10 Critical Diabetic Ketoacidosis Symptoms You Should Never Ignore

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes that occurs when your body produces high levels of blood acids called ketones. This condition develops when your body doesn’t have enough insulin to allow blood sugar into your cells for energy, forcing it to break down fat as fuel instead. This process produces ketones, which accumulate in the blood and can poison the body.

DKA most commonly affects people with type 1 diabetes, but it can also occur in individuals with type 2 diabetes under certain circumstances. Understanding the symptoms of diabetic ketoacidosis is crucial because early recognition and prompt medical treatment can be lifesaving. If left untreated, DKA can lead to severe complications including loss of consciousness, coma, and even death.

The condition typically develops rapidly, sometimes within 24 hours, making it essential to recognize the warning signs early. Below, we outline the 10 most important symptoms of diabetic ketoacidosis that you should never ignore.

1. Excessive Thirst (Polydipsia)

One of the earliest and most common symptoms of diabetic ketoacidosis is an intense, unquenchable thirst. This occurs because high blood sugar levels cause excess glucose to spill into your urine, pulling fluids from your tissues through a process called osmotic diuresis.

As your body loses more fluid through urination, dehydration sets in, triggering an overwhelming urge to drink water. Many people with DKA report feeling like they cannot drink enough water no matter how much they consume. This thirst is often more severe than the typical thirst experienced with uncontrolled diabetes.

Key characteristics:

• Persistent feeling of extreme thirst
• Dry mouth and throat that doesn’t improve with drinking
• Constant desire to drink fluids
• Thirst that worsens despite fluid intake

2. Frequent Urination (Polyuria)

Frequent urination goes hand-in-hand with excessive thirst in diabetic ketoacidosis. When blood sugar levels become extremely elevated, the kidneys attempt to remove the excess glucose by filtering it out through urine. This results in increased urine production and more frequent trips to the bathroom.

During DKA, you may find yourself urinating much more often than usual, including multiple times during the night. The urine volume is typically larger than normal, and this excessive urination contributes significantly to dehydration, which can rapidly worsen the condition.

What to watch for:

• Urinating every hour or more frequently
• Large volumes of urine with each bathroom visit
• Waking up multiple times at night to urinate
• Light-colored or clear urine due to dilution

3. Nausea and Vomiting

Nausea and vomiting are common and distressing symptoms of diabetic ketoacidosis. These symptoms occur due to the buildup of ketones in the bloodstream, which creates an acidic environment that irritates the stomach and digestive system. The metabolic disruption caused by DKA also affects the gastrointestinal tract’s normal functioning.

Vomiting in DKA can be particularly dangerous because it further contributes to dehydration and prevents you from keeping down fluids or medications. Some people experience persistent nausea without vomiting, while others may have severe vomiting episodes that make it impossible to retain anything they consume.

Important considerations:

• Nausea may be constant or come in waves
• Vomiting can be severe and persistent
• Unable to keep down food, fluids, or medications
• May be accompanied by stomach pain or cramping

4. Abdominal Pain

Many people experiencing diabetic ketoacidosis report significant abdominal pain, which can range from mild discomfort to severe cramping. This symptom is particularly concerning because it can sometimes be mistaken for other conditions such as appendicitis, gastroenteritis, or other gastrointestinal emergencies.

The abdominal pain in DKA is thought to result from several factors, including gastric distension, dehydration, electrolyte imbalances, and the acidic environment created by ketone accumulation. The pain may be diffuse or localized and can be accompanied by tenderness when the abdomen is touched.

Characteristics of DKA-related abdominal pain:

• Can be severe and persistent
• May be cramping or sharp in nature
• Often accompanied by nausea and vomiting
• Can mimic other acute abdominal conditions
• May worsen as DKA progresses

5. Fruity-Scented Breath

One of the most distinctive symptoms of diabetic ketoacidosis is a characteristic fruity or sweet-smelling breath, often described as smelling like nail polish remover or acetone. This occurs because one of the ketones produced during DKA is acetone, which is expelled from the body through the lungs when you breathe.

While the person experiencing DKA may not notice this smell themselves, it is often detected by family members, friends, or healthcare providers. This symptom is a clear indicator of ketone buildup and should prompt immediate medical attention.

What to know:

• Breath has a distinctive sweet or fruity odor
• Similar to the smell of acetone or nail polish remover
• May also smell like overripe fruit
• The person with DKA may not detect the odor themselves
• Becomes more noticeable as ketone levels increase

6. Shortness of Breath or Rapid Breathing

Respiratory changes are a significant symptom of diabetic ketoacidosis and represent the body’s attempt to compensate for the metabolic acidosis. As ketones accumulate and blood pH drops, the body tries to eliminate excess acid by increasing the rate and depth of breathing in a pattern called Kussmaul respirations.

This compensatory breathing pattern is characterized by deep, labored breaths that may be rapid. You might feel like you cannot catch your breath or that you need to breathe more deeply than usual. Some people describe feeling like they have just finished exercising even when at rest.

