Diabetic ketoacidosis: Symptoms and treatment

Managing diabetes is an important part of everyday health. What may be less well known is that when people feel they’re not prepared to manage diabetes across different situations, it can lead to serious health effects that extend beyond high or low glucose levels. One of the most serious of these complications is diabetic ketoacidosis, or DKA.

Recognizing the symptoms of DKA early and knowing when to seek medical care can make a critical difference. Here's what you need to know.

What is diabetic ketoacidosis?

DKA happens when your body doesn’t have enough insulin. Insulin acts like a key, allowing glucose to enter your cells so they can produce energy. Without enough insulin – without that key – glucose can’t get into your cells. Instead, your body starts breaking down fat for energy. This process produces ketones. When too many ketones build up, they can make your blood acidic and lead to DKA, a serious condition that can cause coma or even death if not treated quickly.¹

DKA can occur in both Type 1 and Type 2 diabetes, though it’s more common in Type 1.²

What are the symptoms of diabetic ketoacidosis?¹

If you have diabetes, keep an eye out for the following symptoms of rising ketones and early DKA:

• Excessive thirst.
• Having to urinate frequently.
• Vomiting or feeling nauseated.
• Stomach pain.
• Fatigue, or feeling weak or very tired.
• Trouble breathing.
• Fruity-smelling breath.
• Confusion.
• Elevated blood sugar.
• Elevated ketone levels in the urine.

When left unaddressed, elevated ketone levels can increase quickly — sometimes within hours — making it important to seek medical attention as soon as symptoms appear.³

Ketones have traditionally been checked using urine test strips or blood ketone meters. While these methods can provide useful information, they rely on reactive, manual testing, and only offer a snapshot at a single point in time. Many experts advise checking for ketones when your glucose levels are greater than or equal to 250 mg/dL.⁴

However, it’s important to note that DKA can occasionally occur even when glucose levels are near normal, a condition known as euglycemic DKA. This may happen during illness, prolonged fasting or when taking certain medications – making symptom awareness and ketone monitoring especially important. Ask your healthcare provider for a guide on when and how you should check for ketones.⁵

As understanding of DKA risk grows, so does interest in ways to monitor ketones more proactively. Biowearables will soon offer another option to detect ketones. Abbott’s Libre Duo sensing technology, which received CE Mark, is the world’s first to continuously measure glucose and ketones in a single sensor.* While not yet cleared in the U.S. or available for purchase, the Libre Duo systems will eventually give people living with diabetes an opportunity they haven’t had before: the ability to monitor ketones without blood or urine tests. This matters for diabetes management because earlier awareness of rising ketone levels can help reduce the risk of a DKA emergency.⁵

When should you seek medical care for diabetic ketoacidosis?

DKA is a medical emergency. Seek medical care right away if you experience symptoms of DKA, which may include:

• Nausea and vomiting.
• Abdominal pain.
• Rapid or heavy breathing.
• Confusion or difficulty concentrating.
• Extreme fatigue.
• Fruity-smelling breath.
• Excessive thirst or very dry mouth.
• Flushed skin.

Seeking medical care early can minimize the serious effects of diabetic ketoacidosis, which could include coma or death, according to the American Diabetes Association.¹

To make a diagnosis, your healthcare provider will check glucose levels, ketones and electrolyte levels, according to Harvard Health.⁶ They may also check for an infection. If they determine you have DKA, treatment is typically provided in an emergency room or hospital setting, where you can receive intravenous (IV) fluids, insulin therapy and close medical monitoring.

Diabetic ketoacidosis is a serious but preventable complication of diabetes.⁷ Learning to recognize the warning signs and working with your healthcare provider on a DKA plan can help you respond quickly and confidently if symptoms arise. 

References

¹American Diabetes Association. (n.d.). Diabetes & DKA (ketoacidosis). https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones

²Umpierrez, G., Davis, G.M., ElSayed, N.A., Fadini, G.P., Galindo, R.J., Hirsch, I.B., Klonoff, D.C., McCoy, R.G., Misra, S., Gabbay, R.A., Bannuru, R.R., & Dhatariya, K.K. (2024). Hyperglycemic crisis in adults with diabetes: a consensus report. Diabetes Care, 47(8), 1257-1275. https://doi.org/10.2337/dci24-0032.

³Mayo Clinic. (2025, July 25). Diabetic ketoacidosis. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

⁴American Diabetes Association (n.d.). Managing ketones with diabetes. https://diabetes.org/living-with-diabetes/managing-ketones 

⁵Dhatariya, K., Bergenstal, R.M., Al-Sofiani, M., Albanese-O'Neill, A., Battelino, T., Close, K., De Block, C., Heverly, J., Kruger, D., Laffel, L.M., Lally, J., Maahs, D.M., Maffeis, C., Mathieu, C., Miller, E., Munshi, M., Nishimura, R., Nørgaard, K., Oron, T., ... Danne, T. (2026). Continuous ketone monitoring for people with diabetes: international expert recommendations on the application of a new technology. Lancet Diabetes & Endocrinology, 14(1), 82-92. https://doi.org/10.1016/S2213-8587(25)00331-6 

⁶Harvard Health. (2026, January 29). Diabetic ketoacidosis. https://www.health.harvard.edu/a_to_z/diabetic-ketoacidosis-a-to-z 

⁷Nguyen, K.T., Xu, N.Y., Zhang, J.Y., Shang, T., Basu, A., Bergenstal, R.M., Castorino, K., Chen, K.Y., Kerr, D., Koliwad, S.K., Laffel, L.M., Mathioudakis, N., Midyett, L.K., Miller, J.D., Nichols, J.H., Pasquel, F.J., Prahalad, P., Prausintz, M.R., Seley, J.J., ... Klonoff, D.C. (2022). Continuous ketone monitoring consensus report 2021. Journal of Diabetes Science and Technology, 16(3), 689-715. https://doi.org/10.1177/19322968211042656 

* Based on current, publicly available information.

Images for illustrative purposes only.

This article has been updated and was originally published Nov. 13, 2018.