Hyperglycemic crises Diabetic ketoacidosis symptoms diabetes. Your treatment will likely include: Replacing fluids you symptoma through frequent urination and to help dilute excess sugar in your blood. Hyperosmolar hyperglycemic state. DKA is most common among people with type 1 diabetes.

Diabetic ketoacidosis symptoms -

Reichel A, Rietzsch H, Kohler HJ, Pfutzner A, Gudat U, Schulze J. Cessation of insulin infusion at night-time during CSII-therapy: comparison of regular human insulin and insulin lispro.. Exp Clin Endocrinol Diabetes.

Siperstein MD. Diabetic ketoacidosis and hyperosmolar coma.. Endocrinol Metab Clin North Am. Samuelsson U, Ludvigsson J. When should determination of ketonemia be recommended?. Diabetes Technol Ther. Vanelli M, Chiari G, Capuano C, Iovane B, Bernardini A, Giacalone T.

The direct measurement of 3-beta-hydroxy butyrate enhances the management of diabetic ketoacidosis in children and reduces time and costs of treatment.. Diabetes Nutr Metab. Takaike H, Uchigata Y, Iwasaki N, Iwamoto Y. Transient elevation of liver transaminase after starting insulin therapy for diabetic ketosis or ketoacidosis in newly diagnosed type 1 diabetes mellitus..

American Diabetes Association. Hospital admission guidelines for diabetes.. Schade DS, Eaton RP. Diabetic ketoacidosis—pathogenesis, prevention and therapy.. Clin Endocrinol Metab. Umpierrez GE, Latif K, Stoever J, Cuervo R, Park L, Freire AX, et al.

Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis.. Am J Med. Umpierrez GE, Cuervo R, Karabell A, Latif K, Freire AX, Kitabchi AE. Treatment of diabetic ketoacidosis with subcutaneous insulin aspart..

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J Clin Endocrin Metab. Soler NG, FitzGerald MG, Wright AD, Malins JM. Comparative study of different insulin regimens in management of diabetic ketoacidosis.. Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis..

Ann Intern Med. Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, et al. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis?.

Crit Care Med. Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis.. J Clin Endocrinol Metab. Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis..

Br Med J Clin Res Ed. Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis.. Keller U, Berger W. Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma..

Wilson HK, Keuer SP, Lea AS, Boyd AE, Eknoyan G. Phosphate therapy in diabetic ketoacidosis.. Edge JA. Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer finding a cause?. Diabetes Metab Res Rev. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, et al.

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J Pediatr. Malone ML, Gennis V, Goodwin JS. Characteristics of diabetic ketoacidosis in older versus younger adults.. J Am Geriatr Soc. Gale EA, Dornan TL, Tattersall RB. Severely uncontrolled diabetes in the over-fifties.. Feddersen E, Lockwood DH.

Diabetes Educ. Brink SJ. Diabetic ketoacidosis: prevention, treatment and complications in children and adolescents.. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. search close. PREV May 1, NEXT. B 3 Although intravenous insulin infusion can be changed quickly and studies have found more rapid initial improvement in glucose and bicarbonate levels, there is no improvement in morbidity and mortality over insulin administered intramuscularly or subcutaneously.

Check beta-hydroxybutyrate rather than ketones to evaluate the degree of ketosis. B 25 Beta-hydroxybutyrate is the main metabolic product in ketoacidosis. Levels correlate better with changes in arterial pH and blood bicarbonate levels than ketones, and were found to lead to better outcomes in one study of children.

Bicarbonate therapy should not be given to adult patients with a pH level of 7. B 34 , 35 , 37 No studies have found improved outcomes beyond slight increases in serum pH levels after bicarbonate has been administered.

A few studies suggest possible harms. Gradual correction of glucose and osmolality and careful use of isotonic or hypotonic saline will reduce the risk of cerebral edema. C 3 Cerebral edema is less common in adults than in children, and there are no studies in adults to report.

Phosphate should not be given routinely. B 38 , 39 , 40 Low phosphate levels can cause problems, but phosphate does not need to be given routinely. Initial Evaluation. Hyperglycemic crises in diabetes. SIGNS AND SYMPTOMS. INPATIENT VS.

Adapted with permission from Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, et al. Diabetes Care ;27 suppl 1 :S Special Situations—Young and Old Patients. Transition to Standard Regimen and Prevention of Recurrence. DAVID E.