Breathing pattern changes include:

• Deep, rapid breathing (hyperventilation)
• Feeling short of breath without physical exertion
• Labored breathing that requires effort
• Sensation of air hunger
• Breathing that is noticeably faster than normal

7. Fatigue and Weakness

Extreme fatigue and profound weakness are hallmark symptoms of diabetic ketoacidosis. When your body cannot use glucose properly due to insulin deficiency, your cells are essentially starving for energy, despite high blood sugar levels. This energy crisis affects your entire body, leading to overwhelming exhaustion.

The fatigue experienced during DKA is not ordinary tiredness—it is a deep, debilitating exhaustion that makes even simple tasks feel impossible. You may feel too weak to stand, walk, or perform basic daily activities. This weakness results from a combination of cellular energy depletion, dehydration, and electrolyte imbalances.

Manifestations of DKA-related fatigue:

• Extreme tiredness that doesn’t improve with rest
• Muscle weakness affecting the entire body
• Difficulty performing routine activities
• Feeling completely drained of energy
• May progress to difficulty staying awake

8. Confusion and Difficulty Concentrating

Mental status changes are serious symptoms of diabetic ketoacidosis that indicate the condition is affecting brain function. The metabolic disturbances, dehydration, and electrolyte imbalances associated with DKA can impair cognitive function, leading to confusion, difficulty concentrating, and altered consciousness.

In the early stages, you might notice trouble focusing, memory problems, or feeling mentally “foggy.” As DKA worsens, confusion can become more severe, progressing to disorientation, inability to recognize familiar people or places, and in severe cases, loss of consciousness or coma.

Cognitive symptoms may include:

• Difficulty concentrating or focusing
• Memory problems or forgetfulness
• Confusion about time, place, or situation
• Slowed thinking or delayed responses
• Disorientation or inability to think clearly
• In severe cases, decreased consciousness or unresponsiveness

9. Dry Skin and Mouth

Dehydration from diabetic ketoacidosis manifests visibly through dry skin and mucous membranes. As your body loses excessive amounts of fluid through frequent urination and vomiting, your skin loses its normal elasticity and moisture. Your mouth, lips, and tongue may become extremely dry and uncomfortable.

Healthcare providers often check for skin turgor (elasticity) as a sign of dehydration in suspected DKA cases. When the skin on the back of the hand is pinched and released, it may remain “tented” or return to normal very slowly in dehydrated individuals. The eyes may also appear sunken, and tear production may be reduced.

Signs of dehydration in DKA:

• Skin that appears dry, flaky, or lacks normal elasticity
• Extremely dry mouth and tongue
• Cracked or dry lips
• Reduced or absent saliva production
• Sunken appearance of eyes
• Reduced skin turgor (skin “tenting”)

10. High Blood Sugar Levels

Markedly elevated blood glucose levels are a defining feature of diabetic ketoacidosis. While high blood sugar alone doesn’t always mean DKA, blood glucose levels above 250 mg/dL (13.9 mmol/L) combined with other symptoms should raise suspicion for this condition. In many cases of DKA, blood sugar levels can exceed 300-400 mg/dL or even higher.

It’s important to note that while high blood sugar is typical in DKA, it is possible (though less common) to have “euglycemic DKA” where blood glucose levels are only moderately elevated or near-normal, particularly in certain situations such as pregnancy, reduced food intake, or use of certain medications.

Blood sugar considerations in DKA:

• Blood glucose typically above 250 mg/dL (13.9 mmol/L)
• Often exceeds 300-400 mg/dL or higher
• Accompanied by presence of ketones in blood or urine
• May not respond normally to usual insulin doses
• Should be monitored frequently if DKA is suspected

Main Causes of Diabetic Ketoacidosis

Understanding what triggers diabetic ketoacidosis is essential for prevention and early intervention. The following are the primary causes:

Insufficient Insulin

The most common cause of DKA is inadequate insulin, which can occur when people with diabetes miss insulin doses, don’t take enough insulin, or have a malfunctioning insulin pump. Without sufficient insulin, the body cannot use glucose for energy and begins breaking down fat, producing ketones.

Illness or Infection

Infections such as pneumonia, urinary tract infections, influenza, or COVID-19 can trigger DKA. When the body is fighting an illness, it releases stress hormones that increase blood sugar levels and insulin requirements. This increased demand, combined with possible decreased food intake during illness, can precipitate DKA.

New Diagnosis of Diabetes

DKA is sometimes the first sign of previously undiagnosed type 1 diabetes. People who don’t know they have diabetes aren’t receiving insulin treatment, allowing ketoacidosis to develop.

Physical or Emotional Stress

Major stressors such as surgery, trauma, heart attack, or significant emotional stress can trigger the release of hormones like cortisol and adrenaline, which counteract insulin’s effects and raise blood sugar levels, potentially leading to DKA.

Certain Medications

Some medications, including corticosteroids, certain diuretics, and some antipsychotic drugs, can increase blood sugar levels and contribute to DKA development. Additionally, misuse of substances like alcohol or drugs can interfere with diabetes management.

