Diabetic ketoacidosis: why does it happen and what are the risks?

Care with the treatment of diabetes is essential, as it avoids complications and health risks. One of these risks is diabetic ketoacidosis, an emergency condition.

Although it is more common in patients with type 1 diabetes, it can also occur in other types. So it is important to know about the condition and to know how to avoid it:

What is diabetic ketoacidosis?

Incorrect diabetes control can trigger several health risks, including diabetic ketoacidosis. The condition is characterized by an increase in glucose (blood sugar) accompanied by an increase in ketones, which are acidic substances responsible for the balance of blood pH.

One of the most easily observable signs of diabetic ketoacidosis is the odor of acetone, or acid, in the mouth – but since it is not always easy to smell your own body, it is more common for other people to notice this.

It is more common in people with type 1 diabetes (also known as juvenile or insulin dependent), but it can also happen in people who have type 2 diabetes.

The condition is considered a medical emergency, and at the first signs it is essential to go to the hospital. There are several causes involved, but neglect of glycemic control is one of the main factors.

In addition, problems with the insulin cannula (for patients using the pump), alcohol abuse, use of some medications or even infections or health problems may be involved.

To detect the condition, tests that look for ketone bodies in the blood and urine can be done, in addition to measuring the glycemic rate. Thus, the diagnosis is made when:

  • Serum glucose: above 250 mg / dl;
  • arterial pH: below 7.3;
  • Serum bicarbonate: below 18 mEq / l;
  • Ketonuria (ketones in the urine) and / or ketonemia (ketones in the blood).

Read more: What is the normal value of Glucose?

Why does someone with diabetes have ketone breath?

Not necessarily those who have diabetes will have that acid breath, which resembles the smell of acetone. But when this happens, it is indicative that the blood glucose is decompensated.

That is, by making a correction of the treatment or identifying the factor that is impairing the proper control of blood sugar (it may be the use of some medicine or even some other disease), this ketone odor of the breath disappears.

What are blood ketones?

Ketones or ketone bodies are products of the transformation of lipids into glucose. Glucose (or blood sugar) is a source of energy for the body. Then, after eating, the body’s carbohydrates are transformed into sugars and released into the bloodstream.

There is, at that time, the release of the hormone insulin, which makes glucose enter the cells and, consequently, regulating the glycemic rate.

Thus, when some condition in the body prevents or makes it difficult for glucose to enter cells, the body seeks other ways of not running out of energy. So, if the person with diabetes does not regularly inject insulin, for example, the sugar is concentrated in the blood and the body understands that there is not enough energy.

Then it uses the breakdown of lipids in energy, but this process results in ketone bodies, which alter the pH of the blood and, therefore, are toxic to the body.

Why does ketoacidosis happen?

Ketoacidosis occurs when the body uses the breakdown of lipids to obtain energy, but there are some conditions that can trigger this mechanism. In patients with diabetes, the factors that are usually related are a lack of insulin delivery or an obstruction of the insulin pump cannula.

In addition, other triggering factors may be:

  • Prolonged fasting;
  • Use of medications such as corticosteroids, adrenergic agonists, phenytoin, beta-blockers, antipsychotics;
  • Use of drugs, such as alcohol, cocaine;
  • Acute diseases: urinary and pulmonary infections, flu, myocardial infarction, digestive hemorrhage, among others;
  • Endocrine disorders: pheochromocytoma, hyperthyroidism, acromegaly;
  • Lack of hydration: lack of fluid intake or excessive sweating.

What are the symptoms?

In general, ketoacidosis is marked by ketone breath, that is, it refers to that smell of acetone. However, it is necessary to pay attention to other symptoms that may indicate the condition. This is important because the person is not always able to notice the acid smell, which tends to prolong the time for diagnosis and bring risks to the person.

So, in addition to the smell of acetone, some signs and symptoms that may be present in diabetic ketoacidosis are:

  • Excessive thirst;
  • Increase from urine;
  • Weakness and dizziness;
  • Sickness;
  • Vomiting;
  • Fever or drop in temperature;
  • Low pressure;
  • Feeling faint;
  • Mental confusion;
  • Slowness of reasoning;
  • Somnolence;
  • Tachycardia;
  • Difficulty breathing or wheezing;
  • Extreme tiredness;
  • Abdominal pain or tenderness.

Tests: How to measure blood ketones?

There are some devices, similar to a glucometer, that patients with diabetes may have at home. They are able to measure the rate of ketones in the blood by means of a drop of blood.

Among them is the FreeStyle Libre Starter Kit .

At the hospital or in laboratories the test is done with a blood sample as well. In such cases, it can be called:

  • Serum ketones;
  • Cetonas no plasma;
  • Beta-hydroxybutyrate;
  • Ketone bodies;
  • Beta-hydroxybutyric acid;
  • Acetoacetato;
  • Acetoacetic acid;
  • Acetone.

How to deal with?

The treatment of diabetic ketoacidosis consists of hydration and strict glycemic control in all cases. According to the clinical picture, electrolyte replacement may be necessary.

These are the emergency management to normalize the condition of ketoacidosis, but to avoid new occurrences, glycemic control is essential.

Therefore, if the condition is occurring frequently, it is worth reevaluating insulin applications, consulting nutritionists and observing the practice of physical activities. It is also important to see if there are no infections or other associated conditions.

Is diabetic ketoacidosis dangerous?

Yes. If detected and treated quickly, diabetic ketoacidosis has a good prognosis. In a short time, patients are able to stabilize their condition and return to their normal routine.

However, it is still necessary to pay attention, as soon as about 5% of the episodes can progress to severe complications and death, although they are usually the result of secondary conditions, such as sepsis or cerebral edema .

Can it cause coma?

Yes, even though the prevalence is not that high. Diabetic coma occurs when brain function is affected, either by high or low blood glucose. During ketoacidosis, cerebral edema can occur, which is nothing more than a swelling in the brain. In these cases, it occurs because of the rapid change in blood glucose, triggered by treatment.


Diabetic ketoacidosis is a serious condition that involves risks to the health and life of patients. The best way to prevent the condition is to maintain glycemic control and do strict medical follow-up.

Find out more about diabetes care at Minute Healthy!

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