DKA Symptoms: Warning Signs of Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a life-threatening emergency. Early signs are great thirst and urinating a lot; later signs are vomiting, belly pain, fast deep breathing, fruity breath, confusion and extreme tiredness. If you think it may be DKA, check ketones if you can and get care now.
Symptoms
| Stage | Signs | Source |
|---|---|---|
| Early | Very thirsty; urinating a lot more than usual; high glucose (the ADA lists above 200 mg/dL or the level your doctor recommends) | CDC, ADA |
| Developing | Dry skin and mouth, flushed face, headache, muscle stiffness or aches, stomach upset | CDC, ADA |
| Severe | Nausea and vomiting, belly pain, fast and deep breathing, fruity-smelling breath, confusion or trouble focusing, extreme tiredness, decreased consciousness | CDC, ADA, MedlinePlus |
The CDC notes that severe symptoms can appear quickly if DKA is untreated. The ADA says early recognition is critical.
Why DKA happens
DKA develops when the body does not have enough insulin to use glucose, so it burns fat and makes ketones in large amounts, which turn the blood acidic. The CDC names illness and missed or incorrect insulin (missed shots, a clogged pump, wrong dose) as the two most common causes, and also lists heart attack or stroke, injury, alcohol or drug use, and certain medicines. It is most often discussed with type 1 diabetes but can occur in other situations. Ask your care team whether you are at risk.
Testing for ketones
The CDC advises that if you have diabetes and are sick, or your blood sugar is 250 mg/dL or higher, you check blood sugar every 4 to 6 hours and test urine for ketones. The ADA prefers blood ketone meters, and says a level of 1.6 mmol/L or higher needs emergency care. See ketones in urine and the ketone levels chart. For glucose numbers, see 250 and 300.
Prevention and planning
- Get a sick-day plan from your care team that says what to check, how often and whom to call.
- Keep ketone supplies in date and easy to find.
- Tell people close to you the warning signs and the emergency steps.
- Do not wait. The ADA says managing ketones early is the most effective way to prevent DKA.
This page is information only. It does not tell you how to treat DKA, which needs medical care. A low blood sugar is a different problem: see low blood sugar symptoms.
Frequently asked questions
What are the first signs of DKA?
The CDC lists being very thirsty and urinating a lot more than usual as early symptoms. They can progress quickly to fast, deep breathing, dry skin and mouth, a flushed face, fruity-smelling breath, headache, muscle aches, extreme tiredness, nausea, vomiting and stomach pain.
What causes DKA?
The CDC says the two most common causes are illness and missed or incorrect insulin, such as missed shots, a clogged insulin pump or the wrong dose. Other causes include heart attack or stroke, injury, alcohol or drug use, and certain medicines such as some diuretics and corticosteroids.
Is DKA an emergency?
Yes. The ADA and the CDC both call DKA a medical emergency that needs immediate treatment. Symptoms can worsen quickly.
Can I have DKA with a normal blood sugar?
The ADA lists a glucose above 200 mg/dL, or a level your doctor recommends, among the symptoms, but it also says to check ketones when you are sick or not feeling well. If you have DKA symptoms, get care even if your glucose does not seem very high.
How can I lower my chance of DKA?
Ask your care team for a sick-day plan, keep ketone strips or a blood ketone meter on hand, check ketones when you are sick or your glucose is 250 mg/dL or higher (CDC), and do not skip insulin if you use it. The ADA says managing ketones early is the most effective way to prevent DKA.
Information only, not medical advice. Your care team may set different targets for you, and only a lab test ordered by a clinician can diagnose diabetes or prediabetes. See our medical disclaimer.
Sources
Last reviewed: by the Diabetes Blogs editorial team. Information only, not medical advice.
