Written by Dr. Matthew Capozzi, DPM, FACFAS, CWS (board-certified foot surgeon and wound specialist) · Medically reviewed by the CircuFiber Scientific Advisory Board · Updated: October 27, 2026

Diabetic ketoacidosis (DKA) is a life-threatening medical emergency that happens when the body does not have enough insulin, so it burns fat for energy and floods the blood with acidic ketones. The warning signs are sudden increased thirst, excessive urination, nausea or vomiting, stomach pain, deep or rapid breathing, and a fruity smell on the breath. DKA can develop within 24 hours and is treated in hospital with intravenous fluids, electrolytes and insulin. If you or someone with diabetes has these symptoms, call emergency services or go to the nearest emergency room.

Key Takeaways

• Diabetic ketoacidosis is a medical emergency. It takes place when the body doesn't have enough insulin, which results in fat being converted into ketones that make blood acidic. Call emergency services if you suspect it.
• Symptoms come on fast, sometimes within 24 hours: extreme thirst, frequent urination, nausea and vomiting, abdominal pain, weakness, shortness of breath, fruity-smelling breath and, in severe cases, confusion or unconsciousness.
• The two tests that confirm DKA are a blood glucose reading (usually above 250 mg/dL, although it can be only slightly elevated in euglycemic DKA) and a urine or blood test showing ketones.
• Treatment happens in hospital and has three parts: replacing lost fluids, correcting electrolytes such as sodium and potassium, and giving insulin to stop ketone production.
• Prevention rests on never skipping insulin, checking blood sugar more often during illness or stress, and following sick-day guidelines from your care team.
• DKA is most common in type 1 diabetes, but people with type 2 diabetes and pregnant women with diabetes can develop it too.

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes in which a lack of insulin forces the body to break down fat for energy, producing ketones that turn the blood acidic. Insulin is an essential hormone for keeping glucose levels in your blood regulated. Problems arise when insufficient amounts are produced or cells fail to respond appropriately. With inadequate insulin present, sugar cannot enter cells and energy is sourced from fat instead, generating high concentrations of ketones that result in acidity accumulating in one's bloodstream.

DKA often occurs suddenly, due mainly to excessive blood sugar levels, sometimes within 24 hours turning an otherwise good day into an urgent trip for help at the emergency room. That's why knowing how DKA presents itself can go a long way towards timely management and intervention. It is one of the diabetic emergencies every person with diabetes, and their family, should be able to recognize.

What are the symptoms of diabetic ketoacidosis?

The symptoms of diabetic ketoacidosis are excessive urination, increased thirst, nausea and vomiting, abdominal pain, weakness and fatigue, shortness of breath, a sweet or fruity odor on the breath, dizziness and, in advanced cases, confusion or unconsciousness. Typically, several of these symptoms related to high blood sugar show up together.

Early symptoms of DKA

Excessive urination is often among the first signs; increased thirst follows shortly after, as more and more ketones are expelled in urine from breaking down fat stores for energy. Other symptoms may then become evident, such as nausea which can lead to vomiting, or abdominal pain accompanied by a sweet odour on the breath due to the high concentration of acid building up in the blood. Weakness, fatigue and feeling drained also commonly appear at this stage. Many of these overlap with ordinary hyperglycemia attack symptoms, which is why ketone testing matters.

Warning signs that mean DKA is advanced

Shortness of breath, deep or rapid breathing, fruity-smelling breath, confusion, extreme drowsiness and unconsciousness are signs that DKA has become severe and needs emergency care immediately. A key signifier is if your blood sugar levels are unusually high, or even just slightly elevated in euglycemic DKA. Another vital piece of evidence can be found through urine and/or blood tests that reveal whether ketones are present. Both blood and urine exams need to take place, as they'll accurately confirm whether DKA is developing.

What causes diabetic ketoacidosis?

Diabetic ketoacidosis is caused by a shortage of insulin, which stops glucose from entering cells and forces the body to burn fat, producing ketones faster than it can clear them. The two steps on the path to DKA are insulin deficiency and ketone production.

Insulin deficiency

When insulin is not administered or the amount present in your body becomes deficient, blood sugar levels can spike. This occurs when a person either fails to take their recommended insulin therapy properly or has recently been diagnosed with an insulin-dependent diabetes condition and the diagnosis has not yet been made. In both cases, very high glucose concentrations lead to DKA developing. Illness, infection, injury and severe stress also raise the body's insulin needs, so the usual dose may no longer be enough. If there isn't enough fuel available from glucose for cells, the body relies on other energy sources instead, and that comes at a cost: blood sugar climbs even higher than before.

