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Diabetic ketoacidosis

DKA symptoms: What are the early signs of DKA?

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist
Updated Apr. 22, 2024  •  Published Apr. 10, 2023
Fact Checked
DKA symptoms

Overview: What does DKA feel like?

Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes mellitus. It’s a cascade of effects due to a lack of insulin in the bloodstream. People with Type 1 diabetes are most at risk. The single most common cause of diabetic ketoacidosis is missed doses of insulin. However, about 30% of cases are in people who didn’t know they had Type 1 diabetes. When there’s not enough insulin in the body, a series of problems occur. First, blood sugar gets very high. Fats get released into the blood and are turned into ketones. The kidneys start dumping too much water from the body. The blood becomes acidic and highly concentrated, so it pulls water out of the tissues. Potassium levels in the body go down. All these problems produce a wide variety of symptoms: extreme thirst, hunger, weight loss, fatigue, trouble breathing, and problems with the brain like confusion and sleepiness. At its worst, the cluster of issues due to a lack of insulin can result in loss of consciousness, coma, and death. If treated early, diabetic ketoacidosis can be quickly resolved with intensive hospital treatment.

RELATED: Type 1 vs. Type 2 diabetes: What’s the difference?

Key takeaways:

  • DKA is a rare health condition that mostly affects people with Type 1 diabetes or with ketosis-prone Type 2 diabetes.

  • Early signs of DKA include excessive thirst, excessive hunger, and frequent urination.

  • Serious symptoms of DKA, such as dehydration symptoms, abdominal pain, nausea, vomiting, weight loss, mental changes, loss of consciousness, and coma, may require immediate medical attention.

  • DKA is caused by a lack of insulin due to missed insulin shots, insulin pump failure, undiagnosed Type 1 diabetes, infection, injury, heart attack, prescription drugs such as corticosteroids, illicit drugs, and certain medical problems. You may be at an increased risk for developing DKA symptoms if you have Type 1 diabetes or ketosis-prone diabetes. Other risk factors include ethnicity, obesity, a family history of diabetes, or cocaine use. 

  • DKA usually requires a medical diagnosis.

  • DKA generally requires treatment. DKA symptoms usually resolve within 24 hours of treatment.

  • Treatment of DKA may include fluid replacement, insulin, potassium, and sodium bicarbonate. 

  • Untreated DKA could result in complications, such as swelling in the brain, electrolyte imbalances, kidney failure, heart problems, lung problems, respiratory failure, and death.

  • Save on prescriptions for DKA with a SingleCare prescription discount card.

What are the early signs of DKA?

Early signs of DKA are typically symptoms of hyperglycemia, such as excessive thirst, hunger, and frequent urination. 

RELATED: High blood sugar (hyperglycemia) symptoms: what are the early signs of high blood sugar?

Other DKA symptoms

DKA produces multiple problems in the body: high blood sugar, dehydration, electrolyte imbalances, and acidosis. For this reason, it has several different symptoms.

Symptoms of high blood sugar levels include:

  • Excessive thirst (in 98% of people with DKA)

  • Excessive urination (98%)

  • Excessive hunger (23%)

  • Blurred vision

  • Fatigue

Symptoms of high levels of ketones include:

  • Weight loss (81% of patients)

  • Abdominal pain (32%)

Symptoms of acidosis include:

  • Fatigue (in 61% of people with DKA)

  • Difficulty breathing (breathlessness) and rapid breathing (57%)

  • Nausea and vomiting (46%)

  • Fast heartbeat

  • A fruity smell on the breath 

  • Weakness

  • Loss of appetite

  • Confusion

  • Dizziness

  • Stupor

  • Coma

Symptoms of dehydration include:

  • Decreased urination

  • Headache

  • Fatigue

  • Dry mouth and eyes

  • Dry skin

  • Low blood pressure

About 41% of people with DKA will have a fever, chills, and other symptoms due to the underlying illness that may have triggered the crisis.

RELATED: Ketosis vs. ketoacidosis: compare causes, symptoms, treatments & more

DKA symptoms

DKA vs. HHS symptoms

DKA is very similar to hyperosmolar hyperglycemic state (HHS). While DKA most commonly affects people with Type 1 diabetes, HHS is primarily limited to people with Type 2 diabetes. They are both severe hyperglycemic crises. They differ in one respect: DKA results in high ketone levels and acidosis, but HHS does not. Otherwise, they’re very similar. They both have symptoms of high blood sugar and hyperosmolarity. “Hyperosmolarity” means that the blood is so concentrated with other stuff that it draws water out of the body’s tissues. This, combined with excessive urination, leads to severe dehydration, the defining characteristic of HHS. Hyperosmolarity is very bad. Along with severe dehydration, it is the principal cause of the most life-threatening complications of both DKA and HHS.

