Although diabetic ketoacidosis (DKA) is a rarer complication of type 2 diabetes (T2DM), those with T2DM may still develop it. Common signs of DKA include fatigue, extreme thirst, confusion, and frequent urination.

T2DM is a health condition that causes high levels of glucose in the blood due to a lack of insulin or insulin resistance. The hormone insulin is responsible for transferring glucose to the cells for energy.

DKA is a serious complication of diabetes involving a severe lack of insulin in the body. This results in the cells being unable to use glucose for energy and the liver using fat cells instead. This produces ketones, which are acids. High levels of ketones in the blood can be very harmful.

A person drinking water-2.Share on Pinterest
Olga Rolenko/Getty Images

Evidence indicates that DKA can occur in people living with T2DM, although it is rare. Typically, DKA occurs when there is a lack of insulin in the body, preventing glucose from entering the cells for energy. This results in cells burning fat for energy instead, which can lead to the overproduction of ketones.

A person with T2DM can still typically produce insulin, despite the cells being unable to respond to it correctly. Therefore, the cells can still use some glucose for energy instead of fat, preventing the liver from overproducing ketones.

A person with T2DM may be more likely to develop hyperosmolar hyperglycemic state (HHS), which is when blood glucose levels are very high, but the body does not overproduce ketones.

Read on to learn more about the differences between DKA and HHS.

However, according to the Centers for Disease Control and Prevention (CDC), it is still possible for a person with T2DM to develop DKA. According to a 2022 case study, some health experts may refer to this as ketosis-prone T2DM. Ketosis-prone T2DM typically occurs when a person is going through a period of sickness that affects the production of insulin.

Read on to learn more about the potential complications of T2DM.

According to the CDC, it is more common for a person with type 1 diabetes (T1DM) to develop DKA. When a person has T1DM, the pancreas cannot produce any insulin, which can leave a person vulnerable to developing DKA.

In contrast, when a person has T2DM, the pancreas can typically still produce some insulin. Therefore, developing DKA is less common.

The most accurate way to check ketone levels is by using a ketone blood test. A person can go to the doctor for the test or perform a test at home using a blood glucose meter. This test provides a real-time result, similar to how a person may check their blood sugar levels using a blood sugar monitor.

Alternatively, a person can also use a urine test to check levels of ketones. This result will inform a person of what their ketone levels were a few hours ago. To use this test, a person will not require a monitor and will instead urinate on the test strip and wait for the color to change.

Factors that can cause DKA when a person has T2DM include:

  • having an illness such as a chest infection, flu, pneumonia, or a urinary tract infection (UTI)
  • experiencing a spike in blood glucose levels due to puberty, a growth spurt, or menstruation
  • using certain medications such as corticosteroids
  • having a physical injury
  • undergoing surgery
  • experiencing a stroke or heart attack
  • drinking large amounts of alcohol

DKA can be life threatening. Therefore, it is important that a person with T2DM can recognize the signs and symptoms.

Early symptoms of DKA typically include excessive thirst and frequent urination. A person may also notice that they have high blood sugar and ketone levels. Further symptoms of DKA can include:

  • fatigue
  • dry skin
  • dry mouth
  • abdominal pain
  • nausea and vomiting
  • weight loss
  • trouble breathing
  • a fruity odor to the breath
  • headaches
  • confusion

If a person with T2DM experiences symptoms of DKA, they should seek urgent medical attention.

The first treatment for DKA in a person with T2DM will typically be to hydrate the body to restore fluids lost due to frequent urination. This can also help dilute excess glucose in the blood and flush out ketones. A 2023 article suggests the average amount of fluids a person with T2DM may lose when they experience DKA is approximately 10% to 15% of their body weight.

Further treatment of DKA may include:

  • replacing electrolytes in the body
  • receiving insulin medication
  • treating any underlying conditions or infections with medications such as antibiotics

If a person has T2DM, there are several ways they can help prevent DKA.

Illness such as the flu, a UTI, or a chest infection may cause DKA. When a person with T2DM gets sick, they may need to drink more fluids than usual, take more insulin medication, and test their blood glucose levels more regularly. A person may also want to test their ketone levels at home.

Having an injury, undergoing surgery, or menstruating can also increase the risk of developing DKA. In any of these scenarios, a person may also want to test blood glucose and ketone levels more regularly.

A person with T2DM may also help prevent DKA by keeping blood glucose levels within the target range, continuing with any medications a doctor prescribes, and speaking with a healthcare professional about how to manage insulin levels.

T2DM is a health condition that can cause high blood sugar levels due to the way the body insufficiently responds to the hormone insulin.

DKA is a serious potential complication of diabetes. It occurs when the cells in the body burn fat instead of glucose for energy. This results in the production of ketones in the bloodstream, which can be extremely harmful.

DKA is more common in those living with T1DM, but it can still occur in individuals with T2DM. Early signs of DKA include frequent urination and excessive thirst. A person may also notice elevated blood sugar and ketone levels. Other symptoms can include abdominal pain, nausea, vomiting, fatigue, dry skin, and a fruity odor to the breath.