When Diabetes Becomes An Emergency

What Is Diabetic Ketoacidosis & How To Prevent It

According to the Centers for Disease Control and Prevention, more than 37 million adults are living with diabetes in the U.S. Another 96 million are estimated to have pre-diabetes, a significant risk factor for developing the disease. 

If blood sugar levels aren’t adequately controlled, people living with diabetes may experience a range of mild symptoms like lightheadedness and mood swings. Over the long-term, poorly controlled diabetes can take a much more serious toll, including damage to the kidneys, eyesight, and blood circulation (often impacting the feet), and even lead to heart attack or stroke. 
insulin level measurement instrument

Diabetic Ketoacidosis

Despite the range of health challenges that come with diabetes, most people—even many of those living with diabetes—rarely think of the disease as something that can be a medical emergency. However, diabetic ketoacidosis (DKA), is a condition that can be life-threatening if it is not addressed immediately. 

Type 1 diabetics are most at risk of DKA, but it can impact those with Type 2 diabetes as well. DKA occurs when a lack of insulin means blood sugar (glucose) cannot be converted to energy for the body’s cells. Instead, the liver starts breaking down fat for energy, which can produce a byproduct called ketones. 

While burning fat for energy may sound like a good thing, if ketones are produced at too high a rate, it can become dangerous and lead to coma or death. Symptoms of DKA can come on quickly and include:

  • Feeling very thirsty 
  • Cottonmouth
  • Breath that smells like fruit
  • Dry skin
  • Nausea/vomiting
  • Muscle aches and pain
  • Warmth and redness in the face
  • Having to urinate frequently
  • Feeling exhausted

Getting Emergency Care For DKA

Those with diabetes unable to keep food or drink down, have fruity-smelling breath or who are experiencing more than one of any of the other symptoms of DKA listed above should seek care at The Emergency Center. 

Additionally, for people used to managing their diabetes who have access to an at-home blood or urine ketone test kit, seek care at The Emergency Center if results indicate:

  • Moderate to high ketones (30 mg/DL or higher) with a urine test
  • Blood glucose levels at or exceeding 300 mg/dL

Preventing Diabetic Ketoacidosis

Low levels of insulin and high blood glucose are what ultimately cause DKA. There are certain scenarios that make this more likely to occur. 

  • Illness: Not eating or drinking enough (or not eating or drinking the right things) is common when people get sick. For people with diabetes, this can make managing blood glucose more of a challenge. Additionally, a number of DKA symptoms line up with symptoms of other common illnesses, making identifying early warning signs trickier. 
  • Insulin administration issues: Patients with an insulin pump that gets clogged, who miss insulin injections, or whose insulin dose is not appropriate are more likely to experience DKA.

Other causes or risk factors for DKA include traumatic injury, drugs or alcohol, heart attack or stroke, and some medications. Women with diabetes who are pregnant also can be at higher risk.  

The most important step diabetics can take to prevent DKA is to closely manage their blood sugar. This means checking and recording levels several times throughout the day and not waiting to work with your doctor to adjust insulin doses as needed. Other steps to prevent or catch DKA early include:

  • Taking all medications as prescribed 
  • Having at-home ketone tests available
  • Monitoring ketones when ill
  • Having an action plan for DKA symptoms or abnormal ketone test results

Preventing DKA should be a top priority for all people living with diabetes. Knowing what to do and seeking care at The Emergency Center if symptoms of DKA do appear is a cornerstone of the plan. 

Enjoy life. We’ll be here for the bumps along the way.™


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The Emergency Center

San Antonio
11320 Alamo Ranch Pkwy
San Antonio, TX 78253

Phone: 210-485-3644