DKA – What You Need to Know

Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q – My doctor told me I needed to do ketone testing. What is it, how is it done and why is it important?

A – When you live with diabetes, there’s a lot to juggle. It can be understandable if your eyes glaze over when your physician or diabetes educator mentions ketone testing (another test!), but here’s why you should take this part of your treatment plan seriously:

Ketones are acid molecules generated when we burn fat for energy. This isn’t a problem as long as it doesn’t happen in excess. When you flood your body with too many acids, it starts to become toxic. Combined with dehydration and high blood glucose levels, it can lead to a life-threatening condition called diabetic ketoacidosis (DKA).

Often, DKA can occur when you’re not able to get enough glucose into your cells to burn as energy, and the body relies almost exclusively on fat for fuel. This can occur for a number of reasons:

Illness and infection (which can cause intense insulin resistance and elevated blood sugar)
A lack of insulin in the body (due to missed injections, spoiled insulin, or poor absorption)
Insulin pump malfunctions (clogs, leaks, air pockets, cannula displacement, prolonged
disconnection, failure to prime the tubing, or accidentally erasing the basal settings)

This is very different than nutritional ketosis, which is caused by starvation, prolonged fasting, or a severe lack of carbohydrates in one’s diet.

Like most health problems, ketones develop in stages:

Stages Characteristics Symptoms
Stage 1 Rising blood sugar (due to one of the reasons listed above) Thirst, urination, low energy
Stage 2 Ketones in the blood stream (ketosis) Thirst, urination, fatigue and Charaachiness
Stage 3 Ketones in the Urine (ketonuria) Thirst, urination, plus more significant fatigue, headache/body aches, and possible nausea
Stage 4 Diabetic Ketoacidosis (DKA) Same as above, plus vomiting, discomfort, confusion, dizziness, deep/labored breathing and a “fruity” smell to the breath
Stage 5 Coma Unconsciousness
Stage 6 Death

Ketones should be checked any time you experience an unexplained high blood sugar or feel ill. In many instances, you will not be ketotic when you test, but sometimes you might. Just remember that detecting ketones at the earliest possible stage allows you to fix the problem and avoid prolonged periods of high blood sugar, extreme discomfort, and possible progression to the more dangerous stages.

In most cases, ketones can be eliminated by taking extra insulin (via pen or syringe) and taking in plenty of fluids. You should notify your doctor when ketones are present, and exercise should not be performed until the ketones clear up completely.

Ketone testing can be done by way of a urine dipstick or a fingerstick blood sample. The urine test involves peeing on a test strip (or dipping the strip in a cup of urine) and observing the color change. The blood test can be performed with special ketone test strips using the Precision Xtra meter from Abbott, or the NovaMax Plus meter from Nova Biomedical. It is much like performing a blood sugar test, except that a ketone measurement is given. The blood test is a better way to check for ketones, since it provides a specific numerical measurement and detects ketones hours before they appear in the urine.

No one likes to do even more testing, but everyone with diabetes who uses insulin should have a way to test for ketones. DKA can quickly become a downward spiral when untreated, so it’s vital that you catch it and treat it as early as possible.

Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and online for children and adults. Integrated Diabetes Services offers specialized services for insulin pump and continuous glucose monitor users, athletes, pregnancy & Type 1 diabetes, and those with Type 2 diabetes who require insulin. For more information, call 1-610-642-6055, go to or write

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Jennifer Smith holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a registered and licensed dietitian, certified diabetes educator, and certified trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. She has lived with Type 1 diabetes since she was a child,and thus has first-hand knowledge of the day-to-day events that affect diabetes management.

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