Blog - Diabetes Information, Symptoms & Diagnoses
What is Diabetic Ketoacidosis (DKA)?
When the body does not receive energy from food for an extended period of time, the liver breaks down stored fat and releases biomolecules, called ketones into the bloodstream as an alternative energy source to support energy demanding organs like the brain, heart and muscles.1 If high levels of ketones enter the bloodstream, the blood can become increasingly acidic, resulting in a condition called ketoacidosis. Especially for those with diabetes this condition can become life threatening when the body is unable to produce enough insulin to enable blood sugar to enter cells and for your ketone levels to rise, resulting in a diabetic ketoacidosis (DKA).1
High ketones levels are one of the first signs of type 1 diabetes, and without medical intervention, can become fatal for young children as well as adults. Those with type 2 diabetes are also susceptible to diabetic ketoacidosis, particularly those taking SGLT2 inhibitors, but it is less common.2
What are the symptoms of DKA?
The warning signs of diabetic ketoacidosis can occur rapidly within a 24-hour period3 and can include:2,4,5,6
Initial DKA signs and symptoms | Advanced symptoms of ketoacidosis |
Increased urination5 | Lethargy4 |
Increased thirst5 | Abdominal pain4 |
High ketones, found in urine6 | Shortness of breath which may smell fruity5 |
High blood sugar levels (hyperglycaemia)6 | Rapid breathing5 |
Nausea and/or vomiting2 | |
Dry skin and mouth2 | |
Confusion4 | |
Loss of consciousness5 |
Many signs and symptoms of diabetic ketoacidosis, such as headaches, confusion and fatigue, are similar to hypoglycaemia and hyperglycaemia.
If diabetic ketoacidosis is suspected, or those with type 1 diabetes have a blood sugar reading that rises above 17 mmol/L1, is consistently above 13 mmol/L1, or is above 11 mmol/L4 and symptoms are present, ketone levels within blood or urine should be tested.
What are the causes of diabetic ketoacidosis (DKA)?
Diabetic ketoacidosis is caused by high blood sugar levels combined with low insulin levels, triggering an increase in ketones as the body breaks down fat.
For people with diabetes, DKA can be triggered by,:2,7,5,8
- A prolonged delay or interruption of insulin treatment5
- A new onset of diabetes2
- Infections, such as pneumonia and urinary tract infections2
- Pregnancy7
- Exercise8 (which can result in raised ketones and blood sugar levels – it is important not to exercise if ketones are already high)
What is the normal ketone range?
High ketones in either blood or urine can indicate the presence of diabetic ketoacidosis and will require immediate medical intervention. According to the NHS, the following ketone ranges from blood or urine tests with instructions serve as orientation5:
- <0.6 mmol/L – Normal reading
- 0.6 – 1.5 mmol/L – Slightly raised, test again in a couple of hours
- 1.6 – 2.9 mmol/L – Increased risk of DKA. Contact your family doctor
- >3 mmol/L or higher – Very high risk of DKA. Seek immediate medical attention
Testing ketone levels in the blood
For those with diabetes, certain glucose meters can help to determine your ketone levels with the use of ketone test strips with a finger prick. However, it is important to contact your family doctor or pharmacist who can take a blood sample and test your current ketone concentration for you. This will allow for greater sensitivity and specificity for DKA9 and enable your doctor to take swift action if required.
Testing urine ketone levels
Urine home test kits5 can be used to check that ketone levels are in the normal range. The test strips should be placed in a clean container with your urine sample, or your urine must be put directly on the test strip – step by step instructions will be included in the kit. A colour chart will also provide further information on your ketone levels.
Urine testing is a painless process to examine the level of ketones for those with or without diabetes and may be ordered by your family doctor if a risk for DKA is suspected.
When to seek treatment for diabetic ketoacidosis
Without urgent medical assistance, diabetic ketoacidosis can be fatal. Contacting your family doctor if you are experiencing any of the following will be vital to receive the appropriate DKA treatment.
- Your blood sugar levels remain high and do not respond to home treatment6
- If ketone levels remain between 0.6 mmol/L and 2.9 mmol/l with no signs of falling within normal range5
- You are experiencing several symptoms of DKA, such as nausea and vomiting or confusion6
If you have diabetic ketoacidosis, you will be admitted to hospital. Your healthcare team will aim to stabilise your ketone levels over the next one or two days. Treatment options may include:
- Insulin therapy5 – usually given into a vein (intravenously), this will help to counteract the effects of DKA and lower your ketone levels until they reach healthy levels
- Fluid replacement2 – this will help to restore circulatory volume, clear ketones and correct electrolyte imbalances. Nutrients can also be given intravenously to replace any minerals lost through increased urination and remove excess glucose in the blood
- Electrolyte replacement2 – the introduction of sodium, potassium and chloride will enable rehydration and support your heart, brain, nerves and related muscles and improve glycaemic control9
Simplify your diabetes management with Dexcom CGM
Those with type 1 diabetes and type 2 diabetes on intensive insulin treatment should regularly monitor their blood sugar levels and contact their family doctor if glucose readings remain consistently high, or if blood glucose and ketone levels are both slightly elevated.
