Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) is a frightening term for any diabetic. This condition can rapidly kill a diabetic if treatment is not administered immediately.

Ketoacidosis can occur in any person for a number of reasons such as alcoholism or starvation, but diabetic ketoacidosis is only found in diabetics, primarily uncontrolled type 1 diabetics. Often times a diabetic is first diagnosed with diabetes when rushed to the ER in severe ketoacidosis.

In general ketoacidosis is when the body produces too much ketones, it breaks down fatty acids and these build up in the blood and quite literally the blood becomes toxic and poisonous making the body deathly ill. The build up of acetone in the blood is marked by a sweet almost fruity smell on the breath and sometimes in the sweat.

Exactly what causes ketoacidosis in diabetics? When a diabetic is uncontrolled and their blood sugar runs too high over an extended length of time the body recognizes that it is being starved for insulin, so it begins to breakdown fat for energy. This breakdown of fat causes acid to build up in the blood and this leads to ketoacidosis.

Oftentimes diabetic ketoacidosis is triggered by illness and/or dehydration. If you are diabetic and have, say, a cold or the flu and your blood sugar has been running higher for a while, you are at high risk of developing ketoacidosis. Always drink plenty of water to avoid becoming dehydrated and ending up sick. Hydration is good for everyone, especially diabetics.

What are the symptoms of ketoacidosis? Frequent urination, unquenchable thirst/dry mouth, nausea, vomiting, muscle aches/cramps, dehydration, fruity smell on the breath, high blood sugar, shortness of breath (an uncontrollable fast, shallow breathing).

Before the early 1900’s diabetic ketoacidosis was the end-stage of diabetes. A person would develop diabetes and not long after (because insulin was not discovered yet) they would develop diabetic ketoacidosis and that very quickly led to death.


But now days diabetics are much more likely to never experience diabetic ketoacidosis, and if they do it is probably once and that would be at diagnosis of diabetes. If a diabetic suffers ketoacidosis at any time other than diagnosis it is probably due to another illness triggering it or because they don’t control their diabetes. Ketoacidosis can build slowly, but in most cases it goes from mild and barely noticed to an outright life threatening emergency in the blink of an eye.

I personally have been in DKA (Diabetic ketoacidosis) twice in my life. I did not go into DKA at diagnosis because I come from a family of diabetics and my symptoms were caught early (though I may have been on the verge of DKA). I actually had never even heard of DKA until I experienced it for the first time. Yup, no doctor or family member had ever told/warned me about DKA.

I was 19 years old and had been a type 1 diabetic for almost a dozen years already. I caught a bad cold that just wouldn’t go away. I was working but poor, stressed all the time, and had no insurance. I was not taking care of my diabetes at all other than my standard three shots a day. I was pretty much living off of fast food. One day I began to feel very sick, I still had this damned cold but now I was also feeling like I had the flu. I was achy all over, nausea and vomiting like every five minutes, I was so thirsty I would take a sip of water and feel it wet my mouth and then literally feel my entire mouth dry up immediately, I began to lose control of my own breathing, I couldn’t help but breathe fast and shallow, I had to concentrate and force my body to breath normally, but then it would just go back to short, shallow, fast breaths.

Finally I asked to be driven to the ER, I had been putting it off because I had no insurance and knew it would cost me thousands of dollars just to go to ER, but I now felt as if I was going to die.

And I was…

I had to be just about carried into the ER. The triage nurse took one look at me as my sister-in-law told her I was diabetic and she knew what was happening. I was rushed to a bed. I remember the nurse having trouble finding a vein.

“Her veins are collapsed.” She said, but eventually got a line in on the back of my hand.

I remember signing forms. When I looked at them several days later my signature was just a scribble and nowhere near the line it should have been written on.

I lost consciousness just after signing the forms. I came to almost 24 hours later. I had to pee soooooo bad, and my muscles were still very achy, but I did feel better. I was told by the doctor that if I had been brought in even a half hour later I would have probably died. I was told I had a bad bronchitis infection and diabetic ketoacidosis.

I spent almost four days in the hospital and learned a lot about why I needed to take better care of my diabetes.

One year later I fell into DKA again. Once again I was sick with a cold, under a lot of stress, and had no insurance. I recognized the symptoms early this time and went to ER. I was in the hospital for only two days this time but I felt miserable that I would let this happen again.

How do you treat DKA?  First: Recognize the symptoms. Second: Test for ketones using a home test kit (you can buy these at any pharmacy for pretty cheap). Three:Go to your doctor or ER right away!

At the hospital you will be hooked up to an IV and given fluids, insulin, and electrolytes to rehydrate and replace lost electrolytes and reduce your blood sugar level to normal range. Many times your doctor will put you on a low carb (diabetic) and/or liquid diet for your duration of stay in the hospital. You also will be treated for any other illness you may have that could have caused you to fall into DKA (cold, flu, infection, etc.).

Diabetic Ketoacidosis is serious business but by no means should a diabetic live in constant fear of it. The vast majority of the time it can be prevented by keeping your blood sugar under tight control. When you get sick or have any kind of infection you should work even harder at controlling your numbers.

And drink plenty of water! Stay hydrated!


2 thoughts on “Diabetic Ketoacidosis”

  1. Thank you for sharing your story and this very important info for diabetics! As a fellow type 1 diabetic, DKA is a term I know all to well. I hope your doing well and feeling better. I think insulin should be provided for free to type 1 diabetics. I have been in 3 diabetic comas in my 20s when I was a struggling single mom & no insurance. I either had to keep a roof over my son and I, make sure my son had food and diapers or pay for insulin. I chose my sons well being over insulin. I to did the bare minimum and in the process did major damage to body. Anytime our sugar goes over 250 we are doing damage. DKA is horrible to say the least.


  2. My precious daughter just spent a week in hospital with a DKA diagnosis. She had all the symptoms you described. It was very frightening. Her insulin has been adjusted, and I believe the episode has prompted her to check her glucose level 3 – 4 times a day. I hope she never has another DKA episode again!
    Thank you for writing very important entries!


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