What Causes Diabetic Ketoacidosis? Symptoms and Signs

Diabetic ketoacidosis presents many health risks. Understanding what causes diabetic ketoacidosis can help prevent and manage the condition.

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Chelsea Rae Bourgeois, MS, RD
— Signos
Health writer
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Updated by

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Science-based and reviewed

May 20, 2024
April 15, 2024
— Updated:
April 15, 2024

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When we eat a carbohydrate source (with or without gluten), the body is tasked with converting its glucose into energy. Sugar acts as fuel, giving the body energy to operate—but not without insulin. Insulin plays a key role in helping sugar enter the body’s cells. When the body doesn’t make enough insulin, it starts breaking down fat as fuel, putting people at risk for diabetic ketoacidosis (DKA).

What is diabetic ketoacidosis, and how is it different from hyperglycemia or high blood sugar? DKA is a serious complication of diabetes mellitus characterized by the breakdown of fat, resulting in a buildup of acids called ketones in the bloodstream. Too many ketones in the bloodstream can make it acidic or toxic.1 DKA most commonly occurs in those with type 1 diabetes, but those with type 2 diabetes are also at risk.2 Symptoms of diabetic ketoacidosis can be life-threatening, so it’s important to know what to look for and when to seek help from your healthcare provider.

In this article, we’ll discuss what causes diabetic ketoacidosis and shed light on common symptoms associated with the life-threatening diabetes complication. We’ll discuss diabetic ketoacidosis treatments and provide tips to prevent its onset.


DKA Signs and Symptoms

If diabetic ketoacidosis is a concern, it’s usually diagnosed through a series of urine and blood tests that check for ketones and elevated glucose levels. Some facilities also rely on arterial blood gas readings, metabolic panels, and blood pressure measurements to diagnose DKA.

However, it’s essential to be aware of diabetic ketoacidosis symptoms so you know when to seek medical care. DKA symptoms go far beyond the itchy skin and loose stools that occasionally plague those with diabetes. Catching it early can prevent a severe case from developing and reduce the risk of long-term negative effects.

DKA can develop gradually, but if left untreated, severe symptoms can come on quickly. For some, signs of ketoacidosis can be the first sign of a potential diabetes diagnosis.3

Symptoms of DKA may include:

  • Extreme thirst
  • Frequent urination
  • Abdominal pain
  • Nausea and vomiting
  • Fatigue
  • Quick, deep breathing
  • Dry mouth
  • Flushed face
  • Fruity-smelling breath
  • Headaches
  • Muscle stiffness or aches
  • Altered levels of consciousness

Many DKA symptoms often resemble symptoms of hyperosmolar hyperglycemic state (HHS), so it may be beneficial to keep ketone tests on hand. HHS is also characterized by a lack of insulin and high blood sugar levels, but there is usually enough insulin to prevent the buildup of ketones. HHS typically results in severe dehydration and highly concentrated blood.

Many experts recommend checking for urine ketones if blood glucose levels are above 240 mg/dl. High ketone levels may indicate the onset of DKA, but your doctor will advise you based on your individual needs.

<p class="pro-tip"><strong>Also Read: </strong><a href="diabetic-stroke">Diabetes and Stroke: Risks, Symptoms, Treatments, and Key Insights</a>.</p>

Main Causes of DKA

Man wrapped in a blanket drinking tea while sick.

Diabetic ketoacidosis is triggered by insufficient insulin levels, resulting in a cascade of metabolic disturbances in the body. Insulin deficiency leads to a breakdown of fats and the production of ketones that can cause acidosis. Insulin deficiency can stem from various causes, such as missing doses of insulin therapy, suffering from an illness or infection, and poor compliance with your diabetes care plan.

Additionally, some lifestyle factors and pre-existing medical conditions may precipitate DKA. For example, chronic drug or alcohol use can disrupt insulin sensitivity and affect glycemic control, leading to an increased risk of DKA. Similarly, some medications may interfere with insulin’s capabilities. Medications like diuretics and corticosteroids can increase the risk of dehydration, thereby increasing the risk of DKA.

Those with complex medical histories that include a chronic health condition or recent cardiac events, such as a heart attack or stroke, may be at an increased risk for developing DKA. These medical events put a great deal of physiological stress on the body and its metabolic processes.

Without intervention, DKA can progress quickly, and high levels of ketones put you at risk for severe health concerns. Understanding its causes can be critical for preventing and managing life-threatening diabetes complications.

Common causes of DKA include:

  • Getting sick
  • Missing doses of insulin
  • Malfunctioning insulin pump
  • Heart attack or stroke
  • Severe physical injury
  • Chronic alcohol or drug use
  • Some medications, such as select diuretics and corticosteroids

Treatment for DKA

DKA is a critical medical emergency that requires immediate medical attention from a qualified healthcare team. It’s typically managed in a hospital setting, with a focus on correcting the underlying insulin deficiency, restoring fluid and electrolyte levels, and addressing metabolic acidosis. Doctors usually prescribe intravenous insulin therapy to gradually normalize blood glucose levels while suppressing ketone production. Treatment also requires IV fluids that rehydrate cells and help correct electrolyte imbalances.

