Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes. It develops when the body doesn't have enough insulin to let glucose into cells for energy, so it starts breaking down fat instead — producing acidic chemicals called ketones. High blood glucose and ketones build up to dangerous levels.

DKA is most common in people with type 1 diabetes, but people with type 2 diabetes can also develop it, especially under stress of infection or illness. With India's large and rising diabetes population, DKA is a common presentation in emergency departments. Early recognition saves lives.

Triggers

• Missing insulin doses or running out of insulin
• A new diagnosis of type 1 diabetes (DKA is how many people first discover they have type 1)
• Infection — UTI, pneumonia, gastroenteritis, COVID, dengue are common triggers
• Illness, injury, surgery, severe stress
• Certain medicines (some diabetes drugs — SGLT2 inhibitors — can rarely cause DKA)
• Heart attack, stroke
• Alcohol or drug use
• Pregnancy — in a person with diabetes who is not well-controlled

Symptoms

DKA develops over hours to a day or two:

• Excessive thirst
• Frequent urination
• Nausea, vomiting
• Abdominal pain (can mimic appendicitis in children)
• Fruity-smelling breath (ketone smell)
• Deep, rapid breathing ("Kussmaul breathing")
• Weakness, fatigue
• Confusion, drowsiness
• Coma in severe cases

Diagnosis — at hospital

DKA is diagnosed by a combination of high blood glucose (usually over 250 mg/dL), high ketones in blood or urine, and acidic blood (low pH). Electrolyte imbalances (particularly potassium) are common.

Treatment — immediate hospital care

• IV fluids — to correct severe dehydration
• IV insulin — continuous drip to lower blood glucose and stop ketone production
• Electrolyte correction — especially potassium, which can drop dangerously low during treatment
• Treating the underlying trigger — antibiotics for infection, etc.
• Close monitoring — in an ICU or high-dependency ward for severe cases

With prompt treatment, recovery is usually full — but untreated DKA can cause brain swelling, cardiac arrest, and death, so urgency matters.

Preventing DKA

• Never skip insulin doses — if you're vomiting or unable to eat, DO NOT stop insulin; contact your doctor. Smaller or adjusted doses are usually needed, but completely stopping is dangerous.
• Check blood glucose and ketones during illness (sick-day rules)
• Keep up-to-date supplies — insulin, strips, glucose meters
• Wear a medical identification bracelet or card indicating you have diabetes
• Learn warning signs — for yourself and family
• Treat infections early

If you have diabetes and develop any of the warning signs above — particularly vomiting, drowsiness, or rapid breathing — go to a hospital urgently. Dial 112 if severe. Don't wait.