What Is DKA? Diabetic Ketoacidosis Explained — And How to Catch It Early
DKA is one of the most serious acute complications of diabetes. Understanding what causes it, recognising the early warning signs, and knowing how to track your risk can make the difference between a manageable situation and a medical emergency.
Medical disclaimer
This article is for educational purposes only and is not a substitute for medical advice. If you suspect DKA, seek emergency medical attention immediately. Do not rely on this article or any app to manage a potential DKA emergency.
What is DKA?
Diabetic ketoacidosis (DKA) is a serious, potentially life-threatening condition that occurs when the body doesn't have enough insulin to allow glucose to enter cells for energy. Instead, the body breaks down fat for fuel, producing acids called ketones. When ketones build up faster than the body can process them, the blood becomes dangerously acidic.
DKA is most common in people with Type 1 diabetes, where the pancreas produces little or no insulin. It can also occur in people with Type 2 diabetes, particularly during illness, severe stress, or when insulin production is significantly impaired. It's one of the leading causes of hospitalisation and death among people with Type 1 diabetes.
What causes DKA?
The most common triggers include:
- Missed or insufficient insulin: The most common cause — a missed injection, pump failure, or dose error.
- Illness or infection: The body produces stress hormones during illness that counteract insulin, driving glucose up even if you haven't changed your dose.
- New diagnosis: Many people first present with DKA before their Type 1 diabetes is diagnosed.
- Pump failure: An insulin pump infusion set blockage or disconnection can cause DKA within hours, even without obvious high glucose initially.
Warning signs of DKA
Early recognition is critical. Symptoms typically develop over 24 hours:
High blood glucose (hyperglycaemia)
Usually above 14 mmol/L, though DKA can occur at lower levels in pump users.
Elevated blood ketones
Blood ketones above 1.5 mmol/L are cause for concern; above 3.0 mmol/L is a serious risk.
Excessive thirst and urination
The kidneys try to excrete excess glucose and ketones.
Nausea, vomiting, abdominal pain
A significant red flag — vomiting means you can't take in fluids, accelerating dehydration.
Fruity or acetone-smelling breath
Caused by the ketones being exhaled from the lungs.
Weakness, fatigue, confusion
As acidosis worsens, cognitive function is affected. Rapid deterioration is possible.
Rapid, deep breathing (Kussmaul breathing)
The body's attempt to compensate for acidosis by blowing off CO₂.
How ketone tracking and CGM data can help
The combination of sustained elevated glucose and rising ketones is the earliest warning signal for DKA — often appearing hours before overt symptoms. A CGM alone can't detect ketones, and a ketone meter alone doesn't show your glucose trajectory. Together, they give you the earliest possible warning.
GlucoHome's ketone tracking lets you log blood ketone readings and displays them alongside your CGM glucose data on a dual-axis chart. More importantly, it calculates a DKA risk score based on both values — flagging situations where the combination of your glucose level, ketone level, and the duration each has been elevated indicates a heightened risk.
GlucoHome DKA risk levels
Glucose and ketones are both within safe ranges.
One or both values are mildly elevated. Log again in 30–60 minutes. Check for causes.
Values are significantly elevated or have been elevated for an extended period. Contact your diabetes team.
Ketones are dangerously high or symptoms are present. Seek emergency care.
Note: GlucoHome's DKA risk scoring is a monitoring aid — it is not a medical device and not a substitute for clinical judgement. If you are unwell and have elevated ketones, seek medical attention.