Trachtenbarg received his medical degree from the University of Illinois College of Medicine at Chicago and completed his residency training at the Methodist Medical Center Family Practice Residency at the University of Illinois College of Medicine, Peoria.

Trachtenbarg, M. Foods we eat are broken down by the body, and much of what we eat becomes glucose a type of sugar , which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy.

Insulin normally is made by the pancreas, but people with type 1 diabetes insulin-dependent diabetes don't produce enough insulin and must inject it daily.

Your body needs a constant source of energy. When you have plenty of insulin, your body cells can get all the energy they need from glucose. If you don't have enough insulin in your blood, your liver is programmed to manufacture emergency fuels. These fuels, made from fat, are called ketones or keto acids.

In a pinch, ketones can give you energy. However, if your body stays dependent on ketones for energy for too long, you soon will become ill. Ketones are acidic chemicals that are toxic at high concentrations.

In diabetic ketoacidosis, ketones build up in the blood, seriously altering the normal chemistry of the blood and interfering with the function of multiple organs. They make the blood acidic, which causes vomiting and abdominal pain. If the acid level of the blood becomes extreme, ketoacidosis can cause falling blood pressure, coma and death.

Ketoacidosis is always accompanied by dehydration, which is caused by high levels of glucose in the blood. Glucose builds up in the blood if there is not enough insulin to move glucose into your cells.

During an episode of ketoacidosis, it is common for blood sugar to rise to a level over milligrams per deciliter. When blood sugar levels are so high, some sugar "overflows" into the urine.

As sugar is carried away in the urine, water, salt and potassium are drawn into the urine with each sugar molecule, and your body loses large quantities of your fluid and electrolytes, which are minerals that play a crucial role in cell function. As this happens, you produce much more urine than normal.

Eventually it may become impossible for you to drink enough fluids to keep up with amounts that you urinate. Vomiting caused by the blood's acidity also contributes to fluid losses and dehydration.

People with type 1 diabetes are at risk of diabetic ketoacidosis. If you have type 1 diabetes, ketoacidosis can occur because you have stopped taking your insulin injections or because your insulin dose is too low.

It can be triggered by an infection or severe physical stress, such as an injury or surgery, because your body can need more insulin than usual during these stresses. Ketoacidosis is less likely to occur in people with type 2 diabetes.

In most people who have type 2 diabetes, blood insulin levels usually do not get low enough to signal the liver to make ketones. As blood ketone levels increase, the person's breathing pattern may become slow and deep, and his or her breath can have a fruity odor.

A person with ketoacidosis may seem to be tired or confused or may have trouble paying attention. Without prompt treatment in the first day of symptoms, the illness may cause low blood pressure, a loss of consciousness, coma or death. If you have type 1 diabetes, it is important to frequently measure your blood glucose levels.

If your levels are running high or you are prone to ketoacidosis, you will want to test your urine for ketones. If the urine test strip reads "moderate" or "large," it's possible you have ketoacidosis. People with diabetic ketoacidosis are always treated in a hospital. Your doctor will test your blood for levels of glucose, ketones, and electrolytes such as sodium and potassium.

If you have been taking your insulin without missed doses, your doctor will want to determine if you have an infection. But don't let fear keep you from taking good care of yourself.

Follow your diabetes treatment plan carefully. Ask your diabetes treatment team for help when you need it. On this page. When to see a doctor. Risk factors. Diabetic ketoacidosis is a serious complication of diabetes. A Book: The Essential Diabetes Book. Assortment of Health Products from Mayo Clinic Store.

Symptoms might include: Being very thirsty Urinating often Feeling a need to throw up and throwing up Having stomach pain Being weak or tired Being short of breath Having fruity-scented breath Being confused More-certain signs of diabetic ketoacidosis — which can show up in home blood and urine test kits — include: High blood sugar level High ketone levels in urine.

You have ketones in your urine and can't reach your health care provider for advice. You have many symptoms of diabetic ketoacidosis. These include excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion.

Remember, untreated diabetic ketoacidosis can lead to death. Request an appointment. From Mayo Clinic to your inbox.

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You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Diabetic ketoacidosis usually happens after: An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol.

These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis.

A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn't work right also can leave too little insulin in the body. Any of these problems can lead to diabetic ketoacidosis.

Other things that can lead to diabetic ketoacidosis include: Physical or emotional trauma Heart attack or stroke Pancreatitis Pregnancy Alcohol or drug misuse, particularly cocaine Certain medicines, such as corticosteroids and some diuretics.

