6 Things to Know About Diabetic Ketoacidosis if You Are an Adult With Type 1 Diabetes

This article is for people who have type 1 diabetes (T1D), or anyone who wants to learn more about the risks of diabetic ketoacidosis (DKA) in adults with T1D. The goal of this activity is to increase your awareness of the risks for DKA and ways to manage it.

You will learn about:

• What DKA is

• Risks for DKA in adults with T1D

• Warning signs of DKA

• How to check your ketone levels

• Using “STICH” protocol for DKA

• When to ask for help

• What questions to ask your doctor

• DKA happens when there are too many ketones in your blood, which makes your blood too acidic.

  Diabetic = diabetes

  Keto = ketones

  Acidosis = too much acid in blood

So, what are ketones?

• If there isn’t enough insulin in your body, it can’t turn glucose (sugar) into energy, so your body will break down fat to use for energy instead. This process creates chemicals called ketones.

• If ketone levels get too high, you could develop DKA.

If you have T1D, it means that your body doesn’t make enough insulin, or just makes a small amount. This puts you at a higher risk for developing DKA.

We’ve learned so far that if you have T1D you are at a higher risk for DKA. Below are some other risk factors:

• Age: Older adults are more likely to have complications from diabetes, including DKA.

• Insulin-related factors:

  Cost – If the cost of insulin is keeping you from taking the amount your body needs, talk with your doctor about programs that can help you get the insulin you need.

  Missing insulin doses – If you forget to take your insulin, your blood sugar levels could be getting too high. When your diabetes isn’t well-controlled, you have a bigger chance of developing DKA.

  Using expired insulin – Expired insulin may not work as well as it should.

• Missing meals: Not eating regularly could cause your body to make more ketones.

Other causes of DKA include:

• Being sick or stressed – When you’re sick or under stress, your body makes more stress hormones. These hormones can keep insulin from working properly.

• Infections – Sicknesses such as urinary tract infections (UTIs or bladder infections) and pneumonia can lead to DKA.

• Heart attacks, strokes, and blood clots - Problems with your heart, lungs, and blood flow can cause DKA.

• Pregnancy – Being pregnant changes how your body processes sugar and other nutrients, making those who are pregnant and have diabetes at a higher risk for DKA.

• DKA typically forms slowly, so it’s important to know what symptoms to watch out for and when to call your doctor.

• Early symptoms of DKA

  o Being very thirsty or have a very dry mouth

  o Having to pee often

  o High blood sugar levels

  o High ketone levels in urine

• Other symptoms of DKA

  o Feeling weak or tired

  o Dry or flushed skin

  o Nausea, vomiting, or stomach pain. If you are vomiting for more than 2 hours, contact your doctor.

  o Trouble breathing

  o Breath that smells like fruit

  o Hard time paying attention, or feeling confused

• You can check for ketones by using a urine test strip, which is similar to a blood test strip. It's usually recommended to check for ketones in your urine when your blood sugar is over 200 mg/dl.

• When you're sick, like with a cold or the flu, it's a good idea to check for ketones every four to six hours.

• If you have any symptoms of DKA, it is especially important to check for ketones.

• Your doctor can tell you when and how often you should check for ketones.

The “STICH” protocol can be used if you have T1D and are taking a sodium-glucose cotransporter (SGLT) inhibitor. If your ketone levels are high or you’re feeling symptoms of DKA, always call your doctor first. Then you can talk with your doctor about how to follow the STICH steps:  

• STop SGLT inhibitor treatment – If you are taking an SGLT inhibitor, you should stop taking it until your ketone levels are back to normal.

• Insulin injection or a bolus (a dose of insulin taken to handle a rise in blood sugar) – Talk with your doctor to know how much insulin to take.

• Carbohydrates (30g or less) – It’s important to take the insulin with a small amount of food (1 slice of bread or 1 cup of cereal).

• Hydrate – Drinking water is important to flush out ketones. Adults should have one full 8-ounce glass of fluid every 30 to 60 minutes.

Contact your doctor if:

• You’re throwing up and can’t eat or drink anything without getting sick.

• Your blood sugar level is high.

• Your ketone level is high.

Seek emergency care if:

• Your blood sugar level is higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L).

• Your ketone level is high, and you cannot get in touch with your doctor.

• You’re experiencing rapid (quick) breathing.

• You’re slurring your words or feeling confused. 

• You’re experiencing symptoms of DKA.

• What’s important for me to know about DKA and my diabetes?

• How often should I check for ketones?

• What should I do when my ketone levels get too high?

• Where can I get urine test strips?

• If I miss one dose of insulin, should I test my blood sugar and ketone levels right away?

• For those taking an SGLT inhibitor - What do I need to know so I can use the STICH protocol?

Congratulations!

You have successfully completed the program 6 Things to Know About Diabetic Ketoacidosis if You Are an Adult with Type 1 Diabetes

View Additional Materials on this topic that you may find useful:

American Diabetes Association (ADA)

STICH Protocol