(Diabetic Coma; Diabetic Ketoacidosis; DKA)
- Diabetes mellitus (type 1 and 2)
- New infection that may not be obvious (eg, pneumonia , urinary tract infection , sepsis )
- Not taking insulin as prescribed (eg, skipping doses) or not taking enough insulin
- New cardiovascular disease (eg, heart attack )
- New stroke
- Hemochromatosis —a condition in which the body builds up too much iron
- Hyperthyroidism —when the thyroid gland becomes overactive and produces too much thyroid hormone
- Pancreatitis —when the pancreas becomes inflamed
- Some medicines (eg, antipsychotics)
- Recreational drug use (eg, cocaine )
- High blood glucose levels (greater than 250 mg per dL)
- Dry mouth and skin
- Urinating often
- High ketone levels in urine
- Vomiting and nausea
- Severe stomach pain
- Trouble breathing
- Fruity breath odor
- Rapid pulse
- Blood test—to test for levels of glucose and acids in your blood as well as pH
- Urinalysis—your urine will be tested for ketones and infection
- Bacterial cultures—to test for infection in your blood
- Chest x-ray —to examine for pneumonia or cardiopulmonary disease
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- Take your diabetic medicines as recommended by your doctor.
- Discuss with your doctor the level of ketones that are dangerous for you.
- Monitor your ketone and blood sugar levels carefully.
If you use insulin, stock up on:
- Short-acting insulin
- Long-acting insulin
- Needles and syringes
- If you use an insulin pump, make sure you have extra infusion and connector sets as well as insulin syringes in case the pump does not work. The most common cause of hyperglycemia for a pump user is a problem with the tubing. This causes problems with insulin delivery.
- See your doctor if you have infection, cough, sore throat, or pain when you urinate.
If you are sick or your blood sugar levels are greater than 250 mg per dL:
- Check your blood sugar every 3-4 hours.
- Test your urine for ketones every 4 hours.
- If you are unable to eat, reduce your insulin dose. Talk with your doctor about the right dose.
- Take extra insulin if your blood sugar is high. Talk with your doctor about the right dose.
- Drink plenty of fluids (sugar-free and caffeine-free).
- If your blood sugar is greater than 250 mg per dL, eat foods that are low in carbohydrates.
American Diabetes Association http://www.diabetes.org/
National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/
Canadian Diabetes Association http://www.diabetes.ca/
Team Diabetes Canada Canadian Diabetes Association www.diabetes.ca/get-involved/supporting-us/team-diabetes
Charfen MA. Diabetic ketoacidosis. Emerg Med Clin North Am . 2005. 23(3):609-628.
Diabetic ketoacidosis (DKA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 25, 2010. Accessed May 25, 2010.
Trachtenbarg DE. Diabetic ketoacidosis: What it is and how to prevent it. Am Fam Physician . 2005 May1;71(9):1721-1722.
Wood D. Type 1 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 12, 2010. Accessed May 25, 2010.
- Reviewer: Bridget Sinnott, MD, FACE
- Review Date: 06/2012 -
- Update Date: 00/61/2012 -