Diabetic ketoacidosis (DKA): Symptoms, Diagnosis and Treatment

If ketone levels becomes too high, a serious complication called diabetic ketoacidosis (DKA) may be developed.

Updated: June 16, 2022

When ketones build up in the blood it make the blood more acidic causing Diabetic ketoacidosis (DKA). When your blood sugar is too high for too long, this complication may arise. When your body does not have enough insulin, your cells can not use the sugar in your blood for energy. So they use fat for fuel instead of sugar. Burning fat makes acids called ketones and, if the process continues for a long period, they could build up in your blood.

Symptoms of DKA:

Ketone levels using a urine test should be checked if you have the following symptoms:

  • sick for example flu or have an infection
  • nausea or vomiting
  • excessive thirst
  • dry mouth
  • high blood sugar may be above 300 mg/dL
  • constantly feeling tired
  • frequent urination
  • blushed skin
  • sweet odor or fruity breath
  • confusion

Diagnosis of DKA:

A urine glucose test is done to check for abnormally high levels of glucose and ketone in the urine. In case of type 1 and type 2 diabetes, the kidneys often release some of the excess sugar from the blood into the urine when blood sugar levels rise above a target range.
Some additional testing will be done to find out the underlying cause if glucose or ketones are found in the urine during a routine exam. This may include a blood glucose test. If you have diabetes, diet management, exercise, medications, and testing your blood glucose levels regularly can help you manage your blood sugar levels. You may have to regularly monitor ketone levels in your urine using a home test strip, if you have type 1 diabetes. This is important as in type 1 diabetes ketone build up in the blood making the blood more acidic which can be poisonous and may lead to coma or even death. If ketone levels becomes too high, a serious complication called diabetic ketoacidosis (DKA) may be developed.


Understanding the Results of a Urine Test:

Glucose Level:

The normal amount of glucose in urine is 0 to 0.8 mmol/L. A value higher then this could be a sign of a health issue. Diabetes is the most common cause of elevated glucose levels. A blood test can be performed to confirm the diagnosis. A high amount of glucose in urine can also be due to pregnancy. Pregnant women will have a higher urine glucose levels than women who are not pregnant. Women who already have increased levels of glucose in their urine should be screened for gestational diabetes if they become pregnant.
Renal glycosuria is a rare condition in which the kidneys release glucose into the urine. This can be another cause of elevated levels of glucose in urine even if blood glucose levels are normal.
Further testing will be done to find out the underlying cause if the results of your urine glucose test are abnormal. Certain medications can interfere with glucose levels in the blood and urine. Speak to your doctor about prescription or over-the-counter medication you are taking before the tests.

Ketones Level:

As ketones are more commonly seen in the urine of people with type 1 diabetes, ketone levels in urine should be monitored frequently if you have type 1 diabetes. Normal levels of ketones in urine are less than 0.6 mmol/L. If you have more then this in your urin it can be classified as small, moderate, or large.

  • If the level is 0.6 to 1.5 mmol/L or about 10 to 30 mg/dL, it is small to moderate and ketone buildup is starting. Drink plenty of water and test again in a few hours. Do not exercise if your blood glucose levels are also high.
  • If the level is 1.6 to 3.0 mmol/L or about 30 to 50 mg/dL in the urine, it is considered as moderate to large amounts and this can be a indication that your diabetes is not being managed well. You need medical attention in this case.
  • If the level is higher than 3.0 mmol/L or more than 50 mg/dL, it is very large and you will be diagnosed with ketoacidosis. This is a life-threatening condition and requires immediate medical treatment.

Vomiting, nausea, confusion, and a fruity breath odor are the symptoms of ketoacidosis. Ketoacidosis can lead to brain swelling, coma, and even death if left untreated.

Treatment of DKA:

Follow the treatment plan set by your doctor if you have low or moderate ketones in your urine. If you have high levels of ketones in your urine, you need immediate treatment. The treatment of ketoacidosis is done with intravenous fluids and insulin. The imbalance in your blood can be adjusted by getting insulin through an IV to bring your ketones down and fluids to get you hydrated.
Your doctor may change your kind of insulin and adjust your dose to prevent it from happening again. You should drink more water and sugar-free, non-alcoholic beverages.
Keeping track of your glucose and ketone levels can help you and your doctor adjust your diabetes treatment plan and manage it well.




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