Pregnancy

Pregnant women with diabetes have an increased risk of developing DKA, which can occur at lower blood glucose levels than in non-pregnant individuals. Pregnancy increases insulin resistance and metabolic demands, making blood sugar control more challenging.

Prevention of Diabetic Ketoacidosis

While diabetic ketoacidosis is a serious condition, it is largely preventable with proper diabetes management and awareness. Here are essential prevention strategies:

Monitor Blood Sugar Regularly

Frequent blood glucose monitoring is your first line of defense against DKA. Test your blood sugar as recommended by your healthcare provider, and more frequently during illness or stress. Be aware of patterns that indicate your blood sugar is rising.

Check Ketone Levels

Learn to test for ketones using urine or blood ketone testing strips, especially when your blood sugar is consistently above 240 mg/dL, when you’re ill, or when you experience symptoms of high blood sugar. Early detection of ketones allows for prompt intervention.

Never Skip Insulin Doses

Always take your prescribed insulin as directed, even if you’re not eating well. Skipping insulin is one of the most common preventable causes of DKA. If you’re uncertain about insulin dosing during illness, contact your healthcare provider rather than stopping insulin.

Have a Sick Day Plan

Work with your healthcare team to develop a sick day management plan before you need it. This plan should include guidelines for insulin adjustment, when to check ketones, how to stay hydrated, and when to seek emergency care.

Stay Hydrated

Adequate fluid intake helps prevent dehydration and can help flush out excess glucose and ketones. Drink plenty of water throughout the day, and increase fluid intake when blood sugar is elevated.

Maintain Insulin Pump Equipment

If you use an insulin pump, regularly check that it’s working properly, change infusion sites as recommended, and have backup insulin and supplies available in case of pump failure.

Educate Family Members

Ensure family members or close friends know the signs of DKA and what to do if you become ill or unable to care for yourself. They should know when to seek emergency medical help on your behalf.

Attend Regular Medical Appointments

Regular check-ups with your healthcare provider help ensure your diabetes management plan is working effectively and can be adjusted as needed to prevent complications.

Frequently Asked Questions

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis is a serious diabetes complication that occurs when your body produces high levels of blood acids called ketones due to insufficient insulin. The body breaks down fat for fuel instead of glucose, leading to ketone buildup that can poison the body if untreated.

How quickly can DKA develop?

DKA typically develops rapidly, often within 24 hours, though it can sometimes develop more quickly, especially if triggered by acute illness or stress. This is why early recognition of symptoms and prompt treatment are critical.

Can people with type 2 diabetes get DKA?

Yes, although DKA is more common in type 1 diabetes, people with type 2 diabetes can also develop this condition, particularly during severe illness, infection, or significant stress. Certain medications have also been associated with DKA in type 2 diabetes.

What blood sugar level indicates DKA?

DKA typically occurs when blood sugar levels are above 250 mg/dL (13.9 mmol/L), though it can occur at lower levels in some cases. However, high blood sugar alone doesn’t confirm DKA—ketone testing and assessment of other symptoms are also necessary.

Is DKA an emergency?

Yes, diabetic ketoacidosis is a medical emergency that requires immediate hospital treatment. If you suspect DKA, seek emergency medical care immediately. Without treatment, DKA can lead to serious complications including coma and death.

Can DKA be treated at home?

No, DKA requires hospital treatment and cannot be safely managed at home. Treatment involves intravenous fluids, insulin therapy, and electrolyte replacement under medical supervision. Always seek emergency care if DKA is suspected.

How can I tell the difference between high blood sugar and DKA?

While high blood sugar is a feature of DKA, the condition also involves ketone production. Key distinguishing features of DKA include fruity-smelling breath, rapid deep breathing, severe nausea or vomiting, abdominal pain, and confusion. Testing for ketones can help differentiate simple high blood sugar from DKA.

What is the role of ketone testing in preventing DKA?

Regular ketone testing when blood sugar is high (above 240 mg/dL) or during illness helps detect ketone buildup early, before it progresses to full DKA. Early detection allows you to take action, such as adjusting insulin with your healthcare provider’s guidance, to prevent DKA development.

Can stress alone cause DKA?

Significant physical or emotional stress can contribute to DKA by triggering the release of stress hormones that raise blood sugar and increase insulin needs. However, stress typically causes DKA in combination with other factors like insufficient insulin rather than stress alone.

What should I do if I think I have DKA?

If you experience symptoms of DKA, especially if you have diabetes and your blood sugar is above 250 mg/dL with ketones present, seek emergency medical care immediately. Do not attempt to treat DKA at home. Call emergency services or have someone take you to the nearest emergency department.

References:

• Mayo Clinic – Diabetic Ketoacidosis
• American Diabetes Association – DKA
• NHS – Diabetic Ketoacidosis
• CDC – Diabetic Ketoacidosis
• National Center for Biotechnology Information – Diabetic Ketoacidosis