Diabetic ketoacidosis



Diabetic acidosis is a life-threatening condition that can occur in people with type 1 diabetes. Less commonly, it can also occur with type 2 diabetes.

Term watch

Ketones: breakdown products from the use of fat stores for energy.

Ketoacidosis: another name for diabetic acidosis.

It happens when a lack of insulin leads to:

  • high blood sugar levels
  • the presence of ketones in urine and blood
  • certain acids (known as ketoacids) in the blood.

Diabetic acidosis requires immediate hospitalisation for urgent treatment with fluids and intravenous insulin.


It can usually be avoided through proper treatment of Type 1 diabetes. However, ketoacidosis can also occur with well-controlled diabetes if you get a severe infection or other serious illness, such as a heart attack or stroke, which can cause vomiting and resistance to the normal dose of injected insulin.

What causes diabetic acidosis?

The condition is caused by a lack of insulin, most commonly when doses are missed.


While insulin's main function is to lower the blood sugar level, it also reduces the burning of body fat.

If the insulin level drops significantly, the body will start burning fat uncontrollably while blood sugar levels rise.

Glucose will then begin to show up in your urine, along with ketone bodies from fat breakdown that turn the body acidic.

The body attempts to reduce the level of acid by increasing the rate and depth of breathing. This blows off carbon dioxide in the breath, which tends to correct the acidosis temporarily (known as acidotic breathing).

At the same time, the high secretion of glucose into the urine causes large quantities of water and salts to be lost, putting the body at serious risk of dehydration.

Eventually, over-breathing becomes inadequate to control the acidosis.

What are the symptoms?

Since diabetic acidosis is most often linked with high blood sugar levels, symptoms are the same as those for diabetes but much more severe:

  • increased thirst
  • increased urination
  • tiredness
  • confusion
  • possible loss of consciousness when blood sugar levels become very high (diabetic coma).

Symptoms of acidosis are:

  • fast, deep breathing
  • a smell of acetone on your breath
  • nausea and vomiting
  • stomach pains.

Diabetic acidosis is often triggered by an infection, such as a urine or chest infection. It can develop in anything from a matter of hours to a few days, but it usually comes on very quickly.

How can I prevent diabetic acidosis?

Good advice

During serious illness more insulin is almost always necessary – especially if you have an infection with fever.

For this reason, make sure you measure your blood sugar level if you are ill.

If the level is high, take extra insulin.

But be careful not to take so much as to increase your risk of a hypo.

The best way to prevent diabetic acidosis from developing is to keep a tight control of blood sugar levels. Regular measurement with a home glucose monitor will help you do this.


You should always measure your blood sugar level when you feel unwell.

If your blood glucose level is too high you should check your urine for ketones using testing strips. Some blood glucose meters can check for blood ketones, which gives a more accurate assessment of possible acidosis.

Ketone-measuring urine strips go out of date very quickly, so they may not always detect ketones. If you detect ketones in your urine, and your blood glucose levels are also high, contact your doctor.

There are specific instructions around blood glucose/ketone monitoring and giving small amounts of insulin when you are ill. These are known as 'sick day rules'. It is important to discuss these with your diabetes specialist team and ideally to keep a copy of these at home. In general, you must continue your long acting insulin at all times, but your short acting insulin may need adjustment.

Gastritis and diabetic acidosis

Diabetic acidosis can often happen as a result of a stomach infection (gastritis).

This is because the symptoms of gastritis – nausea, vomiting and reduced eating – make you think less insulin is needed. And insufficient amounts of insulin can quickly lead to diabetic acidosis. As above, you must continue your long acting insulin at all times.

How do I know if I have diabetic acidosis?

The diagnosis is made by:

  • measuring your blood glucose level – this is usually in double figures and may be very high
  • measuring the level of ketones in your urine or blood. If they are present in moderate or heavy amounts, ketosis is present and acidosis is likely to occur
  • a blood sample taken from an artery – this is done in hospital and accurately measures the acidity of the blood.

At the same time, the doctor will look for the presence of an infection.

How is diabetic acidosis treated?


Because exercise can help diabetes, some people think it will help the symptoms of ketoacidosis.

In fact, exercise only makes things worse.

Diabetic acidosis is caused by a low insulin level and must be treated with insulin.

Diabetic acidosis is usually treated in hospital and sometimes in an intensive care unit.

Treatment consists of:

  • intravenous fluids, first with salt-containing fluids and then glucose fluids
  • intravenous insulin given with the fluids by seperate drip feed
  • potassium supplements added to the infusion
  • antibiotics if an infection is identified.

In the long term

If the diabetic acidosis is diagnosed and treated early, you should recover completely within a few days.

If the acidosis is not treated promptly, it will become life threatening.

Other people also read:

Type 1 diabetes (insulin-dependent diabetes): what are the symptoms of type 1 diabetes?


Based on a text by Dr Jan Erik Henriksen, Dr Ole Hother Nielsen, Prof Henning Bech-Nielsen

Last updated

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