), especially if your child hasn’t been previously diagnosed with type 1 diabetes.
As many as 30% of children with type 1 diabetes are diagnosed because they experience an episode of DKA. About 6-8% of children diagnosed with type 1 diabetes will experience DKA at some point because of illness or poor diabetes management.
Diabetic ketoacidosis in children is quite serious. It’s the most common cause of hospitalization and death in children with type 1 diabetes. Cerebral edema is rare in adults, but it occurs in up to 1% of pediatric patients with DKA. Seek medical attention if your child shows any symptoms of DKA—whether or not they have a type 1 diabetes diagnosis.
When to Contact a Healthcare Provider
Any diabetic ketoacidosis symptoms, whether early or progressive, require immediate medical care. If your regular healthcare provider is available by phone, you can contact them first for the next steps. If they aren’t available, go to the nearest emergency room or urgent care facility.
Questions To Ask Your Provider
When seeking emergency medical care for symptoms of DKA, ask your provider the following questions:
What is my blood glucose level? Can you perform a urine test for ketones?
What needs to be done to get my blood glucose levels back to normal?
Will I need to be admitted to the hospital to manage my symptoms? If so, how long can I expect to stay there?
What possible complications can occur during treatment?
Once recovered, how can I prevent DKA from happening again?
A Quick Review
Diabetic ketoacidosis (DKA) is a complication of type 1 diabetes that occurs when acids called ketones build up in your blood. It is a dangerous and potentially life-threatening condition that requires urgent medical care.
Early symptoms of DKA include increased thirst and frequent urination. Progressive symptoms include nausea, vomiting, lethargy, muscle weakness, difficulty breathing and hyperventilation, and a fruity odor to your breath. Seek immediate medical attention if you or someone in your care has any potential DKA symptoms.
Frequently Asked Questions
At what blood sugar level does ketoacidosis start?
There’s no official blood glucose level associated with DKA. Most experts agree that ketones are likely to be reaching dangerous levels when blood glucose is 200-250 mg/dL.
Can you treat ketoacidosis at home?
Ketoacidosis is a serious and potentially fatal condition that requires emergency medical care.
Does diabetic ketoacidosis cause coma?
Untreated DKA can cause a diabetic coma and, in severe cases, death.
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