Diabetic Ketoacidosis: Causes, Symptoms, and Treatment

Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.

What kind of doctor treats Diabetic Ketoacidosis?

An endocrinologist, a doctor who treats diabetes and other hormone problems, often cares for people at risk of diabetic ketoacidosis (DKA). DKA itself is treated in the emergency room or the hospital. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It develops when your body does not have enough insulin to let blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, which makes acids called ketones. When too many ketones are made too fast, they can build up to dangerous levels in your body. DKA is most common among people with type 1 diabetes.

Symptoms

DKA usually develops slowly. Early symptoms include being very thirsty. Another early symptom is urinating a lot more than usual. If DKA is not treated, more severe symptoms can appear quickly, such as:

  • Fast, deep breathing.
  • Dry skin and mouth.
  • A flushed face.
  • Fruity-smelling breath.
  • Headache.
  • Muscle stiffness or aches.
  • Nausea and vomiting.
  • Stomach pain.
  • Decreased alertness.

Sometimes DKA is the first sign of type 1 diabetes in people who have not yet been diagnosed.

Causes and who gets it

Very high blood sugar and low insulin levels lead to DKA. The two most common causes are illness and missed or wrong insulin.

  • Illness, which can make it hard to eat or drink as much as usual and hard to manage blood sugar.
  • Missing insulin shots, a clogged insulin pump, or the wrong insulin dose.

Other causes include heart attack or stroke. A physical injury or alcohol or drug use can also cause DKA. Certain medicines, such as some diuretics (water pills) and corticosteroids, can also cause DKA. The stress of surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA.

How doctors diagnose it

If you have diabetes and you are sick, or your blood sugar is 250 mg/dL or above, check your blood sugar every 4 to 6 hours and check your urine for ketones. Ketone test kits are sold over the counter. Elevated ketones are a sign of DKA. Doctors most often test urine first. If the urine has ketones, they most often measure a ketone called beta-hydroxybutyrate in the blood. Other tests include a blood glucose test. A basic metabolic panel is a group of blood tests that measure sodium, potassium, and kidney function.

Treatment

If you have DKA, you will be treated in the emergency room or admitted to the hospital. Treatment replaces fluids you lost through frequent urination. It also replaces electrolytes, which are minerals in your body. You will also receive insulin, which reverses the conditions that cause DKA. Providers also treat any illness that caused DKA, such as an infection. Most people respond to treatment within 24 hours, but sometimes it takes longer to recover.

When to see a doctor

DKA is a medical emergency. If you have diabetes and think you have DKA, test for ketones. If ketones are present, contact your provider right away and do not delay. Go to the emergency room or call 911 right away if:

  • Your blood sugar stays at 300 mg/dL or above.
  • Your breath smells fruity.
  • You are vomiting and cannot keep food or drinks down.
  • You have trouble breathing.
  • You have decreased consciousness.
  • You have more than one sign or symptom of DKA.

How a direct primary care or concierge doctor fits in

A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This kind of doctor can help you plan how to adjust your insulin when you are sick, and can refer you to an endocrinologist. DKA itself needs emergency care, not a routine visit.

Common questions

Is diabetic ketoacidosis an emergency?

Yes, DKA is a medical emergency. It needs to be treated immediately.

Can DKA happen in people with type 2 diabetes?

Yes, it can, though it is most common in people with type 1 diabetes.

Can diabetic ketoacidosis be prevented?

Yes, you can take steps to help prevent it. Check your blood sugar often, especially if you are sick, and keep it in your target range as much as possible. Take your medicines as prescribed, even if you feel fine. If you use an insulin pump, check often that insulin is flowing through the tubing.

What happens if DKA is not treated?

It can lead to severe illness or death. Problems from DKA can include fluid buildup in the brain, a heart that stops working, and kidney failure.

How long does it take to recover from DKA?

Most people respond to treatment within 24 hours. Sometimes recovery takes longer.

Sources

  1. MedlinePlus - Diabetic ketoacidosis
  2. Centers for Disease Control and Prevention - Diabetic Ketoacidosis

Medical Disclaimer

This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.