Dexcom CGM (continuous glucose monitoring) systems are designed to make type 1 and type 2 diabetes management more convenient than self-monitoring of blood glucose (SMBG)10,11,12, whatever your age, lifestyle, daily routine, or health status. Dexcom CGM systems allow for greater glycaemic control10,11,12 in people with diabetes, with real-time glucose readings without the need for finger pricks.†,‡ Stable sugar levels are important to lower the chances for long-term complications.13
Find out more about Dexcom CGM Systems
Compare Dexcom CGM Systems to find the right product for you or find out how you can access CGM through NHS funding.
References and Footnotes
†Display devices sold separately. For a list of compatible smart devices, please visit www.dexcom.com/en-GB/compatibility.
‡Finger pricks are required for diabetes treatment decisions if symptoms or expectations do not match readings
1 Diabetes.co.uk. Diabetes and Ketones. Updated 10 June 2022. Accessed 11 January 2023. Available at diabetes.co.uk.
2 Lizzo JM, et al. Adult Diabetic Ketoacidosis. StatPearls Publishing. Updated 12 July 2022. Accessed 11 January 2023. National Library of Medicine.
3 BMJ Best Practice. Diabetic Ketoacidosis. Accessed 11 January 2023. BMJ Best Practice.
4 NICE. When should I suspect diabetic ketoacidosis in a person with type 1 diabetes?. Updated November 2022. Accessed 11 January 2023. NICE.
5 NHS. Diabetic ketoacidosis. Updated 1 May 2020. Accessed 11 January 2023. NHS.
6 Mayo Clinic. Diabetic ketoacidosis. Published 6 October 2022. Accessed 11 January 2023. Mayo Clinic.
7 Evans, K. Diabetic ketoacidosis: update on management. Clinical Medical Journal. Published September 2019. Accessed 11 January 2023. Royal College of Physicians.
8 American Diabetes Association. Exercise and Type 1. Accessed 11 January 2023. American Diabetes Association.
9 Dhatariya, K. Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis. Review of Diabetic Studies. 2016;13(4):217-225. Rev Diabet Stud.
10 Beck RW, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA. 2017;317(4):371-378.
11 Martens T, et al. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: A randomized clinical trial. JAMA. 2021;325(22):2262-2272.
12 Šoupal J, et al. Glycemic Outcomes in Adults with T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow‐Up from The COMISAIR Study. Diabetes Care. 2020;43:37-43.
13 NHS. Avoiding complications. Updated 9 August 2021. Accessed 24 January 2023. NHS.
‡Finger pricks are required for diabetes treatment decisions if symptoms or expectations do not match readings
1 Diabetes.co.uk. Diabetes and Ketones. Updated 10 June 2022. Accessed 11 January 2023. Available at diabetes.co.uk.
2 Lizzo JM, et al. Adult Diabetic Ketoacidosis. StatPearls Publishing. Updated 12 July 2022. Accessed 11 January 2023. National Library of Medicine.
3 BMJ Best Practice. Diabetic Ketoacidosis. Accessed 11 January 2023. BMJ Best Practice.
4 NICE. When should I suspect diabetic ketoacidosis in a person with type 1 diabetes?. Updated November 2022. Accessed 11 January 2023. NICE.
5 NHS. Diabetic ketoacidosis. Updated 1 May 2020. Accessed 11 January 2023. NHS.
6 Mayo Clinic. Diabetic ketoacidosis. Published 6 October 2022. Accessed 11 January 2023. Mayo Clinic.
7 Evans, K. Diabetic ketoacidosis: update on management. Clinical Medical Journal. Published September 2019. Accessed 11 January 2023. Royal College of Physicians.
8 American Diabetes Association. Exercise and Type 1. Accessed 11 January 2023. American Diabetes Association.
9 Dhatariya, K. Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis. Review of Diabetic Studies. 2016;13(4):217-225. Rev Diabet Stud.
10 Beck RW, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA. 2017;317(4):371-378.
11 Martens T, et al. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: A randomized clinical trial. JAMA. 2021;325(22):2262-2272.
12 Šoupal J, et al. Glycemic Outcomes in Adults with T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow‐Up from The COMISAIR Study. Diabetes Care. 2020;43:37-43.
13 NHS. Avoiding complications. Updated 9 August 2021. Accessed 24 January 2023. NHS.