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Note: All links within content go to MayoClinic.com

Diabetic ketoacidosis is a serious complication of diabetes mellitus. In this condition, insufficient insulin levels in the body result in high blood sugar (glucose) and the buildup of substances called ketones in the blood (ketoacidosis). Left untreated, diabetic ketoacidosis leads to coma and eventual death.

Diabetic ketoacidosis (DKA) is usually triggered by a stressful event, such as an illness or another health problem. The condition may also arise as a result of insufficient insulin therapy. Diabetic ketoacidosis is most common in people with type 1 diabetes, but may also occur in those with type 2 diabetes. Occasionally, diabetic ketoacidosis is the first indication that a person has diabetes.

Fortunately, diabetic ketoacidosis can be successfully treated with prompt medical care. Learning the warning signs of low insulin levels can help prevent future recurrences of diabetic ketoacidosis or other diabetes complications.

Signs and symptoms of diabetic ketoacidosis can develop in less than 24 hours. Elevated blood sugar and high levels of ketones in your blood are typical signs of DKA. Other signs and symptoms may include:

• Excessive thirst or urination
• Weakness and fatigue
• Deep, slow breathing
• Nausea, vomiting and stomach pain
• Decreased appetite and weight loss
• Fruity-scented breath (caused by high ketone levels)

People with diabetic ketoacidosis often become dehydrated because they produce large amounts of urine. Signs of dehydration include a rapid heartbeat (tachycardia) and low blood pressure (hypotension). Untreated diabetic ketoacidosis results in coma and eventual death.

Diabetic ketoacidosis occurs in people who have diabetes. People with diabetes have insufficient levels of the hormone insulin, which is necessary to help your cells take up glucose to use as energy. Even if your blood is flooded with glucose, it's still not available to the cells in the absence of insulin.

As the cells' energy reserves become depleted, your body attributes the problem to a lack of glucose in the blood — which isn't actually the case — and prompts the release of hormones that break down alternate fuels such as fat stores into glucose. The process of breaking down fats forms acids known as ketones. Increased ketone levels in the blood upset the pH balance in your blood, making the blood more acidic (acidosis). An acidic environment is toxic to your body's cells.

Stressful events often set off an episode of diabetic ketoacidosis because stress prompts the release of excessive amounts of hormones that break down fat into glucose, overwhelming the ability of insulin to "permit" the uptake of glucose into the cells.

Underlying triggers
Most cases of diabetic ketoacidosis are triggered by an underlying health problem. The most common cause of DKA is an infection, such as pneumonia or a urinary tract infection. Another common cause is inadequate insulin therapy.

Other possible causes include:

• Heart attack or stroke
• Alcohol or drug abuse
• An inflammation of the pancreas (pancreatitis)
• Physical or emotional trauma
• Insufficient fluid intake, particularly during hot weather

Up to 10 percent of the time, there's no identifiable cause for diabetic ketoacidosis.

The most common risk factors for diabetic ketoacidosis include the following:

• Diabetes mellitus. The main risk factor for diabetic ketoacidosis is type 1 diabetes. However, DKA can also occur in people with type 2 diabetes, especially obese children.
• Age. Diabetic ketoacidosis usually occurs in people younger than 19, but may occur at any age.
• Infusion devices with short-acting insulin. Short-acting insulin is only active in the body for a few hours. If an infusion device containing short-acting insulin malfunctions, the insulin level in the blood quickly drops.

Signs and symptoms of diabetic ketoacidosis may mimic those of the flu, so it can be tricky to know whether you have a viral infection or a more serious health problem. Seek medical attention if dehydration, persistent vomiting or uncontrolled high blood sugar develops. Diabetic ketoacidosis may be fatal if left untreated.

Your doctor may suspect diabetic ketoacidosis if you've missed insulin treatments and you're not feeling well. Doctors generally diagnose DKA if the following three features are present:

• Hyperglycemia. Hyperglycemia is an abnormally high level of glucose in the blood. People with diabetic ketoacidosis have hyperglycemia because there isn't enough insulin available to help your cells take up glucose. The hyperglycemia worsens as your body continues to break down fat into glucose and send the glucose into your bloodstream.
• Ketosis. When glucose is not available for your body to use as fuel, your body begins to break down fat to produce energy instead. This process, known as ketosis, releases byproducts known as ketones.
• Acidosis. Normally, blood is slightly basic, with a pH ranging from 7.35 to 7.45. Acidosis occurs when the blood pH drops below 7.35. An excess of ketones causes the blood to become acidic, which may be harmful to the organs in your body.

