Diabetic Ketoacidosis (DKA)

What is it?

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening condition that happens when the body doesn’t have enough insulin. Without enough insulin, the body can’t use glucose for energy in the usual way. Instead, it switches to breaking down fat — producing substances called ketones, which build up in the blood and make it more acidic. DKA can develop quickly — sometimes within hours — and needs urgent medical treatment.

What’s happening in the body?

DKA is not just about “high blood sugar” — it’s a combination of several processes happening at once. When there isn’t enough insulin:

• Glucose can’t enter cells effectively Even though there is plenty of glucose in the blood, the cells are essentially “starving” of usable energy.
• The body switches to fat as a fuel source Fat is broken down into fatty acids, which are processed in the liver.
• Ketones are produced The liver converts fatty acids into ketone bodies (including beta-hydroxybutyrate and acetoacetate). These can be used as an alternative fuel — but they are acidic.
• Acidosis develops As ketones build up, the blood becomes more acidic. This affects how enzymes, organs, and the brain function.
• Dehydration worsens things High blood glucose leads to glucose spilling into urine, pulling water and electrolytes with it. This makes dehydration — and the acidosis — worse.

Signs and symptoms to look out for

DKA can develop quickly, especially in people living with type 1 diabetes. Early signs may include:

• Rising blood glucose levels
• Ketones in blood or urine
• Increased thirst
• Passing more urine than usual
• Feeling tired

As DKA develops, symptoms may include:

• Nausea and vomiting
• Abdominal pain
• Deep, rapid breathing (sometimes called “air hunger”)
• A fruity or acetone smell on the breath
• Difficulty concentrating or confusion

Severe DKA can lead to reduced consciousness or coma.

What can lead to DKA?

DKA often develops when insulin levels drop too low for the body’s needs. This can happen when:

• Insulin doses are missed or interrupted
• There is an infection or illness (which increases insulin requirements)
• Diabetes has not yet been diagnosed
• There are issues with insulin delivery (e.g. pump failure)

This is not about blame — DKA is usually the result of a mismatch between insulin needs and insulin availability.

When to seek help

You should seek urgent medical advice if:

• Ketones are present and rising
• Blood glucose levels remain high despite taking insulin
• You are vomiting or unable to keep fluids down
• You feel drowsy, confused, or increasingly unwell

DKA can progress quickly, so early action matters.

How is DKA treated?

DKA is treated in hospital, with careful monitoring. Treatment usually includes:

• Intravenous fluids to treat dehydration
• Insulin to reduce blood glucose and stop ketone production
• Replacement of electrolytes (especially potassium)
• Identifying and treating any underlying cause

Treatment is gradual and closely managed to keep the body in balance as it recovers.

Reducing the risk

There are ways to lower the risk of DKA:

• Checking blood glucose and ketones when unwell
• Following your sick day plan
• Continuing insulin (even if you are not eating much — with guidance)
• Seeking early advice if levels are rising or ketones are present

If you use an insulin pump, having a backup plan is especially important!If you don’t yet have a sick day plan, your healthcare team can help you create one that works for you.

>> Download Sick Day Plan template

 

A note on ketones

Ketones are not always harmful — they are a normal alternative fuel the body can use. What makes DKA dangerous is the combination of:

• High ketone levels
• Rising blood glucose
• Dehydration
• Increasing acidity in the blood

Understanding this can help make sense of why monitoring both glucose and ketones matters.

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Last updated: March 2026

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TYPE 1 DIABETES
Living with Type 1 Diabetes
Stages of Type 1 Diabetes
Managing Type 1 Diabetes
Food and Type 1 Diabetes
Exercise and Type 1 Diabetes
Sick Days with Type 1 Diabetes
Blood glucose Monitoring
Continuous Glucose Monitoring
Insulin Pumps
Automated Insulin Delivery (AID) Systems
Low Blood Glucose Levels - Hypoglycaemia
Diabetic Ketoacidosis (DKA)
Type 3c Diabetes

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