The risk of diabetic ketoacidosis is highest if you: Have type 1 diabetes Often miss insulin doses Sometimes, diabetic ketoacidosis can occur with type 2 diabetes. Possible complications of the treatments Treatment complications include: Low blood sugar, also known as hypoglycemia.

Insulin allows sugar to enter cells. This causes the blood sugar level to drop. If the blood sugar level drops too quickly, the drop can lead to low blood sugar. Low potassium, also known as hypokalemia. The fluids and insulin used to treat diabetic ketoacidosis can cause the potassium level to drop too low.

A low potassium level can affect the heart, muscles and nerves. To avoid this, potassium and other minerals are usually given with fluid replacement as part of the treatment of diabetic ketoacidosis. Swelling in the brain, also known as cerebral edema.

Adjusting the blood sugar level too quickly can cause the brain to swell. This appears to be more common in children, especially those with newly diagnosed diabetes.

Untreated, diabetic ketoacidosis can lead to loss of consciousness and, eventually, death. There are many ways to prevent diabetic ketoacidosis and other diabetes complications.

Many Diabtic with diabetes Diabetic ketoacidosis symptoms from diabetic ketoacidosis Diabetic ketoacidosis symptoms every year. Sympptoms is caused by reduced insulin Diabetoc, decreased glucose use, and increased gluconeogenesis Diabetic ketoacidosis symptoms elevated counter regulatory hormones, including catecholamines, glucagon, and cortisol. DKA primarily affects patients with type 1 diabetes, but also may occur in patients with type 2 diabetes, and is most often caused by omission of treatment, infection, or alcohol abuse. Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors Table 1 4 — The most common precipitating factor is infection, followed by noncompliance with insulin therapy. Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap.

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Treatment includes giving insulin and IV fluids. A person with DKA needs to be watched closely in the hospital until their blood sugars and blood acid level are back in a healthy range, and they are feeling better. The care plan tells you exactly how to do this and includes specific instructions about:.

Anyone with diabetes can have high blood sugar readings from time to time, even if they follow their care plan. KidsHealth Parents Diabetic Ketoacidosis. en español: Cetoacidosis diabética.

Medically reviewed by: Chijioke Ikomi, MD. Healthy Weight and Wellness Clinic at Nemours Chlidren's Health. Listen Play Stop Volume mp3 Settings Close Player. Larger text size Large text size Regular text size.

What Is Diabetic Ketoacidosis DKA? Symptoms that can happen in diabetic ketoacidosis when the blood sugar gets too high hyperglycemia include: decreased energy being very thirsty peeing a lot dry mouth and dehydration If sugar levels stay high, more serious symptoms can happen that need treatment in the ER.

What Causes Diabetic Ketoacidosis DKA? So blood sugar levels rise above the healthy range hyperglycemia. The body uses fat for fuel, which sends ketones into the blood. The ketones KEY-tones in the blood make the blood too acidic.

How Is Diabetic Ketoacidosis DKA Diagnosed? How Is Diabetic Ketoacidosis DKA Treated? How Can Parents Help? Tell all adult family members, caregivers, and school staff about DKA.

Be sure they know what to do if your child has an emergency, and when to call Get a medical ID. All kids and teens with diabetes should wear a medical identification like a bracelet or necklace at all times.

Be sure to include your emergency contact information on the ID. Check for ketones. You should check the blood or urine for ketones any time your child is sick, has symptoms of DKA, or their blood sugar is high.

The care plan will tell you what blood sugar levels should be followed up with a ketone check. Know when to call the care team.

