Diabetic Ketoacidosis

Diabetic ketoacidosis is a very dangerous condition, which typically occurs in type 1 diabetes that is treated inadequately or not treated at all. Without medical help diabetic ketoacidosis can be fatal.


Diabetes type 1 is characteristic by inadequately low or even no production of insulin hormone in the pancreas (for details please read the related article). The condition must be treated by regular administration of insulin by special insulin pens or continuous administration by an insulin pump. Ketoacidosis is caused by the lack of insulin in the body. This leads to an increased release of glucose from the liver into the blood and to excessive release of free fatty acids from the adipose tissue. The majority of tissues are unable to process glucose and utilize its energy without the insulin and therefore they resort to an emergency way of obtaining the energy. This way of energy production uses the released fatty acids to produce ketone bodies (ketones). This metabolic pathway has two main disadvantages. Firstly, it produces less energy than glucose metabolism and in addition, the produced ketones cause acidification of the organism (lower pH). This acidity may a fatal complication.


The symptoms may develop gradually and they are often nonspecific – fatigue, weakness, loss of appetite, nausea, vomiting and sometimes the abdominal pain. High blood sugar causes glucose filtration in kidneys into urine. Sugar molecules in urine take the fluid and minerals with causing excessive urination, dehydration and thirst. The decrease of pH can cause symptoms such as weakness, vomiting, headache and later even unconsciousness and death.


Kussmaul breathing is a fairly common symptom of developing metabolic acidosis. It is a deep strenuous breathing that serves to exhale carbon dioxide in order to reduce the acidity.


The above mentioned clinical signs in a patient with type 1 diabetes are always very disturbing and lead to suspicion of developing ketoacidosis. We should do the blood test and at least basic urinalysis. In a classic situation we find hyperglycemia (elevated glucose serum level), glucose in urine and ketones in urine. Blood pH is lower than normal as we find signs of metabolic acidosis.


The therapy depends on the severity of the condition. It is advisable to hospitalize the patient in, check basic vital functions, ensure proper hydration and administrate insulin to lower the elevated blood sugar. The decrease of blood glucose level should not be too fast as it could cause a brain damage. With this careful therapy the internal environment can mend without further interventions. Only in cases of very severe acidosis we administer substances increasing pH (usually sodium bicarbonate).  

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources