What Causes Ketoacidosis?


Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body produces too many ketones and causes a person's blood to become acidic. It is caused by a lack of insulin in the body.

Insulin allows glucose to pass from the bloodstream into the cells of the body, where it is used for energy. When your cells don't get the glucose they need, the liver begins to burn fat for energy. This process produces ketones, and when ketones are produced too quickly and build up, they can be toxic.

This condition is more common in type 1 diabetes , but it can also occur in type 2 diabetes . Diabetic ketoacidosis is dangerous and can be fatal.

Complications of CAD include low potassium levels ( hypokalemia ), brain edema (cerebral edema ), fluid in the lungs (pulmonary edema), and damage to the kidneys and other organs. There are many reasons CAD can occur, and knowing them allows people to recognize if they have CAD.

Oscar Wong / Getty Images

Missed insulin treatment

CAD occurs when there is not enough insulin in the body. This usually happens in people who have diabetes but have not yet been diagnosed and are not receiving the treatment they need. For those diagnosed, skipping treatment or having insulin pump problems can lead to a lack of insulin and contribute to the development of CAD.

When the insulin signal in the body is so low that glucose cannot enter the cells to use as a fuel source, the liver produces a large amount of emergency fuel in the form of ketones and the fat is broken down too quickly for that the body metabolizes it. . process. Ketones are commonly used by the muscles and the heart. When they are produced too quickly and accumulate in the blood, the blood becomes acidic, causing vomiting and abdominal pain.


Another common factor that causes CAD is infection . Viral or bacterial infections such as pneumonia, urinary tract infection, and sepsis can cause CAD. This is because your body needs more insulin than usual during an infection.

Also, an infection can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol, which counteract the action of insulin. If your body cannot meet this need, it can trigger ketone production in the liver to compensate for this need.

Heart disease

Cardiovascular disease, especially myocardial infarction (heart attack), rarely puts people with diabetes at risk of developing CAD. However, CAD can worsen heart conditions and cause cardiopulmonary complications, such as pulmonary edema and respiratory failure.

Missed meals

Food and blood sugar are directly related to CAD. To control blood sugar, people with diabetes should not go more than five to six hours without eating. Skipping meals can put someone at risk for developing CAD, as it can lead to dangerously high or low blood sugar levels.

Skipping meals upsets the balance between eating and insulin production. When someone is dependent on insulin or other medications to maintain optimal blood sugar levels, skipping meals can lead to extremely low blood sugar levels.

Also, skipping meals will cause a blood sugar crash. This will cause the person with diabetes to jump between high and low blood sugar levels, which can be difficult to control.

Drug reactions

Some medicines can cause a reaction that causes CAD. Unfortunately, these can be diabetes medications. In 2015, the FDA warned that three diabetes-specific drugs, called SGLT2, tripled the risk of CAD . Talk to your doctor about medications that can increase your risk.

Three SGLT2s that can increase your risk for CAD include:

  • Farksiga (dapagliflozin)
  • Jardians (empagliflozen)
  • Invokana (canagliflozin)

Also, some prescription drugs can increase glucose levels and therefore cause CAD. This includes:

Medicines that increase the level of certain hormones or glucose can cause CAD. Therefore, discussing these risks with your healthcare provider and informing them about the medications and symptoms you are taking can help you avoid CAD.

Alcohol abuse

Alcohol abuse can cause CAD for a number of reasons. Excessive amounts of alcohol can cause alcohol in the body to turn into acid. This is called alcoholic ketoacidosis. Alcohol consumption must not be excessive to induce CAD.

Drinking alcohol can cause:

  • Interruption and failure to detect the occurrence of hypoglycemia.
  • Hypoglycemia, which can be mistaken for poisoning by yourself or by others.
  • Disruption of hormonal response.

Also, in some people with type 2 diabetes, too much alcohol can make dehydration worse and contribute to the development of CAD. Occasionally, excessive alcohol consumption should be combined with wearing identification indicating a diagnosis of diabetes, keeping a blood glucose meter nearby, and consuming carbohydrates.

Trauma or surgery

Trauma and surgery can lead to stress, which has been shown to cause hyperglycemia. This is an undesirable consequence for people with diabetes, who can develop hyperglycemia quickly and should be treated as soon as possible.

Similar to illness, the body reacts to trauma by releasing elevated levels of hormones, leading to high blood sugar levels. Therefore, people with diabetes who have had a recent injury or surgery should pay attention to the symptoms of CAD and check their blood sugar frequently.


Hyperthyroidism occurs when the thyroid gland produces too much thyroxine hormone. Hyperthyroidism can destabilize blood sugar metabolism, which can lead to hyperglycemia and cause CAD. Hyperthyroidism is also associated with a decrease in the half-life of insulin.

In addition, hyperthyroidism causes a metabolic acceleration; therefore, medications such as insulin are removed more quickly from the body. This means that people with hyperthyroidism and diabetes should be aware of possible high blood sugar levels because a dose of insulin does not stay in the body long enough.

The pregnancy

Finally, pregnancy is another common cause of CAD. During pregnancy, the body changes a lot and one of the ways is to increase insulin resistance. This, along with the vomiting that is often associated with pregnancy, causes dehydration, stress, and more, which can lead to CAD. CAD occurs most often in the second or third trimester, when insulin resistance is highest.

When to contact a healthcare provider

Diabetic ketoacidosis usually develops slowly, but with vomiting, this life-threatening condition can develop within hours. Watch for the first signs of CAD, which include thirst or very dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. Seek emergency medical attention or call 911 right away if you have these symptoms and suspect CAD.

Get the word of drug information

Diabetes is a chronic disease that requires constant care and treatment. CAD is a serious complication that can occur in people with diabetes and can be caused by many different reasons.

You can lower your chances of getting CAD by following your treatment and checking your blood sugar and ketone levels regularly. While some of the causes of diabetic ketoacidosis are unavoidable, you can still prevent them by studying and recognizing the warning signs of diabetic ketoacidosis early so that you can get help as soon as possible when it happens.

Related Articles
Thyroid adenoma: Causes, Treatment, and Diagnosis

The thyroid is a small, butterfly-shaped gland in the front of your throat that produces hormones affecting a number of Read more

NSAIDs and You Thyroid Function

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently taken over-the-counter medications. Due to their systemic or whole body effects, it's Read more

How Doctors Are Failing Thyroid Disease Patients

The thyroid disease community has continually mentioned the lack of support they experience and the difficulty they have navigating the Read more

How the Family Deductible Works in an HDHP

If your family’s health insurance is a high-deductible health plan, your family deductible may work differently than it did when Read more