Insulin allows glucose to pass from the bloodstream into body cells, where it is used for energy. When your cells don’t get the glucose they need, your liver begins to burn fat for energy instead. This process produces ketones, and when ketones are produced too quickly and build up, they can be toxic.
This condition is most commonly seen intype 1 diabetes, but can also occur intype 2 diabetes. DKA is dangerous and possibly fatal.
Complications of DKA include low levels of potassium (hypokalemia), swelling inside the brain (cerebraledema), fluid in the lungs (pulmonary edema), and damage to the kidneys and other organs. There are many reasons why DKA can happen, and knowing them allows people to recognize if they have DKA.
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Missed Insulin Treatment
DKA occurs when there is not enough insulin in the body. This commonly happens in people who have diabetes but haven’t been diagnosed yet and aren’t getting the treatment they need. For those who are diagnosed, skipping a treatment or havinginsulin pumpproblems can result in a lack of insulin and contribute to DKA.
What Is Insulin?
Infection
Another common trigger of DKA isinfection. Viral or bacterial infections such as pneumonia,urinary tract infection, andsepsiscan trigger DKA. This is because your body needs more insulin than usual during an infection.
Also, an infection can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol, that counter the effect of insulin. If your body is unable to meet the demand, it may set off the liver’s ketone production to compensate for this need.
Heart Disease
Cardiovascular disease, particularlymyocardial infarction(heart attack), can rarely put people with diabetes at risk for DKA. However, DKA can worsen heart conditions and cause cardiopulmonary complications, including pulmonary edema and respiratory failure.
Kussmaul Breathing: Sign of a Medical Emergency
Missed Meals
Eating and blood sugar levels are directly related to DKA. For blood sugar management, people with diabetes shouldn’t go more than five or six hours without food. Missing meals can put someone at risk for DKA because it can result in dangerously high or low blood sugar levels.
Skipping a meal throws off the balance of food intake and insulin production. When someone is dependent on insulin or other medications to maintain optimal blood sugar levels, missing a meal can lead to extremely low blood sugar.
Additionally, missing meals will create a roller-coaster effect on your blood sugar levels. This will cause the person with diabetes to jump between low and high blood sugar levels, which can be difficult to control.
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Reaction to Medication
SGLT2s that may increase your risk of DKA include:
Also, some prescription medications can raise your glucose and therefore lead to DKA. These include:
Medications that increase certain hormones or glucose levels have the potential to lead to DKA. Therefore, discussing these risks with your healthcare professional and keeping them up to date on your medication and symptoms can help you avoid DKA.
Type 2 Diabetes Medication and Treatment
Alcohol Abuse
Alcohol abuse can cause DKA for a few reasons. Excessive amounts of alcohol can lead to alcohol changing to acid in the body. This is called alcoholic ketoacidosis. Alcohol consumption doesn’t have to be excessive to trigger DKA.
Drinking alcohol can lead to:
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Injury or Surgery
Injury and surgery can lead to stress, which has been shown to trigger hyperglycemia. This is an undesirable consequence in people with diabetes, where hyperglycemia can be brought on quickly and should be treated as soon as possible.
How to Prepare for Cataract Surgery When You Have Diabetes
Hyperthyroidism
Hyperthyroidismoccurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can destabilize blood sugar metabolism, which can lead to hyperglycemia and result in DKA. Hyperthyroidism is also associated with a reduction of insulin’s half-life.
Additionally, hyperthyroidism causes metabolism to be quicker; therefore, medications like insulin will be eliminated faster. This means those with hyperthyroidism and diabetes should be aware of possible high blood sugar due to insulin dose not staying in the body long enough.
Thyroid Disease and Diabetes
Pregnancy
Finally, pregnancy is another common cause of DKA. The body changes extensively during pregnancy, and one way is increased insulin resistance. This, along with vomiting often associated with pregnancy, causes dehydration, stress, and more that can lead to DKA.DKA is most likely to present during the second or third trimester when insulin resistance is at its highest.
When to See a Healthcare ProviderDKA usually develops slowly, but when vomiting occurs, this life-threatening condition can develop in a few hours. Watch out for early signs of DKA, including thirst or a very dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. Seek emergency medical attention or call 911 immediately if you have these symptoms and suspect DKA.
When to See a Healthcare Provider
DKA usually develops slowly, but when vomiting occurs, this life-threatening condition can develop in a few hours. Watch out for early signs of DKA, including thirst or a very dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. Seek emergency medical attention or call 911 immediately if you have these symptoms and suspect DKA.
