Diabetic Ketoacidosis: Causes, Signs, and What You Need to Know

When your body doesn’t have enough insulin, it can’t use sugar for energy, so it starts burning fat instead. That process produces toxic acids called ketones, acidic substances built up in the blood when the body breaks down fat for fuel. When ketones pile up too fast, they poison your blood — this is diabetic ketoacidosis, a life-threatening condition caused by severe insulin deficiency and high blood sugar. It’s most common in people with type 1 diabetes, an autoimmune condition where the body destroys insulin-producing cells, but it can also happen in type 2 diabetes under extreme stress like infection or missed insulin doses.

Diabetic ketoacidosis doesn’t sneak up quietly. You’ll likely feel extremely thirsty, urinate more than usual, and get tired fast. Your breath might smell fruity — like nail polish remover — because of the ketones. Nausea, vomiting, and stomach pain are common, and if it gets worse, you might get confused, have trouble breathing, or pass out. It’s not something you wait on. Blood sugar over 250 mg/dL, ketones in urine or blood, and symptoms like vomiting mean you need help now. Hospitals see this often during flu season, after missed insulin doses, or when people don’t realize they have undiagnosed diabetes.

What makes it worse? Skipping insulin, especially during illness. A simple cold or flu can spike blood sugar and trigger ketoacidosis in someone with type 1 diabetes. Even a faulty insulin pump or a missed dose can set it off. Some people think they’re fine if they’re not diabetic yet — but ketoacidosis can be the first sign of type 1 diabetes in kids and young adults. That’s why unexplained weight loss, extreme thirst, and fatigue shouldn’t be ignored.

It’s not just about insulin. Stress, heart attacks, strokes, and certain drugs like SGLT2 inhibitors can also push someone into ketoacidosis. Even if you’ve had diabetes for years, your body’s needs change. What worked last month might not be enough now. That’s why checking ketones during illness is as important as checking blood sugar.

Below, you’ll find real, practical advice from people who’ve dealt with this — from how to spot early warning signs to what to do when insulin isn’t working. You’ll see how medication plans, emergency responses, and even travel safety connect to managing this condition. No fluff. Just what matters when every hour counts.