Diabetic ketoacidosis is a complication of diabetes that occurs when sugar (glucose) is not available as a fuel source by the body and fat is used instead. Byproducts of fat breakdown, called ketones, build up in the body.

People with Type I diabetes lack enough insulin, a hormone the body uses to process sugar (glucose) for energy. When glucose is not available, body fat is broken down instead.

The byproducts of fat metabolism are ketones and acid. When fat is broken down, ketones and acid build up in the blood. A condition called ketoacidosis develops when the blood has more acid than normal.

Blood glucose levels rise (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin.

Diabetic ketoacidosis may lead to a diagnosis of type 1 diabetes, because it is often the first symptom that causes a person to see a doctor. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases. Missing doses of insulin can also lead to ketoacidosis in people with diabetes.

People with type 2 diabetes can develop ketoacidosis, but it is rare. It is usually triggered by a severe illness. People of Hispanic and African-American ethnicity seem to be more likely to have ketoacidosis as a complication of type 2 diabetes.

• Fatigue
• Frequent urination or thirst for a day or more
• Fruity breath (breath odor)
• Mental stupor that may progress to coma
• Muscle stiffness or aching
• Nausea and vomiting
• Rapid breathing
• Shortness of breath

Other symptoms that can occur with this disease:

• Abdominal pain
• Breathing difficulty while lying down
• Decreased appetite
• Decreased consciousness
• Headache

• Arterial blood gas
• High blood glucose
• Low blood pressure
• Presence of glucose and ketones in urine by home or office testing
• Rapid heart rate
• High serum amylase
• High serum potassium
• Signs of dehydration

This disease may also affect the results of the following tests:

• CO2
• CSF collection
• Potassium - urine
• Serum magnesium
• Serum phosphorus
• Serum sodium
• Sodium - urine
• Urine pH

The goal of treatment is to correct the high blood glucose level by giving more insulin. Another goal is to replace fluids lost through excessive urination and vomiting. You may be able to recognize the early warning signs and make appropriate corrections at home before the condition gets worse.

If ketoacidosis is severe, you will need to go to the hospital. The following will be done at the hospital:

• Insulin replacement will be given.
• Fluid and electrolytes will be replaced.
• The cause of the condition (such as infection) will be found and treated.

Acidosis can lead to severe illness or death. Improved therapy for young people with diabetes has decreased the death rate from this condition. However, it remains a significant risk in the elderly, and in people who fall into a coma when treatment has been delayed.

• Fluid buildup in the brain (cerebral edema)
• Heart attack and death of bowel tissue due to low blood pressure
• Renal failure

This condition can become a medical emergency. Call your health care provider if you notice early symptoms of diabetic ketoacidosis.

Go to the emergency room or call the local emergency number (such as 911) if you experience:

• Decreased consciousness
• Difficulty breathing
• Fruity breath
• Mental stupor
• Nausea
• Vomiting

People with diabetes should learn to recognize the early warning signs and symptoms of ketoacidosis. In people with infections or who are on insulin pump therapy, measuring urine ketones can give more information than glucose measurements alone.

Insulin pump users need to check often to see that insulin is still flowing through the tubing, and that there are no blockages, kinks, or disconnections.