High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

Diabetes Complications. Know the warning signs of DKA and check urine for ketones, especially when you're sick. What are the warning signs of DKA?

Early symptoms include the following: Thirst or a very dry mouth Frequent urination High blood glucose blood sugar levels High levels of ketones in the urine Then, other symptoms appear: Constantly feeling tired Dry or flushed skin Nausea, vomiting, or abdominal pain.

Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than two hours, contact your health care provider. Difficulty breathing Fruity odor on breath A hard time paying attention, or confusion.

More on ketones and DKA. How do I check for ketones? Also, check for ketones when you have any symptoms of DKA. What if I find higher-than-normal levels of ketones? Call your health care provider at once if you experience the following conditions: Your urine tests show high levels of ketones.

Your urine tests show high levels of ketones and your blood glucose level is high. Your urine tests show high levels of ketones and you have vomited more than twice in four hours. What causes DKA? Here are three basic reasons for moderate or large amounts of ketones: Not enough insulin Maybe you did not inject enough insulin.

Or your body could need more insulin than usual because of illness. Not enough food When you're sick, you often don't feel like eating, sometimes resulting in high ketone levels. High levels may also occur when you miss a meal. Insulin reaction low blood glucose If testing shows high ketone levels in the morning, you may have had an insulin reaction while asleep.

We're here to help. Follow any instructions you are given. It is likely that you will need to go to the hospital. There, you will receive insulin, fluids, and other treatment for DKA. Then providers will also search for and treat the cause of DKA, such as an infection.

Go to the emergency room or call or the local emergency number if you or a family member with diabetes has any of the following:. If you have diabetes, learn to recognize the signs and symptoms of DKA.

Know when to test for ketones, such as when you are sick. If you use an insulin pump, check often to see that insulin is flowing through the tubing.

Make sure the tube is not blocked, kinked or disconnected from the pump. Atkinson MA, Mcgill DE, Dassau E, Laffel L.

Type 1 diabetes. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; chap ElSayed NA, Aleppo G, Aroda VR, et al.

Classification and diagnosis of diabetes: standards of care in diabetes Diabetes Care. PMID: pubmed. Maloney GE, Glauser JM. Diabetes mellitus and disorders of glucose homeostasis. In: Walls RM, Hockberger RS, Gausche-Hill M, Erickson TB, Wilcox SR, eds.

Rosen's Emergency Medicine: Concepts and Clinical Practice. Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.

Editorial team. Diabetic ketoacidosis. DKA happens when the signal from insulin in the body is so low that: Blood sugar glucose can't go into cells to be used as a fuel source.

The liver makes a large amount of glucose. Fat is broken down too rapidly for the body to process. Common symptoms of DKA can include: Decreased alertness Deep, rapid breathing Dehydration Dry skin and mouth Flushed face Frequent urination or thirst that lasts for a day or more Fruity-smelling breath Headache Muscle stiffness or aches Nausea and vomiting Stomach pain.

Exams and Tests. Ketone testing is usually done when DKA is suspected: Most often, urine testing is done first. If the urine is positive for ketones, most often a ketone called beta-hydroxybutyrate is measured in the blood.

This is the most common ketone measured. The other main ketone is acetoacetate. Other tests for ketoacidosis include: Arterial blood gas Basic metabolic panel , a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions, including the anion gap Blood glucose test Blood pressure measurement Osmolality blood test.

Outlook Prognosis. Most people respond to treatment within 24 hours.

Develop and improve services. Use limited data to select content. List of Partners vendors. Health Conditions A-Z Endocrine Diseases Type 1 Diabetes. By Amanda Gardner. Medically reviewed by Isabel Casimiro, MD, PhD. Isabel Casimiro, MD, PhD, is an endocrinologist at the University of Chicago in Illinois.

As a physician-scientist in molecular biology, she uses her research on diabetes, lipid disorders, cardiovascular function, and more to provide comprehensive care to her patients.

Her research findings have been published in several scientific and medical journals, including Cell Metabolism and the Journal of the Endocrine Society.

Casimiro also has extensive experience providing gender-affirming hormone therapy and improving education regarding transgender medicine for endocrinology fellows. Her work with transgender patients has been published in the Journal of the Endocrine Society and Transgender Health.

Casimiro also serves on graduate and medical school program committees and is a clinical instructor at the University of Chicago. Casimiro received her PhD in biomedical research from the Albert Einstein College of Medicine and her medical degree from the University of Washington.

She completed her internal medicine residency and endocrinology fellowship through the Physician Scientist Development Program at the University of Chicago. She is board-certified in internal medicine. learn more. Trending Videos. What Is Gestational Diabetes? Was this page helpful?

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Related Articles. Newsletter Sign Up. Diabetic ketoacidosis. DKA happens when the signal from insulin in the body is so low that: Blood sugar glucose can't go into cells to be used as a fuel source. The liver makes a large amount of glucose. Fat is broken down too rapidly for the body to process.

Common symptoms of DKA can include: Decreased alertness Deep, rapid breathing Dehydration Dry skin and mouth Flushed face Frequent urination or thirst that lasts for a day or more Fruity-smelling breath Headache Muscle stiffness or aches Nausea and vomiting Stomach pain.

Exams and Tests. Ketone testing is usually done when DKA is suspected: Most often, urine testing is done first. If the urine is positive for ketones, most often a ketone called beta-hydroxybutyrate is measured in the blood.

This is the most common ketone measured. The other main ketone is acetoacetate. Other tests for ketoacidosis include: Arterial blood gas Basic metabolic panel , a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions, including the anion gap Blood glucose test Blood pressure measurement Osmolality blood test.

Outlook Prognosis. Most people respond to treatment within 24 hours. Sometimes, it takes longer to recover. If DKA is not treated, it can lead to severe illness or death.

Possible Complications. Health problems that may result from DKA include any of the following: Fluid buildup in the brain cerebral edema Heart stops working cardiac arrest Kidney failure.

When to Contact a Medical Professional. DKA is a medical emergency. Contact your provider if you notice symptoms of DKA. Go to the emergency room or call or the local emergency number if you or a family member with diabetes has any of the following: Decreased consciousness Fruity breath Nausea and vomiting Trouble breathing.

Alternative Names. Food and insulin release Oral glucose tolerance test Insulin pump. Learn how to cite this page. Related MedlinePlus Health Topics. Diabetes Complications Diabetes Type 1 Hyperglycemia. Your breath smells fruity.

You have multiple signs and symptoms of DKA. Your treatment will likely include: Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood. Replacing electrolytes minerals in your body that help your nerves, muscles, heart, and brain work the way they should.

Too little insulin can lower your electrolyte levels. Receiving insulin. Insulin reverses the conditions that cause DKA. Taking medicines for any underlying illness that caused DKA, such as antibiotics for an infection.

Keep your blood sugar levels in your target range as much as possible. Take medicines as prescribed, even if you feel fine. Learn More. Learn About DSMES Living With Diabetes 4 Ways To Take Insulin Low Blood Sugar Hypoglycemia. Last Reviewed: December 30, Source: Centers for Disease Control and Prevention.

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