What Is Diabetic Ketoacidosis? Causes and Symptoms Explained

Diabetic ketoacidosis is a potentially life-threatening condition that primarily affects individuals with type 1 diabetes and is typically caused by missed or incorrect insulin therapy. 

Discover common diabetic ketoacidosis symptoms and learn how to manage and prevent this serious medical issue.   

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is characterized by excessive concentrations of blood ketones, a group of acids that can change the body’s pH, leading to a state of metabolic acidosis. 

While individuals with type 2 diabetes can develop DKA, it typically affects those with type 1 diabetes who have to rely on insulin therapy to manage blood sugar levels. 

Administering not enough insulin or a faulty insulin pump can quickly lead to very high blood sugar levels as the body requires adequate amounts of this hormone to utilize glucose as a fuel source.  

This triggers the rapid breakdown of fat to provide an alternative energy source, resulting in the production of large quantities of ketones.

Because of their acidity, too many ketones can lower the blood's pH levels. This can cause electrolyte imbalances, cardiovascular and respiratory issues, impaired central nervous system function, and bone demineralization.  

Watch the video below to learn how to manage and prevent ketoacidosis. 

Signs and symptoms of ketoacidosis

Ketoacidosis can develop within hours, especially in individuals who are experiencing significant insulin deficiency. 

Here are common early warning signs of ketoacidosis:

• Excessive thirst

• Frequent urination 

• Nausea and vomiting

• Abdominal pain

• Fatigue

• Breath with a fruity odor

• Brain fog 

• Poor blood pressure regulation

• Difficulty breathing 

In addition, severe electrolyte imbalances are a serious complication of ketoacidosis and can trigger symptoms such as muscle weakness, irregular heartbeat, and a weak pulse. 

Causes and risk factors

A study published in The Lancet found that most DKA cases are linked to missed insulin doses, insulin pump problems, or incorrect insulin dosage calculations. 

In addition, the body’s demand for insulin can be affected by stress and illness, making it difficult to assess accurate insulin requirements, increasing the risk of ketoacidosis in individuals with type 1 diabetes.  

Research published in Diagnostics investigated the link between infections and DKA and found that “About 50 percent of cases of ketoacidosis result from bacterial infections like urinary tract infections (UTIs).”

Not only can a UTI interfere with the body’s insulin requirements, but it may also lead to dehydration, which reduces fluid levels and blood volume. This significantly increases the risk of ketoacidosis as low blood volume results in higher glucose and ketone concentrations in the bloodstream.

In addition, type 1 diabetics who don’t carefully monitor carbohydrate intake may experience fluctuations in blood glucose levels that can contribute to the risk of ketoacidosis. 

How is ketoacidosis diagnosed?

Ketoacidosis is typically diagnosed with a combination of blood tests and clinical evaluation of symptoms. 

Various laboratory tests can help diagnose ketoacidosis and assess its severity.

Elevated blood glucose levels greater than 250 mg/dL (13.9 mmol/L) and blood ketone concentrations of more than 54 mg/dL (3 mmol/L) are indicative of severe DKA. 

Medical professionals can also perform arterial blood gas analysis, a test measuring bicarbonate concentrations in arterial blood, which helps assess the severity of metabolic acidosis. 

Additionally, electrolyte panels and renal function tests are frequently performed to determine the appropriate doses for electrolyte replacement therapy and to assess kidney function, which can be affected by DKA.

These tests also help distinguish DKA from hyperosmolar hyperglycemic state (HHS), another serious complication of diabetes. 

HHS is characterized by extremely high blood sugar levels greater than 600 mg/dL (33.3 mmol/L), which can induce symptoms similar to DKA, such as extreme thirst, frequent urination, and stomach pain. 

Can keto cause ketoacidosis?

There is a common misconception that a low-carb ketogenic diet can cause ketoacidosis. However, this is inaccurate as ketosis and ketoacidosis are distinct metabolic states that differ significantly. 

Ketosis is a natural metabolic state in which the body burns fat for fuel instead of sugars. This causes the release of ketones and can be induced by carbohydrate restriction. 

However, blood ketone concentrations associated with ketosis typically range between 10.8 to 27 mg/dL (0.6 to 1.5 mmol/L) and won’t result in the dangerously elevated levels seen in ketoacidosis.

It’s crucial to remember that ketoacidosis is caused by a lack of insulin and primarily only affects individuals with type 1 diabetes. 

Even when following a low-carb diet, the body continues to produce insulin, which helps keep blood sugar levels within a normal range and prevents the development of ketoacidosis.

“Ketosis has profound health benefits, including weight loss, neuroprotective effects, and improved energy,” explains Dr. Berg. “In contrast, ketoacidosis is a rare but dangerous condition caused by insulin insufficiency, not dietary carbohydrate restriction.”

