DKA  is a medical emergency that should be treated in hospital.. It evolves quickly, over a period of 24 hours. If not adequately treated on time, it can result in coma or death. It is usually seen among type 1 diabetics.

DKA is an acute severe complication of diabetes where there is excess production of certain acids (ketones) in our blood along with hyperglycemia.

This happens either because of insulin deficiency or due to high levels of stress hormones ( like glucagon, cortisol, catecholamines etc) that reduces the action of insulin. Thus, there is increased production of glucose and decreased use of glucose resulting in hyperglycemia.

When the required insulin is low in order to allow glucose entry inside the cells for energy, our liver breaks down fat into a fuel called ketones, which makes the blood acidic.

Hence, the three features of DKA are : Hyperglycemia, Hyperketonemia (elevated levels of ketone bodies like acetoacetate, 3-beta hydroxybutyrate and acetone), Metabolic acidosis (an electrolyte imbalance in the body where there is increased acid level in the body fluids).

Many undiagnosed diabetics may present for the first time with DKA.

  • Inadequate insulin treatment or missed doses of insulin.
  • Infections
  • Stressful events like stroke, myocardial infarction, trauma.
  • Certain drugs
  • Extreme fasting
  • Diet modifications like ketogenic diet


  • Extreme thirst (polydipsia)
  • Frequent urination, including at night (polyuria)
  • Abdominal pain
  • Nausea and vomiting
  • Hypotension
  • Deep breathing with smell of acetone in breath (similar to fruity smell or nail polish remover).
  • Fast heartbeats (tachycardia)
  • Symptoms of dehydration like dry tongue, cracked lips, sunken eyes. Cold fingers and toes.
  • Blurred vision
  • Lethargy
  • Altered consciousness which may progress to coma.

These patients should be hospitalized and treated immediately with intravenous insulin infusions, fluid, electrolytes and correction of any other precipitating abnormalities.