DKA Quick Reference (Type 1 Diabetes)

Intro

Diabetic ketoacidosis (DKA) is a medical emergency caused by insufficient insulin leading to high blood glucose and acidic blood. It develops over hours and needs urgent hospital treatment.

Key Points

Think DKA if high glucose + positive ketones + symptoms (nausea/vomiting, abdominal pain, deep breathing, dehydration).
Do not delay: give correction insulin, drink fluids, and seek urgent care if ketones remain high or you’re vomiting.
Pump users: suspect site/tubing failure first.

Red Flags — Go to ED Now

Blood ketones ≥3.0 mmol/L (or moderate/large urine ketones).
Persistent vomiting, severe abdominal pain, drowsiness/confusion, fast/deep breathing (Kussmaul), fruity breath, or unable to keep fluids down.
Child, pregnancy, or significant illness → lower threshold to attend ED.

Home Assessment (If Not Yet in Distress)

Check glucose and blood ketones (preferred) or urine ketones.
Hydrate: small frequent sips of water/electrolytes.
Inspect pump (if using): check site, tubing, occlusions; change set and give a pen/syringe correction if needed.

Quick Action Table

Situation	What to do at home (while arranging care)
Glucose >13.9 mmol/L (>250 mg/dL) and ketones 0.6–1.4	Take correction insulin per plan; drink fluids; recheck ketones in 1–2 h.
Ketones 1.5–2.9	Extra insulin per sick-day plan (often 10–20% of total daily dose or 0.1 u/kg; follow your clinician’s plan); fluids; recheck hourly.
Ketones ≥3.0 or any vomiting/abdominal pain/drowsiness	ED now. Give correction insulin if advised, do not delay travel.

Always follow your personalized sick-day rules; numbers above are common frameworks but vary by clinic.

Common Triggers

Missed insulin doses or pump/site failure.
Infection/illness, dehydration.
New-onset type 1 diabetes.

In the Emergency Department — What to Expect

Blood tests: glucose, ketones, electrolytes, blood gases.
IV fluids, insulin infusion, and electrolyte (potassium) replacement.
Treatment of underlying cause (infection, pump failure).
Frequent monitoring until ketones clear and you can switch to usual insulin.

Prevention

Sick-day plan written and accessible.
Keep backup pens/syringes even if you use a pump.
Check ketones whenever glucose is high and you feel unwell.
Change infusion sets regularly; carry spares and inspect for leaks.

FAQ

Can I exercise to lower high glucose with ketones?
No. Exercise can worsen ketones when insulin is low.

I took a correction but ketones won’t drop.
Suspect pump/site failure—inject with a pen/syringe and seek care.

Does DKA happen in type 2?
Less common, but possible—especially in ketosis-prone T2 or with SGLT2 inhibitors (then called euglycaemic DKA).