What to do if you have ketoacidosis

Ketoacidosis requires immediate medical attention. It’s vital to call emergency services or visit the emergency room if you experience symptoms of DKA or have elevated blood glucose levels of over 250 mg/dL.  

If left untreated, ketoacidosis can lead to severe dehydration, electrolyte imbalances, cerebral edema, coma, and even death. 

Medical care typically involves electrolyte and fluid replacement and intravenous insulin to treat ketoacidosis and restore metabolic balance. 

Work closely with your healthcare provider to determine the cause of ketoacidosis and implement strategies to prevent future episodes of DKA. 

Ketoacidosis prevention

Ketoacidosis prevention involves careful monitoring of blood sugar and ketone levels and consistent adherence to insulin therapy.

In addition, individuals at risk of ketoacidosis may benefit from following a low-carb ketogenic diet. 

Restricting carbohydrates keeps blood sugar levels steady and reduces insulin requirements, which can help reduce the risk of ketoacidosis. 

Research published in Pediatrics confirms the benefits of a ketogenic diet for diabetes by concluding, “Exceptional glycemic control of type 1 diabetes with low rates of adverse events was reported by a community of children and adults who consume a very low carbohydrate diet.”

However, it’s crucial that keto dieters with type 1 diabetes regularly test their blood glucose levels and discuss adjusting their insulin dosage with a doctor to avoid abnormally low blood sugar levels.

Promoting electrolyte balance is another important aspect of ketoacidosis prevention.   

Electrolytes play a critical role in maintaining the body’s pH balance, and a lack of sodium or potassium increases the risk of ketoacidosis if insulin therapy is inadequate or missing.  

Most people consume enough sodium from table salt. However, potassium deficiency is widespread due to inadequate dietary intake of potassium-rich foods such as green leafy vegetables, avocados, and tomatoes.

This explains why it’s important to follow a nutritious low-carb diet such as Healthy Keto®.

By restricting carbohydrates while focusing on nutrient-dense whole foods, Healthy Keto promotes blood sugar control and electrolyte balance, which are crucial for ketoacidosis prevention.    

If you are considering starting a ketogenic diet to reduce the risk of DKA, it's crucial to consult a healthcare provider before making any significant changes to your dietary pattern. 

Individual responses to keto can vary, especially in individuals with type 1 diabetes, and working closely with your doctor is essential to ensure that a low-carb diet is safe and appropriate for your specific health needs. 

Key takeaways

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening condition primarily seen in individuals with type 1 diabetes.

DKA is characterized by elevated blood ketone levels due to missed or inadequate insulin therapy. This leads to metabolic acidosis, which is associated with cardiovascular and respiratory issues and impaired central nervous system function.

Left untreated, DKA can be fatal, and it’s crucial to seek immediate medical attention if you develop signs of acidosis, including increased thirst, frequent urination, difficulty breathing, and nausea. 

FAQ

1. Can you recover from diabetic ketoacidosis?

Yes, you can recover from diabetic ketoacidosis with prompt medical attention, including intravenous insulin and electrolyte replacement therapy.

However, ketoacidosis can cause kidney damage and neurological complications that may require dietary and lifestyle changes to preserve kidney function and overall health.  

2. What blood sugar level is diabetic ketoacidosis?

A diabetic ketoacidosis diagnosis is typically made when blood sugar levels rise to 250 mg/dL (13.9 mmol/L) in combination with ketone blood concentrations greater than 54 mg/dL (3 mmol/L). 

3. Can diabetic ketoacidosis go away on its own?

No, diabetic ketoacidosis doesn’t resolve itself and requires immediate medical treatment to prevent complications such as dehydration, electrolyte imbalances, and potential organ damage. 

It’s vital to treat diabetic ketoacidosis promptly with insulin therapy and fluid replacement to stabilize blood sugar levels and prevent serious complications such as brain swelling, coma, and even death.

4. What is the first treatment for diabetic ketoacidosis?

The first treatment for diabetic ketoacidosis is intravenous insulin administration to lower blood sugar and ketone concentrations in combination with fluid and electrolyte replacement to manage dehydration and electrolyte loss. 

5. Can a keto diet cause ketoacidosis?

Although a ketogenic diet promotes fat-burning, which releases ketones, it won’t lead to ketoacidosis. 

Ketoacidosis is caused by insulin deficiency, which is typically only seen in people with type 1 diabetes. In healthy individuals, insulin levels are generally adequate to prevent excessive ketone production and maintain normal blood sugar and pH levels.

Sources

1. https://www.thelancet.com/journals/lancet/article 

2. https://www.mdpi.com/2075-4418/13/14/2441 

3. https://pubmed.ncbi.nlm.nih.gov/29735574/