If your blood sugars are persistently high, call your doctor. Your doctor can determine whether you have hyperglycemia, ketosis or acidosis through blood tests.

People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment:

• Hypoglycemia. Hypoglycemia refers to low blood sugar. As insulin is given during the course of treatment for diabetic ketoacidosis, sugar is rapidly picked up by the cells, causing the blood sugar level to drop. Sometimes the blood sugar level drops too quickly, resulting in hypoglycemia.
• Hypokalemia. This is an abnormally low level of the electrolyte potassium in the blood. Insulin and fluids facilitate the entry of potassium into the cells, which decreases the blood potassium levels. Low blood potassium levels can impair heart, muscle and nerve activities.
• Cerebral edema. A rare complication, cerebral edema is brain swelling caused by a buildup of fluid in the brain cells. It's not certain why treatment causes cerebral edema to develop, although it may be related to rapid fluid replacement. Cerebral edema most frequently occurs in children.

With appropriate medical care, diabetic ketoacidosis is usually successfully treated. Untreated DKA results in coma and eventual death.

You'll need to begin treatment for diabetic ketoacidosis immediately after diagnosis, because the condition can quickly worsen. Treatment for DKA usually consists of:

• Fluid replacement. As a first step in treating diabetic ketoacidosis, you'll receive fluids, either orally or through a vein in your arm (IV), until your body is rehydrated. Fluid replacement is an important part of DKA treatment because people with diabetic ketoacidosis tend to lose large amounts of fluids. Fluids also help dilute the high levels of glucose in your blood.

• Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge. The most common ones are sodium, potassium and chloride. Maintaining correct levels of electrolytes in your body is important because electrolytes help keep your heart, muscles and nerve cells functioning normally. The absence of insulin can affect the levels of several electrolytes in your blood.

  Your doctor will monitor your electrolyte levels during the course of treatment. Certain electrolytes, such as potassium, sodium and sometimes bicarbonate, may need to be replenished at the time of fluid replacement. If any of the electrolytes are especially low, your doctor will monitor your heart to make sure it's working properly.

• Intravenous insulin therapy. Along with replenishing fluids and monitoring electrolytes, you'll receive insulin therapy, usually through your veins (intravenously). Insulin helps your cells take up glucose and use it for energy instead of fat. After insulin enters your body, it inhibits the breakdown of fat in the liver and lowers the concentration of glucose in your blood. Insulin also reverses the processes that cause ketosis and acidosis. It's likely that your blood glucose level will be monitored every couple of hours until it has returned to a normal level. After your glucose level falls below 250 milligrams per deciliter (mg/dL) and your blood is no longer acidic, intravenous insulin therapy is stopped. You'll then resume your normal insulin therapy.

After initial treatment
As your body chemistry is returning to normal, your doctor will try to determine what triggered the diabetic ketoacidosis episode in the first place and treat that condition. For example, if your doctor suspects a bacterial infection as the cause, he or she may prescribe antibiotics. Or if a heart attack is a possible cause, your doctor may recommend further evaluation of your heart and its blood vessels.

Whatever the cause, most people who have had diabetic ketoacidosis need to take insulin therapy for the rest of their lives.

The best way to help prevent diabetic ketoacidosis and other complications from diabetes is to educate yourself about the disease. Here are a few tips to help you manage your diabetes:

• Monitor your blood sugar and ketone levels at home. Keep an eye on your glucose level especially when you have an infection, trauma, excessive stress or if you are pregnant. If your blood sugar levels persistently exceed 300 mg/dL, check your ketone levels. If your ketone levels are above normal, talk to your doctor.
• Assess your diabetic regimen. Diabetic ketoacidosis is often caused by irregular or insufficient insulin treatment. Talk to your doctor about how to alter your insulin therapy if your blood sugars are poorly controlled, you're sick or you're not eating. Become familiar with the signs and symptoms of low insulin levels.
• Know when to seek medical attention. If you experience any unusual signs or symptoms such as severe stomach pain, vomiting or confusion along with persistently elevated blood sugars, seek medical attention right away. Diabetic ketoacidosis may be fatal if left untreated.