Diabetic Ketoacidosis: What You Need to Know
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that happens when insulin runs low and blood sugar spikes, setting off dangerous chemical shifts in the body. It’s most common in type 1 diabetes but can show up in type 2 during illness or stress. The good news is that most cases are preventable with attention and early action.
When blood sugar climbs, the kidneys try to dump the excess through urine, which drags water and vital salts along for the ride. That osmotic diuresis leads to dehydration and losses of electrolytes like sodium and potassium, while bicarbonate levels also fall as the blood becomes more acidic. Those combined changes are what make DKA dangerous and often dramatic in presentation.
Insulin normally helps glucose enter cells to be burned for energy; without it, the body turns to fat as an alternative fuel. Breaking down fat produces ketones, and at high levels those ketones acidify the bloodstream, which is why the condition is called “ketoacidosis.” Acid build-up brings nausea, vomiting, belly pain and the rapid, deep breathing you might recognize as the body trying to blow off acid.
Bicarbonate acts like a chemical buffer against acid, but in DKA its level drops as ketone production climbs and acidosis worsens. Treating DKA quickly with insulin and fluids lowers blood sugar, stops excess ketone formation, and allows bicarbonate to recover over time. That recovery is gradual and needs close medical oversight.
Potassium is tricky in DKA: total body potassium is often depleted because of urinary losses and vomiting, but blood tests can appear normal or high at first. Once insulin is given, potassium is driven back into cells and blood levels can fall rapidly, so monitoring is critical. Low potassium causes weakness, cramps, fatigue and dangerous heart rhythm problems when severe.
Because of that risk, clinicians check potassium frequently and correct deficits promptly, usually with intravenous replacement in moderate to severe cases. Oral supplements can work for mild shortages, but IV delivery lets doctors restore potassium quickly and safely in the acute setting. Timely correction can prevent life-threatening arrhythmias.
Sodium matters too for blood pressure and fluid balance; sugar-driven diuresis removes sodium and water, which can produce dehydration and low blood pressure. As the body shifts water back into the bloodstream from tissues, measured sodium can appear diluted and low, causing dizziness, weakness or confusion. In serious cases, very low sodium may trigger seizures.
Treatment of sodium and fluid deficits centers on careful IV fluids, often saline, and insulin to address the root problem. Both elements work together to restore pressure, rehydrate tissues and normalize lab values. Medical teams adjust rates and solutions based on labs so the correction is safe and effective.
Preventing DKA is largely about being proactive: stick to treatment plans, check glucose often, and test for ketones when sugar is high or if you feel unwell. Illness, stress and missed insulin doses are common triggers, so increase monitoring during those times and talk with your doctor about sick-day rules. If you notice persistent nausea, vomiting, abdominal pain or trouble breathing, seek care right away; early intervention keeps DKA from spiraling.