Your healthcare team, which may consist of endocrinologists, nurses, and registered dietitian nutritionists, will closely monitor your medical status throughout treatment. They will monitor your blood glucose levels, blood ketones, electrolytes, and acid-base status to adjust your treatment appropriately. If an underlying medical condition, such as a urinary tract infection or pancreatitis, is contributing to the severity of the DKA, the multidisciplinary team will treat and manage it accordingly.

Doctors may also regularly test your electrolytes, including sodium, chloride, potassium, and bicarbonate concentrations. You may need an electrocardiogram to check your heart rhythm, as fluctuations in electrolyte levels can cause cardiovascular issues.

DKA Possible Complications

While prompt treatment for DKA is crucial for preventing life-threatening complications, the therapy itself may also present a number of risk factors. Administering insulin in excessive doses or providing it too quickly may cause a rapid decline in blood sugar levels, leading to hypoglycemia. Low blood glucose may require glucose supplementation and further insulin adjustments.

DKA treatment also requires careful attention to fluid and electrolyte levels to avoid neurological complications, such as cerebral edema or brain swelling. Rehydrating too quickly can cause a shift in fluid locations, potentially sending excess fluid to the brain.

Healthcare providers follow strict treatment protocols to reduce the risks associated with treatment, which may include:

  • Hypoglycemia or low blood sugar
  • Hypokalemia or low potassium levels
  • Cerebral edema or swelling in the brain
  • Alterations in cardiac function
  • Changes in renal function

How to Prevent DKA?

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Prevention is key when it comes to diabetic ketoacidosis. Adherence to your diabetes management plan can help lower the risk of developing diabetic ketoacidosis. For example, taking your medicines as prescribed, including insulin, can help keep blood sugar levels within normal limits and prevent DKA.

Measure your blood sugar often to make sure it isn’t too high or too low, as extreme readings may indicate a concern for DKA or other complications. If you are sick, consider discussing your insulin dose with your doctor, as you may need to temporarily increase your dose to account for your infection or illness.

Communication with your healthcare provider is key to successful diabetes management. Call your provider if your blood sugar is high or if you are presenting with DKA symptoms. Catching ketoacidosis early may help prevent it from becoming a severe concern.

Tips to prevent DKA include:

  • Follow a diabetes-friendly diet
  • Routinely check your blood sugar levels, especially on sick days
  • Keep blood glucose levels within your target range
  • Maintain compliance with prescription medications
  • Prioritize open communication with your doctor and diabetes care team

Learn More About How to Improve Blood Sugar Health With Signos’ Expert Advice

Diabetic ketoacidosis can be an alarming complication associated with type 1 and type 2 diabetes. When the body doesn’t produce enough insulin, it can turn to fat for energy, resulting in the production of ketones.

Managing diabetes, both type 1 and type 2, requires a holistic approach that includes choosing the proper medication under the guidance of your medical provider. Compliance with your care plan can improve overall health, bolster diabetes management, and support sustainable weight loss. Thankfully, we don’t have to take on these lifestyle changes alone. Signos’ experts are equipped to help you improve your blood sugar health.

Curious how Signos can improve health and help you manage your blood glucose levels? Learn more about glucose levels on Signos’ blog and find out if Signos is a good fit for you by taking a quick quiz!

<p class="pro-tip"><strong>Learn More: </strong><a href="non-diabetic-track-their-glucose">Why Would a Non-Diabetic Want to Track Their Glucose?</a>.</p>

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Topics discussed in this article:


  1. Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020). Diabetic ketoacidosis. Nature reviews. Disease primers, 6(1), 40. https://doi.org/10.1038/s41572-020-0165-1
  2. Calimag, A. P. P., Chlebek, S., Lerma, E. V., & Chaiban, J. T. (2023). Diabetic ketoacidosis. Disease-a-month : DM, 69(3), 101418. https://doi.org/10.1016/j.disamonth.2022.101418
  3. Elendu, C., David, J. A., Udoyen, A. O., Egbunu, E. O., Ogbuiyi-Chima, I. C., Unakalamba, L. O., Temitope, A. I., Ibhiedu, J. O., Ibhiedu, A. O., Nwosu, P. U., Koroyin, M. O., Eze, C., Boluwatife, A. I., Alabi, O., Okabekwa, O. S., Fatoye, J. O., & Ramon-Yusuf, H. I. (2023). Comprehensive review of diabetic ketoacidosis: an update. Annals of medicine and surgery (2012), 85(6), 2802–2807. https://doi.org/10.1097/MS9.0000000000000894

About the author

Chelsea Rae Bourgeois is a registered dietitian nutritionist with several years of experience working in the clinical setting. Once a track and field athlete on a competitive stage, she now finds joy in combining her passions as a health writer to help people embrace their wellness through nutrition and fitness.

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