DKA Warning Signs
Go to A&E Immediately If You HaveBlood glucose >11 mmol/L PLUS ketones >1.5 mmol/L on home monitor | OR: Vomiting, deep rapid breathing (Kussmaul breathing), extreme thirst, fruity-smelling breath, confusion, or abdominal pain. Do not wait for symptoms to worsen.
The DKA Triad on Blood Tests
| Finding | DKA Values | Normal |
|---|---|---|
| Blood glucose | Usually >14 mmol/L (>250 mg/dL) | 4–7 mmol/L |
| Ketones (blood) | ≥3.0 mmol/L (severe) | <0.6 mmol/L |
| Bicarbonate | <18 mmol/L (low = acidosis) | 22–29 mmol/L |
| pH (arterial blood gas) | <7.35 (acidosis) | 7.35–7.45 |
| Potassium | Initially normal or high — falls with treatment | 3.5–5.0 mmol/L |
Common Triggers of DKA
- Missed insulin doses — most common trigger
- Infection (UTI, chest infection, flu) — increases insulin resistance
- New diagnosis of type 1 diabetes — presenting as DKA
- Insulin pump failure or disconnection
- Alcohol or drug use
- Certain medications (SGLT2 inhibitors can cause euglycaemic DKA at normal glucose)
Sick Day Rules for Type 1Never stop insulin when you're ill — even if you're not eating. Illness raises blood glucose and ketone production. Check blood glucose and ketones every 2 hours. Drink extra fluids. Take your background insulin. See your diabetes team's sick day rules leaflet.
Hospital Treatment Protocol
- IV fluid resuscitation — 1L normal saline over 1 hour
- Fixed-rate IV insulin infusion
- Potassium replacement (starts once K <5.5 and urine output confirmed)
- Hourly glucose and 2-hourly ketone monitoring
- Continue subcutaneous insulin when ketones <0.6 mmol/L and eating
Can type 2 diabetics get DKA?
Rarely — but yes, especially if on SGLT2 inhibitors (flozins) or during severe illness. SGLT2-inhibitor-associated DKA may occur at normal blood glucose ('euglycaemic DKA') — often misdiagnosed.
What is HHS (hyperosmolar hyperglycaemic state)?
HHS is a different emergency, mainly in type 2 diabetes. It involves very high glucose (>30 mmol/L) without significant ketosis. It has a higher mortality than DKA. Presents with severe dehydration and confusion.
How long does DKA treatment take?
Typically 24–48 hours in hospital. Resolution of DKA (glucose <14, ketones <0.6, pH normal) usually takes 12–24 hours. Transition back to subcutaneous insulin requires the patient to be eating.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.