People with diabetes lack sufficient insulin, a hormone the body uses to process glucose (a simple sugar) for energy. When glucose is not available, body fat is broken down instead. The by-products of fat metabolism are ketones. When fat is metabolized, ketones build up in the blood and "spill" over into the urine. A condition called ketoacidosis develops when the blood becomes more acidic than body tissues.

Blood glucose levels become elevated (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem and because cells cannot take up that glucose without insulin. Diabetic ketoacidosis may lead to the initial diagnosis of type 1 diabetes, as it is often the first symptom that causes the person to come to medical attention. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases.

People with type 2 diabetes usually develop ketoacidosis only under conditions of severe stress. Poor compliance with diet and treatment is usually the cause when episodes are recurrent.

• Frequent urination or frequent thirst for a day or more
• Fatigue
• Nausea and vomiting
• Muscular stiffness or aching
• Mental stupor that may progress to coma
• Rapid deep breathing
• Fruity breath (breath odor)

• Headache
• Decreased consciousness
• Breathing - rapid
• Breathing difficulty - lying down
• Low blood pressure
• Appetite - loss
• Abdominal pain

• Low blood pressure
• Rapid heart rate
• Signs of dehydration
• High blood glucose (above 300 mg/dL)
• Presence of glucose and ketones in urine by home or office testing
• Serum potassium (may be elevated)
• Serum amylase (may be elevated)
• Arterial blood gas (reveals pH of less than 7.3)

• Urine pH
• Sodium - urine
• Serum sodium
• Potassium - urine
• Serum phosphorus
• Serum magnesium - test
• CSF collection
• CO2

The goal of treatment is to correct the elevated blood glucose level by giving additional insulin, and to replace fluids lost through excessive urination and vomiting. A person with diabetes may be able to recognize the early warning signs and make appropriate corrections at home before the condition progresses.

If ketoacidosis is severe, hospitalization is required to control the condition. Insulin replacement will be given, fluid and electrolytes will be replaced, and the cause of the condition (such as infection) will be identified and treated.

• Heart attack and tissue death of bowel tissue due to associated low blood pressure
• Renal failure