Ketone production

When the body can't access glucose for energy, it must resort to breaking down fat, which leads to an overabundance of ketones. This in turn causes a buildup of acidity in your bloodstream, and this is what DKA (diabetic ketoacidosis) entails. Ketones can be detected in urine with test strips or in blood with a ketone meter, which is why your care team may ask you to check your blood sugar and ketones whenever readings run high.

How is diabetic ketoacidosis treated?

Diabetic ketoacidosis is treated in hospital, usually in the emergency department or intensive care, with three major components: replenishing lost fluids, rectifying electrolyte imbalances, and administering insulin to regulate hyperglycemia. DKA is not something to manage at home; once vomiting, deep breathing or confusion appear, intravenous treatment is needed. Depending on severity and other factors like age or other medical conditions, treatment ranges from fluids and insulin given intravenously to a longer hospital stay.

Fluid and electrolyte therapy

Fluid replacement is the crucial first element of DKA management, as it helps restore normal blood flow and relieves the dehydration caused by frequent urination. Not only must fluids be restored, but essential electrolytes like sodium and potassium need to be replaced too. These are important for muscle, nerve and heart function, and potassium in particular is monitored closely because insulin treatment moves potassium into cells and can drop blood levels dangerously low.

Insulin treatment

Insulin is the treatment that stops ketone production and brings blood sugar back under control. In hospital, insulin is given intravenously, then transitioned back to the patient's usual subcutaneous insulin as the blood sugar level drops and the blood acidity normalizes. The patient's regular insulin therapy may need to be adjusted before discharge. After recovery, careful monitoring and awareness of changes in normal sugar readings, plus managing stressors that could push them abnormally high, are what prevent the next episode.

How can you prevent diabetic ketoacidosis?

Preventing diabetic ketoacidosis comes down to never running out of insulin, checking blood sugar and ketones more often during illness or stress, and following a sick-day plan agreed with your care team. It is widely accepted that preventing a condition like DKA from occurring in the first place is preferable to having it treated afterwards. To this end, people with diabetes must adhere to an effective diabetes management plan that includes frequent blood sugar monitoring and insulin treatment, coupled with lifestyle modifications, so as to keep glucose levels balanced.

Follow a diabetes management plan

A personalized diabetes management plan keeps blood sugar levels stable while warding off dangerous conditions such as DKA. To make sure that your sugar levels don't fluctuate in an unpredictable way, monitoring glucose frequently is essential; these tips for blood sugar monitoring can help. Insulin treatment, taken on schedule and never skipped, maintains equilibrium within the body's blood sugars and prevents the spikes that lead to ketone production. If you use an insulin pump, check the infusion set and tubing whenever readings are unexpectedly high, because a blocked or dislodged pump is a common trigger. Healthy habits, including nourishing meals and regular physical activity, are integral parts of taking care of yourself when you have diabetes.

Use sick-day guidelines

Illness raises the risk of DKA because the body requires more insulin during illness or distress, which pushes glucose higher. To maintain control on sick days: keep taking insulin even if you are eating less, test blood sugar and ketones every few hours, adjust insulin only as your care team has instructed, keep drinking fluids regularly even when feeling unwell, and eat where possible. Ask your doctor for a written sick-day plan before you need it, and learn how stress affects diabetes, since emotional and physical stress both raise insulin needs.

What are the complications of diabetic ketoacidosis?

The complications of diabetic ketoacidosis fall into two groups: problems that can arise during treatment, such as low blood sugar, high chloride levels and low potassium, and long-term damage from untreated or repeated DKA, including kidney injury, brain swelling (cerebral edema), coma and death. DKA is a treatable illness, but careful monitoring during treatment mustn't be ignored.

Treatment-related complications

Common issues with DKA stem from its treatment and may include hypoglycemia (low blood sugar) from insulin administration, hyperchloremia (high chloride levels), and hypokalemia (reduced potassium), which can affect heart rhythm and muscle function. Cerebral edema (swelling in the brain) is rare but is the most dangerous treatment-era complication and is seen most often in children. Hospital teams monitor glucose, electrolytes and blood acidity frequently to catch these early.

Long-term consequences

The long-term effects of not treating DKA are dire. High glucose levels and ketones in the blood may cause impairment to organs such as the kidneys, while cerebral edema is also possible and more dangerous among those affected by severe cases. Untreated DKA leads to coma and death, which is why any suspected episode needs medical attention immediately. Even after short-term symptoms are under control, follow-up with your diabetes care team is needed to find out why the episode happened and prevent the next one.

Can people with type 2 diabetes or pregnant women get DKA?

Yes. Diabetic ketoacidosis is most common in type 1 diabetes, but it can also develop in type 2 diabetes and during pregnancy, and both groups need to know the warning signs.

