Diabetic Ketoacidosis: The Diagnosis No Nurse Wants to Sing About!

Diabetic Ketoacidosis, or DKA, is every nurse’s nightmare. It’s not only a tricky diagnosis, but it’s also a potentially life-threatening condition that requires prompt intervention. As a nurse, one is bound to come across patients who have been diagnosed with DKA, and knowing how to anticipate and intervene is crucial.

In this article, we’ll delve into the world of DKA, explore its etiology, diagnosis, and management, and unravel the reasons why DKA is a diagnosis no nurse wants to sing about.

Diabetic Ketoacidosis (DKA) is a severe complication of diabetes mellitus that occurs when the body produces high levels of blood acids called ketones. The condition is most common in people with type 1 diabetes, but it can occur in those with type 2 diabetes as well. When your body doesn’t have enough insulin, the glucose (which is supposed to be used as fuel for the body) is unable to enter the cells. The body, therefore, starts to burn fat for fuel, which produces acidic ketones that build up in the body.

The Signs and Symptoms of DKA

Signs and symptoms of DKA include:

  • High levels of blood sugar (300 mg/dL or more)
  • Dry mouth and excessive thirst
  • Frequent urination
  • Nausea and vomiting
  • Abdominal pain
  • Weakness or fatigue
  • Shortness of breath
  • Fruity-smelling breath
  • Confusion or delirium
  • Coma

Note: DKA can develop rapidly, even in a matter of hours. Therefore, it’s essential always to be on the lookout for the signs and symptoms listed above.

Diagnosing DKA is straightforward, as it’s assessed by a set of lab values. The following tests are commonly used to diagnose DKA in patients:

  • Blood glucose level
  • Blood pH level
  • Arterial blood gas
  • Electrolyte panel
  • Ketone levels
  • Urine ketone levels
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Note: A blood glucose level of 250 mg/dL or higher, a pH level of 7.3 or less, and the presence of ketones in the urine or blood are primary indicators of DKA.

It’s important for patients living with diabetes to know the signs and symptoms of DKA and to have a plan in place in case of an emergency. This plan should include:

  • Knowing the signs and symptoms of DKA
  • Testing blood sugar regularly (or as recommended by the doctor)
  • Knowing the steps to take if blood sugar levels rise
  • Keeping a supply of insulin on hand
  • Keeping blood glucose monitoring supplies handy
  • Knowing when to call 911

Note: Empowering diabetic patients to take ownership of their condition can prevent DKA, which is why nurses should provide diabetic patients with the resources and guidelines needed to manage their illness.

Preventing DKA requires several preventative strategies, including:

Ensuring Proper Insulin Therapy

Insulin therapy is essential for the treatment of diabetes, and proper administration is critical in preventing DKA. The following measures can help prevent DKA:

  • Testing blood sugar regularly (or as recommended by the doctor)
  • Consistent administration of insulin according to the doctor’s direction
  • Monitoring blood sugar levels and adjusting insulin as needed
  • Educating patients on how to use insulin therapy

Monitoring Fluid Intake

Excessive fluid loss contributes to dehydration, which is a significant risk factor for DKA. Patients living with diabetes should:

  • Drink plenty of fluids
  • Monitor fluid intake
  • Monitor urine output

Healthy Lifestyle Habits

Several lifestyle changes can reduce the risk of DKA, including:

  • Eating a well-balanced, healthy diet
  • Engaging in regular physical activity
  • Quitting smoking
  • Limiting alcohol consumption
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The treatment of DKA involves the following actions:

Fluid Resuscitation

Patients experiencing DKA are oftentimes severely dehydrated. As such, fluid resuscitation with saline solution is necessary to rehydrate the body and replace lost electrolytes.

Insulin Therapy

Insulin therapy is critical for the treatment of DKA. In this regard, patients are often administered insulin via an IV. The goal is to reduce the level of ketones in the blood and bring blood sugar levels back to a healthy range.

Electrolyte Replacement Therapy

When patients are diagnosed with DKA, they lose electrolytes, mainly sodium and potassium, at an alarming rate. Replacement of these electrolytes is essential, as a lack of potassium can cause serious heart problems.

Nothing about DKA is funny, but sometimes, humor can help to break down the seriousness of the illness. Check out these DKA-related memes and anecdotes (that you can use to lighten the mood) from the global nursing community:

  1. “I asked my patient with DKA if he’d like a snack, and he replied, ‘I’ll have some insulin, please, with a side of sugar!'”

  2. “Me: ‘Are you sure you’ve been checking your blood sugar regularly?’ My diabetic patient: ‘Yes, it’s right here in my pocket next to my cake.’ “


Caption Image
That moment when you realize the patient’s high blood sugar is because they have not been taking insulin Image
When you explain DKA to a group of nursing students… Image
Entering a room with a diabetic patient’s records and realizing you are the first person to check their insulin in eight hours. Image
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DKA is a severe and potentially life-threatening complication of diabetes that can occur in those with type 1 or type 2 diabetes. As healthcare professionals, we must take all necessary steps to prevent and manage DKA in our patients. These steps include ensuring proper insulin therapy, monitoring fluid intake, and encouraging healthy lifestyle habits. Early diagnosis and prompt intervention can make all the difference in the treatment of DKA.


  1. Centers for Disease Control and Prevention. (2020). Diabetic Ketoacidosis. https://www.cdc.gov/diabetes/ndep/pdfs/complications/DKA_Module-508.pdf
  2. American Diabetes Association. (2020). Diabetic Ketoacidosis. https://www.diabetes.org/diabetes/complications/dka-ketoacidosis