What DKA Is, and Why It Happens
Reviewed by CDE Mehandi Sharma · Updated
Diabetic ketoacidosis, usually shortened to DKA, is the most serious short-term complication of Type 1 diabetes. Understanding the mechanism makes the warning signs and the rules around it make sense.
It starts with not enough insulin to let blood sugar into your cells for energy. Your cells need fuel, so the body turns to its backup plan and starts breaking down fat instead.
Burning fat produces ketones. In small amounts that is normal. But without insulin the process does not stop, ketones build up, and because they are acidic they make the blood itself acidic. That is the dangerous part — it affects how every system in the body works, and it can be life-threatening.
There are two common triggers. Illness, because infection raises glucose and increases how much insulin you need. And missing insulin doses, including a pump that has failed or an infusion site that has stopped delivering.
Less commonly it can be set off by a heart attack, stroke, injury, some medicines, or substance use.
The crucial difference from Type 2 is speed. With essentially no insulin production of your own, this can develop over hours rather than days — which is why insulin is never skipped, even when you are not eating.