DKA HHS
Shared symptoms
  • Excessive thirst 
  • Excessive hunger 
  • Excessive urination 
  • Blurred vision
  • Tiredness
  • Weakness
  • Confusion
  • Lethargy
  • Loss of consciousness
  • Coma
  • Seizures
  • Dehydration symptoms
  • Fast heartbeat
  • Symptoms of an underlying infection such as fever or chills
Unique symptoms
  • Rapid onset of symptoms
  • Rapid breathing 
  • Nausea and vomiting 
  • A fruity smell on the breath 
  • Loss of appetite
  • Weight loss 
  • Abdominal pain 

RELATED: What is a dangerous level of blood sugar?

Types of DKA: How can I tell which one I have?

Healthcare professionals classify DKA as mild, moderate, or severe. All three of these classifications have high serum glucose levels and ketones in the blood and urine. The severity is determined by specific chemical properties of the blood and urine:

  • The acidity of the blood measured in pH

  • The concentration of bicarbonate in the blood

  • The balance of electrolytes in the blood

The worse these values, the more severe the condition. The only physical signs of the severity of DKA are mental changes. People with mild DKA are alert and conscious. Drowsiness is a sign of moderate DKA, and near-unconsciousness or coma is a sign of severe DKA.

When to see a doctor for DKA symptoms

Immediate medical care is needed if blood glucose levels rise to about 240 mg/dL or if there are any other symptoms of diabetic ketoacidosis. DKA can progress rapidly, so go immediately to an urgent care or emergency room.

DKA is diagnosed through a blood test. The four main criteria for a DKA diagnosis are:

  • Serum glucose higher than 250 mg/dL

  • Blood pH levels lower than 7.3

  • Ketones in the blood and urine

  • Bicarbonate in the bloodstream lower than 18 mEq/L

The blood test will also check the balance between electrolytes in the blood. This is called an anion gap test and can help determine the type of acidosis that is present.

Other blood, sputum, and urine tests will be required. An electrocardiogram will be performed to assess heart function. If an underlying infection is suspected, a chest X-ray may be needed.

RELATED: What are ketones, and why are they dangerous?

Complications of DKA

The most common complication of DKA is low blood sugar (hypoglycemia) as a result of treatment. The most serious complication of DKA is cerebral edema or swelling in the brain. Almost 1 in 4 people with DKA who develop cerebral edema will not survive. Other complications of DKA include:

How to treat DKA symptoms

DKA symptoms are usually treated in a hospital, emergency room, or intensive care unit. Treatment consists of fluid resuscitation, restoration of insulin levels, electrolyte replacement, and monitoring.

  • Fluid resuscitation Dehydration due to DKA could be severe and life-threatening, so the first order of business is to restore fluids intravenously.

  • Insulin therapy:The second order of business is to reduce blood sugar levels by restoring normal insulin levels. This will involve an intravenous insulin infusion. 

  • Electrolyte replacement: Potassium and often bicarbonate is administered to bring levels of these electrolytes back to normal. Some people may need magnesium or phosphate if those levels are low.

If an infection or other medical condition has triggered DKA, the healthcare team will treat that problem. Complications, such as cerebral edema, will also need treatment. Glucose and electrolyte monitoring will be required, along with ongoing monitoring for any possible complications of DKA or its treatment.

Signs DKA is getting better

With hospital care, DKA typically resolves in about a day, depending on the severity. This resolution can be determined by blood and urine test results. These will be regularly performed to monitor how well the treatment is working. According to the American Academy of Family Physicians, the signs that DKA has resolved include a blood sugar lower than 200 mg/dL, a blood pH in the normal range (above 7.3), and bicarbonate levels above 18 mEq/L. When that happens, patients can usually start drinking fluids and taking their normal insulin shots, though the insulin doses may be adjusted.

Most importantly, get immediate medical care

Diabetic ketoacidosis is a medical emergency that can rapidly progress to a life-threatening medical condition. If blood sugar is higher than 240 mg/dL or there are symptoms of DKA, get immediate medical care. The longer you wait, the worse the outcome. 

FAQs about DKA symptoms

What are the symptoms of non-diabetic ketoacidosis?

Non-diabetic ketoacidosis is rare. It’s primarily seen in people who are starving, but some people may experience it if they abuse alcohol, have severe hyperthyroidism, or are on an ultra-low-carbohydrate diet. Non-diabetic ketoacidosis has many of the same symptoms as diabetic ketoacidosis, but without the telltale signs of hyperglycemia, such as excessive thirst, hunger, urination, and blurred vision.

What is the most common early symptom of DKA?

The first signs of DKA tend to be high blood sugar symptoms. After all, high blood sugar typically starts the whole series of DKA health problems. The warning signs of overly high blood sugar are the “three P’s”: polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (extreme hunger).

Why does DKA cause confusion?

DKA can cause mental changes such as confusion, disorientation, drowsiness, and even loss of consciousness. These are all common symptoms of acidosis or acidic blood. The acidity affects how nerves function, so central nervous system problems are often the first signs that something is going wrong. 

What’s next? Additional resources for people with DKA symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist

Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.

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