Diabetic ketoacidosis (DKA): symptoms, ketone levels and what to do

The NHS lists these symptoms, which usually develop over 24 hours but can be faster. Diabetes UK adds that passing out can occur, and that these symptoms are sometimes called a diabetic attack, a term that can also refer to other things such as hypoglycaemia.

• Feeling thirsty and needing to pee more often.

• Stomach pain, feeling sick or being sick, and diarrhoea.

• Breathing more deeply than usual.

• Breath that smells fruity, like pear drop sweets or nail polish remover.

• Feeling tired, sleepy or confused.

• Blurred vision.

Diabetes UK explains that without insulin the body cannot move sugar into the cells for energy, so it breaks down fat instead, releasing harmful chemicals called ketones. These build up and make the blood acidic, and a large build-up can make a person seriously ill very quickly.

The NHS says it usually affects people with type 1 diabetes. Diabetes UK says it is more likely in someone with type 1 diabetes, someone with any type who uses insulin, and people taking SGLT2 inhibitors, but it can also happen to other people on tablets or without a diagnosis. For some people, including children, DKA is how type 1 diabetes is first discovered.

Diabetes UK notes that people with type 2 diabetes may develop a different emergency, hyperosmolar hyperglycaemic state (HHS), rather than DKA.

The NHS says that if you have diabetes and any symptoms of DKA, check your blood glucose and, if it is high, test for ketones if you can. Diabetes UK says to check ketones if blood sugar is high (usually above 13) or you feel very unwell, and that a blood test shows ketone levels in real time while a urine test shows what they were a few hours ago.

The NHS stresses that these levels are a guide: normal blood ketone levels can be different for different people, and your diabetes care team will advise you what to look for.

The NHS says to call 999 or go to A&E if you have a high level of ketones (over 3mmol/L in blood or over 2+ in urine), if you do not know your ketone levels but have symptoms of DKA, or if you have symptoms and have not been diagnosed with diabetes. Do not drive yourself: ask someone to drive you or call 999, and bring any medicines you take.

The NHS says to call your diabetes care team now or get help from NHS 111 if your blood glucose is high and your insulin is not reducing it even if your ketones are normal, or if ketones are 0.6 to 1.5mmol/L and you feel unwell, or 1.6 to 3mmol/L even if you do not feel unwell.

The NHS says that if you have DKA you will be admitted to hospital for urgent treatment. You are given insulin, fluids and nutrients through a drip into a vein, and are monitored for complications because DKA can sometimes affect the brain, heart or lungs. Diabetes UK adds that the kidneys are also monitored.

You can go home once your ketones are at a safe level and you can eat and drink normally. The NHS says doctors will talk to you about what caused it and how to reduce the risk of it happening again. Diabetes UK says early signs can often be treated with extra insulin and fluids if picked up quickly.

The NHS lists being unwell, having an injury or surgery, having your period, or not taking enough insulin. Diabetes UK expands the list and says sometimes there is no obvious trigger, which can be worrying and confusing. If you suspect DKA, get medical help straight away.

• Illness such as a chest infection, flu or a urinary tract infection.

• High blood sugar from a growth spurt or puberty.

• Not taking insulin or missing doses.

• An insulin pump not working properly or becoming dislodged.

• Surgery or an injury.

• Having a heart attack or stroke.

• High blood sugar linked to having your period.

The NHS advises that you follow the treatment plan agreed with your diabetes care team, including adjusting insulin when you need to, check blood glucose regularly, ask about a continuous or flash glucose monitor, test for ketones when your glucose is high and when you are ill, and follow sick day rules. You can get ketone testing kit free from the NHS or buy it from a pharmacy.

Diabetes UK says sick day rules usually include drinking more sugar-free fluids, taking more insulin and checking blood sugars more often, with the extra insulin worked out with your team. It says to still contact your GP or diabetes team if you feel fine but have higher than usual readings, feel unwell with only slightly higher readings, or are being sick a lot. Share the symptoms with friends, relatives, teachers and childminders.

Diabetes UK says there is no screening for DKA because it develops very quickly rather than over a long time, so it is something to check for at home if you are unwell or your blood sugar is high.

DKA is an emergency dealt with through 999, A&E and hospital admission on the NHS. Your diabetes care team provides your plan, sick day rules and ketone testing equipment, and the NHS says ketone testing kit is available free.

Private diabetes clinics can offer reviews and advice on technology such as glucose monitors, but a suspected episode of DKA needs emergency care, not a private appointment. Ask any clinic to coordinate with your NHS diabetes team so your sick day plan is consistent.