What are the symptoms of diabetic ketoacidosis?

What DKA actually is

Without enough insulin, glucose cannot get into cells however much of it is in the blood. The body treats this as starvation and burns fat for fuel instead. That process produces ketones, which are acidic. Enough of them and the blood becomes dangerously acidic — ketoacidosis.

So there are two problems at once: very high glucose, and acid.

The symptoms, roughly in order

Early — the same as ordinary high blood sugar:

• Excessive thirst and a very dry mouth
• Frequent urination
• Fatigue and weakness
• High readings, usually above 250 mg/dL (13.9 mmol/L)

Progressing:

• Nausea and vomiting
• Abdominal pain — can be severe enough to be mistaken for appendicitis
• Deep, rapid, laboured breathing (Kussmaul breathing) as the body tries to blow off acid
• Breath smelling sweet or fruity, like acetone or pear drops
• Flushed, dry skin
• Confusion, drowsiness, and eventually loss of consciousness

The progression from early to serious can happen within hours.

Who gets it

Most common in type 1 diabetes, and it is sometimes the presentation that leads to diagnosis — particularly in children and young adults, where symptoms escalate over days to weeks.

But it happens in type 2 diabetes too, especially during illness. And people taking SGLT2 inhibitors can develop euglycemic DKA, where ketones are high but glucose is only modestly raised or even normal. That one is easy to miss precisely because the number looks reassuring.

The usual triggers

• Infection or illness — the most common
• Missed or insufficient insulin, including a failed pump site or insulin degraded by heat
• New-onset, undiagnosed type 1 diabetes
• Surgery, trauma, heart attack
• Some medications, including steroids and SGLT2 inhibitors

What to do

Go to emergency care. DKA needs intravenous fluids, insulin and electrolyte correction — it cannot be managed at home.

While arranging that: drink water if you can keep it down, do not exercise, and do not stop your insulin.

Check ketones any time you are above 240 mg/dL (13.3 mmol/L) if you use insulin, and any time you are unwell — blood ketone meters are more reliable than urine strips, which lag behind.