Ketones and DKA Risk in LADA

Diabetic ketoacidosis, or DKA, is a medical emergency that happens when there is too little insulin in the body. Without insulin your cells cannot use glucose, so your body burns fat instead and produces ketones. Ketones are acidic, and enough of them make the blood dangerously acidic.

At diagnosis, LADA is usually ketosis-resistant — one of the features that distinguishes it from Type 1 and helps explain the Type 2 label. That protection is not permanent. It comes from the insulin you are still making, and it fades as that production falls.

So DKA risk in LADA rises over the years. Anyone on insulin, and anyone whose C-peptide has fallen low, should know the signs.

• Blood sugar staying high, usually above 250 mg/dL.
• Nausea, vomiting or stomach pain.
• Breath with a sweet or fruity smell.
• Deep, rapid breathing.
• Very dry mouth, intense thirst, passing large amounts of urine.
• Confusion, drowsiness or difficulty staying awake.

Vomiting with high blood sugar is an emergency. Go to a hospital — this is not something to manage at home.

Ketones can be checked at home with urine strips, which are inexpensive and available at most pharmacies, or with a blood ketone meter. Check when your glucose is above 250 mg/dL, when you are ill, and any time you feel unwell with high readings.