(Diabetic Coma; DKA)
DefinitionDiabetic ketoacidosis (DKA) occurs when a person’s blood sugar (glucose) is too high because there is not enough insulin. Instead, the body starts to burn fat for energy. Fat is broken down into acids, causing acid levels to build up in the blood. These acids appear in urine and blood as ketones. DKA is a serious condition that can lead to coma or death if not treated.
CausesThis situation is most often caused by uncontrolled type 1 diabetes and sometimes type 2 diabetes.
Risk FactorsFactors that may increase your risk of DKA:
- New infection that may not be obvious, such as pneumonia , urinary tract infection , or sepsis
- Not taking insulin as prescribed or not taking enough insulin at all
- New heart disease, such as heart attack
- Recent stroke
- Recreational drug use, such as cocaine
- Blood clot to the lungs
SymptomsDKA may cause:
- High blood glucose levels (greater than 250 mg per dL)
- Dry mouth and skin
- Frequent urination
- Vomiting and nausea
- Severe stomach pain
- Trouble breathing
- Fruity breath odor
- Rapid pulse
DiagnosisYour doctor will ask about your symptoms and medical history. A physical exam will be done. A urine and/or blood test will be done to look for the presence of ketones.
TreatmentDKA is treated with insulin and fluids. This may require treatment in an intensive care unit.Insulin may be given by IV or injections. The insulin will immediately start reversing the cycle causing DKA. The insulin will let the body use glucose for fuel again. Fat will not be needed for fuel, so new ketones will not be made. The body will then be able to get rid of the extra ketones.Fluids and electrolytes will also be given through IV. Fluids will help flush the ketones from your body. Electrolytes will help your blood restore balance.
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PreventionYou and your doctor will make a plan to manage your diabetes. These steps will also reduce the chance of DKA. Steps may include:
- Take your insulin as recommended. Always have insulin available. Plan ahead for refills.
- Monitor your blood glucose level as recommended, generally at least 3-4 times per day. Monitor more often when you are sick or you have high blood glucose levels.
- Drink plenty of fluids throughout the day.
- Check for ketones in your urine if you have a high blood glucose reading or are ill.
- Create a sick day plan that may include changes in insulin dose and what to do if you are having trouble eating.
- See your doctor if you have infection, cough, sore throat, or pain when you urinate.
- Contact your doctor
- Increase your insulin as recommended
- Eat foods that are low in carbohydrates
- Drink plenty of sugar-free and caffeine-free fluids
- Do not exercise until your glucose is in balance again
American Diabetes Association
National Diabetes Information Clearinghouse
Canadian Diabetes Association
Public Health Agency of Canada
Diabetic ketoacidosis (DKA) in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 7, 2014. Accessed August 13, 2014.
Ketoacidosis (DKA). American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html. Accessed August 13, 2014.
Westerberg D. Diabetic ketoacidosis: Evaluation and treatment. Am Fam Physician. 2013;87(5):337-346..
- Reviewer: Kim Carmichael, MD
- Review Date: 08/2014
- Update Date: 09/30/2013