: Diabetic ketoacidosis symptoms

What is diabetic ketoacidosis?	Feddersen E, Detoxification and lymphatic system DH. Which problem did you ketoxcidosis on this Diabetic ketoacidosis symptoms Diabetif long as there are no further problems, Diabetic ketoacidosis symptoms should be able to leave hospital when you're well enough to eat and drink normally; and when tests show a safe level of ketones in your body. Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, et al. Your urine tests show high levels of ketones and you have vomited more than twice in four hours.
Treatment for diabetic ketoacidosis (DKA)	Diabetic ketoacidosis DKA is life-threatening—learn the warning signs to be prepared for any situation. DKA is caused by an overload of ketones present in your blood. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. When ketones build up in the blood, they make it more acidic. They are a warning sign that your diabetes is out of control or that you are getting sick. High levels of ketones can poison the body. When levels get too high, you can develop DKA. DKA may happen to anyone with diabetes, though it is rare in people with type 2. Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly. DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following:. DKA is dangerous and serious. The doctors will talk to you about what caused DKA and give you advice on how to reduce the risk of it happening again. If you have diabetes, it's important to be aware of the symptoms of diabetic ketoacidosis DKA and how to reduce the risk of getting it. Causes of DKA can include being unwell, having an injury or surgery, having your period, or not taking enough insulin. Testing for ketones will help you know when you need to take action, such as increasing your insulin dose. You can get kit to test for ketones free from the NHS, or buy it from a pharmacy. You can use:. follow the treatment plan agreed with your diabetes care team, including adjusting your insulin dose when you need to. ask your care team about getting a continuous glucose monitor or flash monitor if you do not already have one. follow the sick day rules you've been given by your care team when you're ill. Page last reviewed: 08 June Next review due: 08 June Home Health A to Z Back to Health A to Z. Diabetic ketoacidosis. See also Diabetes Mellitus Diabetes Mellitus DM Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia read more and Complications of Diabetes Mellitus Complications of Diabetes Mellitus In patients with diabetes mellitus, years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels microvascular , large vessels macrovascular read more. Diabetic ketoacidosis DKA occurs in patients with type 1 diabetes mellitus and is less common in those with type 2 diabetes. DKA is the first manifestation of type 1 diabetes in a minority of patients. Insulin deficiency can be absolute eg, during lapses in the administration of exogenous insulin or relative eg, when usual insulin doses do not meet metabolic needs during physiologic stress. Acute infection eg, pneumonia Overview of Pneumonia Pneumonia is acute inflammation of the lungs caused by infection. Initial diagnosis is usually based on chest x-ray and clinical findings. Causes, symptoms, treatment, preventive measures, and read more , urinary tract infection Introduction to Urinary Tract Infections UTIs Urinary tract infections UTIs can be divided into upper and lower tract infections: Upper tract infections involve the kidneys pyelonephritis. Lower tract infections involve the bladder read more , COVID COVID COVID is a respiratory illness caused by the novel coronavirus SARS-CoV Infection may be asymptomatic or have symptoms ranging from mild upper respiratory symptoms to acute respiratory Myocardial infarction Acute Myocardial Infarction MI Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery. Stroke Overview of Stroke Strokes are a heterogeneous group of disorders involving sudden, focal interruption of cerebral blood flow that causes neurologic deficit. Pancreatitis Overview of Pancreatitis Pancreatitis is classified as either acute or chronic. Acute pancreatitis is inflammation that resolves both clinically and histologically. Chronic pancreatitis is characterized by histologic DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes also referred to as Flatbush diabetes is a variant of type 2 diabetes, which sometimes occurs in patients with obesity, often those with African including African American or Afro-Caribbean ancestry. Patients with ketosis-prone diabetes can have significant impairment of beta-cell function with hyperglycemia, and are therefore more likely to develop DKA when significant hyperglycemia occurs. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 diabetes. In pregnant patients and in patients taking SGLT2 inhibitors, DKA may occur at lower or even normal blood glucose levels. Insulin deficiency and an increase in counterregulatory hormones glucagon , catecholamines, cortisol causes the body to metabolize triglycerides and amino acids instead of glucose for energy. Serum levels of glycerol and free fatty acids rise because of unrestrained lipolysis. Alanine levels rise because of muscle catabolism. Glycerol and alanine provide substrate for hepatic gluconeogenesis, which is stimulated by the excess of glucagon that accompanies insulin deficiency. Glucagon also stimulates mitochondrial conversion of free fatty acids into ketones. Insulin normally blocks ketogenesis by inhibiting the transport of free fatty acid derivatives into the mitochondrial matrix, but ketogenesis proceeds in the absence of insulin. Acetone derived from the metabolism of acetoacetic acid accumulates in serum and is slowly disposed of by respiration. Hyperglycemia due to insulin deficiency causes an osmotic diuresis that leads to marked urinary losses of water and electrolytes. Urinary excretion of ketones obligates additional losses of sodium and potassium. Serum sodium may fall due to natriuresis or rise due to excretion of large volumes of free