What is diabetic ketoacidosis?

No one wants to have high blood sugar—you'd rather feel your best. But there's even more to it. When your blood sugar is high, your body can't move the large amount of glucose in the blood into your cells. Instead, your body uses more fat for fuel. And when fat is burned in this way, ketones are formed.

Any time your blood sugar is over 240, you should immediately use a ketone test strip to check your urine.¹

Ketones make the blood acidic, making you feel ill and possibly leading to diabetic ketoacidosis (or DKA). DKA is a serious medical condition that causes nausea and vomiting. With vomiting can come severe dehydration as well. When a person has DKA, immediate hospitalization may be necessary, as untreated DKA can be deadly.

If you wear an insulin pump, you have to take note any time there is a disruption in insulin delivery—if the site falls out or is disconnected, if the cannula is bent, or if insulin is not being absorbed properly. Because your insulin pump uses short-acting insulin, blood sugar can increase in just a few hours and ketones can form.

1. If ketones are moderate to large, you will need to take additional insulin to correct your high blood sugar level, based on your correction rule or sensitivity factor. (If you don't know your correction rule or sensitivity factor, call your healthcare provider.)
2. Use a syringe for this additional insulin.
3. Change out your infusion set and insert a new one. See if the cannula is bent.
4. Check your blood sugar again in 2 hours. If you haven't brought your blood sugar down, contact your doctor.

• Did you forget to bolus for a meal or snack earlier in the day?
• Is it possible you didn't calculate carbohydrates correctly on a meal earlier in the day?
• Did your infusion set fall out of the site?
• Is your pump functioning properly? Disconnect your insulin pump from your body and prime it to see if insulin drips out of the infusion set.
• If insulin is coming out of the pump, your pump is working. You need to consider whether your site was the problem. When you removed the old site, was the cannula bent? This can impair the absorption of the insulin.
• If your cannula tip was not bent, it could be the site itself. Sometimes insulin can pool at a site and not be absorbed. Be sure, when you rotate sites, to choose a new site at least 2 inches from the last one.
• Are you ill? Illness can make your blood sugar run high.¹

Having a plan to follow when you develop high sugars and form ketones is a big help in preventing hospitalization for DKA. Be sure to talk about the possibility of DKA at your next office visit, to find out if your healthcare team has any specific guidelines for you.

¹American Diabetes Association. Diabetes & DKA (Ketoacidosis). Available at: https://diabetes.org/aboutdiabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones. Accessed August 07, 2024.