Diabetic ketoacidosis (DKA) is a serious, life-threatening condition that occurs when the body doesn’t have enough insulin. Without sufficient insulin, the body cannot use glucose for energy and begins to break down fat instead. The process produces ketones, which, if accumulated in the bloodstream, can cause it to become acidic.
Common symptoms of DKA include increased thirst, frequent urination, stomach pain, nausea or vomiting, diarrhea, deep breathing, fruity-smelling breath, tiredness, confusion, and blurred vision. If left untreated, DKA can be fatal and requires immediate medical attention.
DKA is often triggered by illness, stress, growth spurts, puberty, or insufficient insulin intake. Monitoring ketone levels can help detect rising ketone levels and signal when medical help is needed.
Nearly 45% of Type 1 diabetes (T1D) diagnoses in children in Canada occur with DKA. Screening for T1D and educating those at risk about the disease’s signs and symptoms can help reduce DKA incidence at diagnosis.
It’s important to check ketone levels during illness, particularly when symptoms like vomiting, stomach pain, or fever are present, or when blood glucose is higher than target levels. Testing for ketones is also recommended before exercise, especially if blood glucose is elevated. Exercise can worsen high ketones and exacerbate hyperglycemia, increasing the risk of DKA.
Ketones can be checked using urine test strips or blood ketone meters. Blood ketone monitoring is preferred for its accuracy. Urine tests can provide inaccurate results due to delays in bladder storage, and urine test strips degrade over time. Always check expiration dates and discard strips older than six months.
Ketone levels can indicate the risk of DKA. Urine test strips will show levels ranging from negative to large, with higher levels signaling increased risk. Blood ketone meters provide numerical readings.
The following ranges are used for blood ketones:
- Less than 0.6 mmol/L is normal for T1D individuals.
- 0.6 to 1.5 mmol/L requires close monitoring. If ill, consult your diabetes care team.
- 1.5 to 3.0 mmol/L signals DKA risk. Immediate consultation with your care team is necessary.
- Over 3.0 mmol/L is an emergency, requiring immediate medical attention and possibly a trip to the emergency room.
If ketone levels are elevated, follow the treatment plan set with your diabetes care team. This typically involves increasing insulin and fluid intake.
Illness increases the risk of DKA in people with T1D. When the body is stressed by infection or illness, it releases stress hormones that can affect blood glucose. During illness, both blood glucose and ketone levels should be monitored every 2-4 hours to prevent complications.
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