Diabetic Ketoacidosis (DKA) is a frightening complication of diabetes, but fortunately it can be prevented. Monitoring ketones is the first step. So if you are living with Type 1 diabetes, NICE guidelines advise that you should have access to a blood glucose meter that can also test for ketones.

But what exactly is diabetic ketoacidosis? And how do you interpret ketone levels? The more you understand DKA, the easier it will be to recognize symptoms early on and the sooner precautions can be taken to prevent it from worsening.

What is diabetic ketoacidosis (DKA)?

When we eat carbohydrates, they are broken down by our bodies. The breaking down of carbohydrates results in glucose, which is then released into our bloodstream. Glucose is our principle source of energy, but in order to free this energy, glucose must be processed within our cells. Insulin acts as the key, allowing glucose to enter our cells.

When our cells are lacking glucose (e.g. because of an insulin deficiency), our body will start burning fat as an alternative source of energy. The breakdown of fat produces ketones. In people living with diabetes, high levels of ketones in the blood can lead to a dangerous condition known as diabetic ketoacidosis.

Diabetic ketoacidosis

How to prevent DKA?

It is important to recognize risk factors, higher-risk situations, and DKA symptoms. We have listed all 3 of them for you here:

Example risk factors are:

  • Fasting
  • Prolonged exercise
  • Pregnancy
  • Gastroenteritits
  • Having an infection, injury, or surgery
  • Alcohol intoxication
  • Illegal drug use

Higher risk situations are situations that require extra awareness and should trigger you to test for ketones:

  • During illness with fever and/or vomiting
  • When blood glucose values rise above 14 mmol/L (250 mg/dL)
  • When you are frequently urinating and have elevated blood glucose values (especially if combined with abdominal pains and rapid breathing)
  • Days where you do not manage to control your blood glucose and you have uncontrolled hyperglycemia

You can recognize DKA by the following symptoms:

  • Dry mouth, strong thirst
  • Urinating more than usual
  • Deep breathing, with a fruity smell/odor
  • Feeling nauseous, vomiting, and/or stomach pains
  • Feeling confused, being sleepy, and/or loss of consciousness

If you experience any of the above DKA symptoms, or if you encounter any higher-risk situation, you should contact your diabetes team and:

  • Test your blood glucose levels frequently (every 2 to 4 hours)
  • Test your blood ketone levels

This color chart will help you interpret your blood ketone test results:

     B-ketone test result Chart

Click here for an easy-to-print pocket reference of blood ϐ-ketone values. Keep it handy in your wallet or meter carrying case for quick reference!

Other considerations: 

  • It is important to stay hydrated (especially when you are ill), so remember to drink plenty of unsweetened fluids.
  • Do not stop taking your insulin under any circumstances. It is possible that you may need more insulin than you would normally administer.
  • If you are worried or if you have any questions, please contact your GP, practice nurse, or diabetes team.
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  2. Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State. Schumann C., Faust M.Dtsch Med Wochenschr. 2018 Mar;143(6)
  4. Blood ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis. Dhatariya K., et al., Rev Diabet Stud. 2016 Winter; 13(4):217-225.
  5. Diabetic Ketoacidosis: Risk Factors and Management Strategies, Umpierrez, G.E. & Kitabchi, A.E. Mol Diag Ther (2003) 2:95.
  6. Type 1 diabetes in adults: diagnosis and management, NICE guideline Aug. 2015
  7. Diabetes (Type 1 and Type 2) in children and young people: diagnosis and management, NICE guideline Aug. 2015