water. Potassium is also lost in large quantities. Despite a significant total body deficit of potassium, initial serum potassium is typically normal or elevated because of the extracellular migration of potassium in response to acidosis. Potassium levels generally fall further during treatment as insulin therapy drives potassium into cells. The most common read more may develop. Symptoms and signs of diabetic ketoacidosis include symptoms of hyperglycemia Symptoms and Signs Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. read more with the addition of nausea, vomiting, and—particularly in children—abdominal pain. Lethargy and somnolence are symptoms of more severe decompensation. Patients may be hypotensive and tachycardic due to dehydration and acidosis; they may breathe rapidly and deeply to compensate for acidemia Kussmaul respirations. They may also have fruity breath due to exhaled acetone. Fever is not a sign of DKA itself and, if present, signifies underlying infection. In the absence of timely treatment, DKA progresses to coma and death. Headache and fluctuating level of consciousness herald this complication in some patients, but respiratory arrest is the initial manifestation in others. The cause is not well understood but may be related to too-rapid reductions in serum osmolality or to brain ischemia. It is most likely to occur in children 5 years when DKA is the initial manifestation of diabetes mellitus Diabetes Mellitus DM Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Children with the highest BUN blood urea nitrogen levels and lowest PaCO2 at presentation appear to be at greatest risk. Delays in correction of hyponatremia and the use of bicarbonate during DKA treatment are additional risk factors.
Diabetic ketoacidosis	Adjusting your insulin dose as advised by your diabetes care team will often correct your blood sugar and ketone levels, preventing diabetic ketoacidosis. Seek medical advice if your levels are still high after taking insulin or you develop the symptoms mentioned above. You will not receive a reply. We will consider your feedback to help improve the site. Don't include any personal or financial information, for example National Insurance, credit card numbers, or phone numbers. Comments or queries about angling can be emailed to anglingcorrespondence daera-ni. If you have a comment or query about benefits, you will need to contact the government department or agency which handles that benefit. Contacts for common benefits are listed below. Call Email dcs. incomingpostteamdhc2 nissa. Call Email customerservice. unit communities-ni. Comments or queries about the Blue Badge scheme can be emailed to bluebadges infrastructure-ni. uk or you can also call For queries or advice about careers, contact the Careers Service. For queries or advice about Child Maintenance, contact the Child Maintenance Service. For queries or advice about claiming compensation due to a road problem, contact DFI Roads claim unit. For queries about your identity check, email nida nidirect. uk and for queries about your certificate, email covidcertni hscni. For queries or advice about criminal record checks, email ani accessni. For queries or advice about employment rights, contact the Labour Relations Agency. For queries about the High Street Spend Local Scheme, email HSSS. mail economy-ni. For queries or advice about passports, contact HM Passport Office. For queries or advice about Penalty Charge Notices PCNs , including parking tickets and bus lane PCNs, email dcu infrastructure-ni. For queries or advice about pensions, contact the Northern Ireland Pension Centre. If you wish to report a problem with a road or street you can do so online in this section. If you wish to check on a problem or fault you have already reported, contact DfI Roads. For queries or advice about historical, social or cultural records relating to Northern Ireland, use the Public Record Office of Northern Ireland PRONI enquiry service. For queries or advice about rates, email LPSCustomerTeam lpsni. If you have a question about a government service or policy, you should contact the relevant government organisation directly. We don't have access to information about you. Main navigation Home News Contacts Help Twitter Facebook YouTube RSS. The information on this page has been adapted from original content from the NHS website. For further information see terms and conditions. You must have JavaScript enabled to use this form. report a problem. leave feedback. If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test. Often, your health care provider can tell you what to do over the phone. Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation. Diabetes Complications. Know the warning signs of DKA and check urine for ketones, especially when you're sick. What are the warning signs of DKA? Early symptoms include the following: Thirst or a very dry mouth Frequent urination High blood glucose blood sugar levels High levels of ketones in the urine Then, other symptoms appear: Constantly feeling tired Dry or flushed skin Nausea, vomiting, or abdominal pain. Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than two hours, contact your health care provider. Difficulty breathing Fruity odor on breath A hard time paying attention, or confusion. More on ketones and DKA. How do I check for ketones? Also, check for ketones when you have any symptoms of DKA. What if I find higher-than-normal levels of ketones? Call your health care provider at once if you experience the following conditions: Your urine tests show high levels of ketones. Your urine tests show high levels of ketones and your blood glucose level is high. Your urine tests show high levels of ketones and you have vomited more than twice in four hours. What causes DKA? Here are three basic reasons for moderate or large amounts of ketones: Not enough insulin Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness. Not enough food When you're sick, you often don't feel like eating, sometimes resulting in high ketone levels.