RISING KETONES CAN CREEP UP ON YOUR PATIENTS.
Will they see symptoms of a stomach flu and miss the real threat? People with diabetes often misattribute the symptoms of rising ketones, like nausea, to less serious ailments, missing the threat of DKA lurking behind them1-3.
Stay up-to-date with information about rising ketones and DKA.
THREAT OF DKA
A DKA emergency can strike at any age in people with any type of diabetes1.
DKA can pose serious challenges and life-threatening risks for your patients with type 1 diabetes or type 2 diabetes1.
Can escalate quickly1,4,5
Your patients may not know unchecked rising ketones can escalate to a life-threatening DKA emergency in just a few hours1,4,5.
- Ketone levels may increase to >1 mmol/L within about 3 hours of insulin being suspended6.
Precipitating factors can be unpredictable and hard to avoid7
The most common precipitating factors of DKA can be unpredictable and hard to avoid1,7.
• Missed or insufficient insulin doses
• Infections
• Illness
• Stress
Leading cause of T1D mortality5
DKA is still a leading cause of mortality for people with type 1 diabetes (T1D) under 58 years old5.
SGLT2 inhibitors increase risk in T2D1
SGLT2 inhibitors are associated with an almost 3-fold increased risk for DKA in people with type 2 diabetes (T2D)1.
GAPS IN PATIENT KNOWLEDGE
Many people with diabetes are unaware of DKA2*.
Many people living with diabetes may be unprepared for a DKA emergency, lacking an understanding of the condition, the symptoms, and the importance of testing ketone levels2.
were not familiar with
the term DKA2†
were unable to name a single
symptom of DKA2
did not test for ketones at all2
*Multinational, multicenter survey of endocrine outpatient clinic patients with average duration of type 1 diabetes of 22 years (N=333)2.
†Participants rated their own knowledge of DKA significantly lower than their physicians did (p<0.0001)2.
People with diabetes often miss the symptoms of rising ketones3.
Many symptoms of rising ketones are similar to common, less serious ailments. It’s easy to see why people with diabetes may misattribute them—and miss the opportunity to test ketone levels early before they progress into later symptoms of DKA3.
• Thirst or a very dry mouth
• Frequent urination
• High blood glucose
• High levels of ketones in the urine
• Nausea, vomiting, or abdominal pain
• Constant fatigue/tiredness
• Dry or flushed skin
• Difficulty breathing
• Fruity odor on breath
• Confusion or a hard time paying attention
“Before my first DKA experience, I didn’t know what the symptoms were. I was feeling very nauseous. I would have to urinate every five minutes, and I would have that funky smell in my breath. I didn’t know I should have sought help—I just thought this is what happens when you have high blood sugar.
— Gibran lives with type 1 diabetes
SETTING A PLAN
Set and review a plan to help your patients stay on top of rising ketones5,9,10.
It can be helpful to talk with your patients regularly about managing ketones for a more complete approach to their diabetes care. This may help them feel more prepared to prevent a DKA emergency and know how to act quickly if they experience one.
1. Recognize
Help your patients recognize early symptoms of rising ketones and later symptoms of DKA.
2. Check
Be sure patients know how and when to monitor ketone levels.
3. Act
Revisit what to do when ketones rise and in case of a DKA emergency.
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DKA=diabetic ketoacidosis; SGLT-2=sodium-glucose cotransporter-2; T1D=type 1 diabetes; T2D=type 2 diabetes.
1. Umpierrez, G. E. Diabetes Care (2024). https://doi.org/10.2337/dci24-0032.
2. Hepprich, M. BMJ Open Diabetes Research & Care (2023).https://doi.org/10.1136/bmjdrc-2023-003662.
3. Virdi, N. Diabetes Technology & Therapeutics (2023).https://doi.org/10.1089/dia.2023.0149.
4. Centers for Disease Control and Prevention. “About Diabetic Ketoacidosis.” Accessed May 30, 2025 https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html.
5. Nguyen, K. T. Journal of Diabetes Science and Technology (2022). https://doi.org/10.1177/19322968211042656.
6. Sherr, J. Diabetes Technol Ther (2024). https://doi.org/10.1089/dia.2024.2525.abstracts.
7. Lizzo, J. M. “Adult Diabetic Ketoacidosis” In StatPearls. Treasure Island (FL): StatPearls Publishing, July 10, 2023.
8. American Diabetes Association. “Diabetes & DKA (Ketoacidosis).” Accessed May 30, 2025.https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones.
9. American Diabetes Association. “Planning for Sick Days.” Accessed May 30, 2025.https://diabetes.org/getting-sick-with-diabetes/sick-days.
10. Huang, J. Journal of Diabetes Science and Technology (2024).https://doi.org/10.1177/19322968231152236.
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