Diabetic ketoacidosis (DKA) is a serious diabetes complication—most commonly linked to type 1 diabetes—that's caused by a buildup of blood acids in the body. The condition can lead to a diabetic coma or even death, so it's of the utmost importance that you understand the signs, symptoms, and proper precautionary measures.

DKA develops when the body is unable to produce enough insulin, which normally plays a key role in supplying sugar to cells. Without enough insulin, the body begins to break down fat as an alternate fuel. This process causes toxic acids called ketones to accumulate in the bloodstream, eventually leading to diabetic ketoacidosis if left untreated.

High levels of ketones can poison the body, and while DKA may happen to anyone with diabetes, it is rare in people with type 2 diabetes.

People with DKA are treated in the hospital. Help prevent this serious diabetes complication by learning the warning signs.


Diabetic ketoacidosis symptoms often develop quickly—sometimes within 24 hours. For some people, these signs may be the first indication of having diabetes. When vomiting occurs, this life-threatening condition can develop within a few hours.

Know these possible warning signs of DKA:

  • Thirst or a very dry mouth
  • High blood glucose (blood sugar) levels
  • Frequent urination
  • High levels of ketones in the urine

Then, other symptoms may begin to appear:

  • Constantly feeling tired
  • Dry or flushed skin
  • Nausea, vomiting, or abdominal pain (Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than two hours, contact your healthcare provider.)
  • Difficulty breathing
  • Fruity odor on breath
  • A hard time paying attention, or confusion

It may be a good idea to check your blood or urine for ketones, especially when you're sick. To do this, either get tested in a laboratory or look for over-the-counter blood and urine tests at the pharmacy.

Who's at risk

Your risk of developing DKA might be higher if you:

  • Have type 1 diabetes
  • Are under the age of 19
  • Have a high fever
  • Smoke or abuse drugs or alcohol

When to call for help

Contact your doctor immediately if:

  • Your blood sugar level is higher than your target range and doesn't respond to home treatment
  • You are vomiting and unable to handle any food or liquid
  • Your urine ketone level ranges from moderate or high

Seek emergency care if:

  • Your blood sugar level is consistently higher than 300 milligrams per deciliter, or 16.7 millimoles per liter
  • You have multiple signs and symptoms of DKA

To learn more about diabetes complications:

Avoiding Diabetes Complications
Complications: It's All about Early Detection!
Complications: Complications are NOT Inevitable