A Word From Verywell
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Diabetic ketoacidosis.Harvard Health Publishing.Diabetic ketoacidosis.Alakkas Z, Alzaedi OA, Somannavar SS, Alfaifi A.Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review.Am J Case Rep. 2020;21:e923372. Published 2020 May 18. doi:10.12659/AJCR.923372Robinson A, Nwolise C, Shawe J.Contraception for women with diabetes: challenges and solutions.Open Access J Contracept. 2016;7:11-18. Published 2016 Mar 3. doi:10.2147/OAJC.S56348Haldar R, Khandelwal A, Gupta D, Srivastava S, Singh PK.Acute post-operative diabetic ketoacidosis: Atypical harbinger unmasking latent diabetes mellitus.Indian J Anaesth. 2016;60(10):763-765. doi:10.4103/0019-5049.191697Himuro H, Sugiyama T, Nishigori H, Saito M, Nagase S, Sugawara J, Yaegashi N.A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester.Endocrinol Diabetes Metab Case Rep. 2014:130085. doi:10.1530/EDM-13-0085
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Diabetic ketoacidosis.Harvard Health Publishing.Diabetic ketoacidosis.Alakkas Z, Alzaedi OA, Somannavar SS, Alfaifi A.Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review.Am J Case Rep. 2020;21:e923372. Published 2020 May 18. doi:10.12659/AJCR.923372Robinson A, Nwolise C, Shawe J.Contraception for women with diabetes: challenges and solutions.Open Access J Contracept. 2016;7:11-18. Published 2016 Mar 3. doi:10.2147/OAJC.S56348Haldar R, Khandelwal A, Gupta D, Srivastava S, Singh PK.Acute post-operative diabetic ketoacidosis: Atypical harbinger unmasking latent diabetes mellitus.Indian J Anaesth. 2016;60(10):763-765. doi:10.4103/0019-5049.191697Himuro H, Sugiyama T, Nishigori H, Saito M, Nagase S, Sugawara J, Yaegashi N.A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester.Endocrinol Diabetes Metab Case Rep. 2014:130085. doi:10.1530/EDM-13-0085
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Diabetic ketoacidosis.Harvard Health Publishing.Diabetic ketoacidosis.Alakkas Z, Alzaedi OA, Somannavar SS, Alfaifi A.Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review.Am J Case Rep. 2020;21:e923372. Published 2020 May 18. doi:10.12659/AJCR.923372Robinson A, Nwolise C, Shawe J.Contraception for women with diabetes: challenges and solutions.Open Access J Contracept. 2016;7:11-18. Published 2016 Mar 3. doi:10.2147/OAJC.S56348Haldar R, Khandelwal A, Gupta D, Srivastava S, Singh PK.Acute post-operative diabetic ketoacidosis: Atypical harbinger unmasking latent diabetes mellitus.Indian J Anaesth. 2016;60(10):763-765. doi:10.4103/0019-5049.191697Himuro H, Sugiyama T, Nishigori H, Saito M, Nagase S, Sugawara J, Yaegashi N.A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester.Endocrinol Diabetes Metab Case Rep. 2014:130085. doi:10.1530/EDM-13-0085
MedlinePlus.Diabetic ketoacidosis.
Harvard Health Publishing.Diabetic ketoacidosis.
Alakkas Z, Alzaedi OA, Somannavar SS, Alfaifi A.Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review.Am J Case Rep. 2020;21:e923372. Published 2020 May 18. doi:10.12659/AJCR.923372
Robinson A, Nwolise C, Shawe J.Contraception for women with diabetes: challenges and solutions.Open Access J Contracept. 2016;7:11-18. Published 2016 Mar 3. doi:10.2147/OAJC.S56348
Haldar R, Khandelwal A, Gupta D, Srivastava S, Singh PK.Acute post-operative diabetic ketoacidosis: Atypical harbinger unmasking latent diabetes mellitus.Indian J Anaesth. 2016;60(10):763-765. doi:10.4103/0019-5049.191697
Himuro H, Sugiyama T, Nishigori H, Saito M, Nagase S, Sugawara J, Yaegashi N.A case of a woman with late-pregnancy-onset DKA who had normal glucose tolerance in the first trimester.Endocrinol Diabetes Metab Case Rep. 2014:130085. doi:10.1530/EDM-13-0085
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