Diabetic Ketoacidosis (DKA)

Diabetic Ketoacidosis (DKA) is a dangerous and potentially life threatening complication of diabetes, with thousands of preventable cases each year. DKA most commonly happens in people with Type 1 Diabetes although it occasionally occurs in people with insulin-treated Type 2 Diabetes. DKA occurs when there is persistently high glucose and a severe lack of insulin.

• 10,434 people with Type 1 diabetes hospitalised at least once during 2011-12 ¹
• 9% of children experienced DKA in 1 year ²

Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period, with the first sign often being hyperglycemia.
Typical symptoms of diabetic ketoacidosis include:

• Vomiting
• Dehydration
• Deep laboured breathing (called kussmaul breathing)
• Confusion and sometimes even coma

Click here to download the full DKA Information Brochure

What are Ketones?

Ketones are the by-product of fat metabolism. Ketones can provide the body with energy when glucose is not available. As you know, in order to derive energy from the carbohydrates in the foods that we eat, the body needs insulin.

Insulin is the key that unlocks the body’s cells in order to allow glucose to enter to provide energy. In the absence of sufficient insulin, glucose cannot enter the cells and the glucose levels build up in the blood. Without insulin, the body begins to metabolize fat and produces ketones.

Ketones can be very dangerous when the blood glucose level is high. If the blood glucose and ketones levels continue to rise, one can get very sick very quickly. The person begins to get dehydrated and acidotic, meaning that the body loses water and salts and the pH falls with a build up of acids, the ketones, developing DKA.

What are blood ketones versus urine ketones

You may have heard about or learned how to check urine ketones. Urine ketones reflect what has happened in the recent past but not necessarily what is happening right now. Blood ketones give information about what the body is experiencing at this very moment – so that you get the best and most up-to-date information about what to do.

Urine ketones are checked by dipping a strip into urine, an inconvenient process in the current era of checking blood levels. And, you can only estimate the level of the urine ketones by looking at the strip’s colour after 30-60 seconds. The American Diabetes Association states that blood ketone testing is preferred over urine ketone testing as a more reliable method of diagnosing DKA. Blood ketones are checked the same way that you check your blood sugar, PLUS the meter gives you the exact ketone level in only 10 seconds.

Who may be at risk and would benefit from checking blood ketones

• Patients with Type 1 Diabetes and Insulin treated Type 2 Diabetes
• Children & teenagers – who are more likely to develop DKA quickly and who it might be difficult to collect urine from
• Insulin pump users – as DKA can develop rapidly if the pump fails
• Pregnant women – who can also develop DKA quickly which can seriously affect both their own health and the baby

Preventing DKA with blood ketone monitoring

It is easy to understand the importance of blood glucose monitoring but what about blood ketone monitoring? Blood glucose levels provide the road map to your diabetes management by helping determine the proper insulin dosage and by evaluating the effects of diet and exercise. Checking blood ketone levels reduces the risk of DKA. Checking ketone levels and reacting in a timely manner with extra insulin, fluids, and communication with the healthcare team can keep you healthy and avoid the need for emergency treatment.

Diabetic Ketoacidosis can result from any of the following:

• Missing insulin injections
• Administering too little insulin for a larger quantity of carbohydrate
• High sugar levels brought on by stress, illness or infection
• Having undiagnosed type 1 diabetes
• During a growth spurt/puberty
• Faulty insulin pen
• Problems with delivery of insulin from an insulin pump

Remember to check for blood ketones whenever you are sick and/or you have elevated blood glucose levels of 13.9 mmol/L or higher!

• Test blood glucose levels more often – at least for times a day. And test during the night as well
• If blood glucose levels are 13.9 or higher
• Continue to take insulin or diabetes medication as normal and adjust the dose in response to test results if you have been taught to do so.
• Drink plenty of sugar-free drinks
• If vomitting, take carbohydrate-containing drinks such as milk, fruit juice or sugary drinks such as Lucozade, Coca Cola or Lemonade.
• Eat little and often, taking carbohydrates and snacks such as toast, biscuits and cereal.

DKA usually develops over 24 hours but can develop faster particularly in young children. Hospital admission and treatment is essential to correct the life-threatening acidosis and involves closely monitored intravenous fluids, insulin and glucose.