What it means
Without enough insulin, cells cannot use glucose for fuel. The liver breaks down fat instead and releases ketones. At high levels, ketones make the blood too acidic. This is very different from the mild ketosis that can happen with low-carb eating in people without diabetes.
DKA is most common in type 1 diabetes but can happen in type 2 diabetes, and it is sometimes the first sign that someone has diabetes. Early signs include strong thirst and frequent urination. Later signs include fast deep breathing, fruity-smelling breath, nausea, vomiting, belly pain and extreme tiredness.
The CDC advises going to the emergency room or calling 911 if blood sugar stays at 300 mg/dL or higher, breath smells fruity, you cannot keep fluids down or you have trouble breathing.
People with diabetes who are ill or eating very little should follow their sick-day plan, including ketone testing when advised.
Why it matters
People who use insulin should not cut doses on their own when GLP-1 appetite loss sets in, so sick-day rules matter.
Related terms
Sources
Clinician review pending. Drafted from primary sources and waiting for sign-off by a licensed clinician (MD, DO or PharmD) before launch. Every number is checked against its source. Drug facts are re-checked quarterly, prices monthly and whenever a label changes. How we review · Report an error