What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious life-threatening complication of diabetes characterized by hyperglycemia (high blood glucose levels), ketosis (high levels of ketone bodies in the blood or urine), and metabolic acidosis (high anion gap).^[1][2]

What causes diabetic ketoacidosis?

DKA occurs when the body doesn’t have enough insulin, which prevents glucose from entering cells and producing energy. This insulin deficiency triggers the liver to rapidly break down fat into ketones as an alternative fuel source. The excessive production of ketones (ketoacidosis) causes the blood to become acidic (lowering blood pH).

While DKA is most common in people with type 1 diabetes, it can also develop in those with type 2 diabetes.^[1][2] Noncompliance with insulin medication and insulin pump malfunctions are the most common causes,^[1][2] but common triggers for DKA include infections (e.g., urinary tract infections and acute gastroenteritis) and conditions that raise counterregulatory stress hormones like cortisol (e.g., acute coronary syndrome, stroke, pancreatitis).^[1][2] However, delays in being diagnosed with diabetes, challenges in accessing care, the use of some medications (SGLT2 inhibitors, corticosteroids, atypical antipsychotics, etc), and psychological factors (including disordered eating) can also further contribute to the risk of DKA.^[1][2]

What are the symptoms of diabetic ketoacidosis?

DKA is considered a medical emergency because if left untreated, it can progress rapidly and become life-threatening.^[1][2] Therefore, DKA requires immediate medical treatment using fluids, electrolytes, and insulin therapy to correct fluid loss, lower blood glucose, and address electrolyte imbalances and acid-base abnormalities.^[1][2][3]