Type 2 diabetes and DKA

Regardless of the type of diabetes, individuals must be proactive in managing their condition, as it is possible for DKA to develop in type 2 diabetes, although it is usually less common and less severe than in type 1. When an individual experiences periods of stress and/or illness, the risk increases, so monitoring blood glucose levels closely during such times becomes ever more important. If you are unsure which type you have, read about diagnosing type 1 versus type 2 diabetes.

Pregnancy and DKA

Pregnant women with diabetes are at a higher risk of developing diabetic ketoacidosis because of hormonal changes throughout pregnancy that increase insulin resistance, so extra care should be taken when looking after both mother and baby's health. Monitoring blood sugar levels carefully, taking appropriate insulin doses as prescribed, and following a gestational diabetes diet are essential for minimizing this risk. DKA in pregnancy can occur at lower blood sugar levels than usual, so report nausea, vomiting or unexplained high readings to your obstetric team promptly.

When should you see a doctor about diabetic ketoacidosis?

Diabetic ketoacidosis is a medical emergency: call emergency services or go to the nearest emergency room right away if you have moderate or large ketones, vomiting that stops you keeping fluids down, abdominal pain, fruity-smelling breath, deep or rapid breathing, confusion or extreme drowsiness. Do not drive yourself. Call your doctor or diabetes care team the same day if your blood sugar is persistently above about 250 mg/dL, you have small ketones, or you are sick and unsure how to adjust insulin. Anyone who is diagnosed with DKA for the first time, especially without a known diabetes diagnosis, should be evaluated for signs and symptoms of diabetes and started on a treatment plan before leaving hospital.

Frequently asked questions about diabetic ketoacidosis

What does DKA stand for in diabetes?

DKA stands for diabetic ketoacidosis, a dangerous condition in which a lack of insulin causes ketones to build up and make the blood acidic. It is different from the mild ketosis produced by a low-carbohydrate diet, because in DKA the ketone levels are far higher and are combined with very high blood sugar and dehydration.

At what blood sugar level does ketoacidosis start?

Diabetic ketoacidosis is usually diagnosed when blood glucose is above 250 milligrams per deciliter together with ketones in the blood or urine and acidic blood. However, DKA can occur with only slightly elevated or even near-normal blood sugar; this is called euglycemic DKA, which is why ketone testing, not just glucose testing, is important when you feel unwell.

How quickly does diabetic ketoacidosis develop?

Diabetic ketoacidosis can develop quickly, sometimes within 24 hours of a missed insulin dose, a pump failure or the start of an illness. Early symptoms such as thirst and frequent urination can progress to vomiting, breathing changes and confusion within hours, so test for ketones as soon as blood sugar runs high.

Can you die from diabetic ketoacidosis?

Yes. Untreated diabetic ketoacidosis leads to severe dehydration, dangerous electrolyte shifts, cerebral edema, coma and death. With prompt hospital treatment, most people recover fully, which is why the moment to act is when the first warning signs appear, not after they worsen.

How long does it take to recover from diabetic ketoacidosis?

With intravenous fluids, electrolytes and insulin, the acidosis itself usually resolves within about a day, but the hospital stay and full recovery depend on how severe the episode was, what triggered it, and whether complications occurred. Fatigue can last several days afterward, and your care team will review your insulin plan before discharge.

Can diabetic ketoacidosis be treated at home?

No. Diabetic ketoacidosis requires hospital treatment because fluids, insulin and electrolytes must be given intravenously and monitored with blood tests. What you can do at home is catch it early: if your blood sugar is high and a ketone test shows small ketones, follow your sick-day plan and call your care team; if ketones are moderate or large, or you are vomiting, seek emergency care.

References, studies and sources

• Centers for Disease Control and Prevention (CDC). Diabetic Ketoacidosis. https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html
• American Diabetes Association. Diabetes complications and DKA (ketoacidosis) and ketones. https://diabetes.org/
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetes health information. https://www.niddk.nih.gov/health-information/diabetes
• MedlinePlus (U.S. National Library of Medicine). Diabetes. https://medlineplus.gov/diabetes.html

About the author: Dr. Matthew Capozzi, DPM, FACFAS, CWS, is a board-certified foot surgeon through the American Board of Foot and Ankle Surgery. He is a Diplomate of the American Academy of Wound Management and Fellow of the American College of Foot and Ankle Surgeons. He completed a three-year residency program in Foot and Ankle Reconstructive Surgery at St. Francis Hospital & Medical Center in Hartford, CT in 2010. Dr. Capozzi is a board-certified Wound Specialist® granted by the American Academy of Wound Management.

Healthcare disclaimer: Always consult your physician before beginning any program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you experience any pain or difficulty, stop and consult your healthcare provider. CircuFiber socks are a general wellness product intended to promote a temporary increase in local blood flow and circulation; they are not intended to diagnose, treat, cure, or prevent any disease. Individual results vary.