Rising Ketones can creep up on you

Will you see symptoms of a stomach ache and miss the real cause? People with diabetes often mistake the symptoms of rising ketones, like nausea, to something else, missing the seriousness of DKA lurking behind them1-3.

Stay up-to-date with information about rising ketones and DKA.

UNDERSTANDING DKA

DKA can occur at any age in people with any type of diabetes.1

What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a serious condition that occurs when the level of ketones in the blood is too high. The buildup of ketones makes the blood too acidic. When you are at risk of DKA, you may need medical attention.

Common DKA triggers can can be unpredictable and hard to avoid7

DKA may occur when you:

  • Forget to take insulin.
  • Don't take enough insulin.
  • Are unwell.
  • Are stressed.

Ketones can escalate quickly1,4,5

You may not know that unchecked rising ketones can escalate to DKA in just a few hours.1,4,5

  • Ketone levels may increase to >1 mmol/L within about 3 hours of insulin being suspended.6

Certain medications increase risk in T2D1

Certain medications like SGLT2 inhibitors are associated with an increased risk of DKA in people with type 2 diabetes (T2D).1

LACK OF AWARENESS OF DKA

Globally, many people with diabetes are unaware of DKA2*

Many people living with diabetes may be unprepared for DKA, lacking an understanding of the condition, the symptoms, and the importance of testing ketone levels.2 To find out more, please speak to your doctor.

Were not familiar with the term DKA2†

Were unable to name a single symptom of DKA2

Did not test for ketones at all2

*Multinational, multicenter survey of endocrine outpatient clinic patients with average duration of type 1 diabetes of 22 years (N=333)2.
†Participants rated their own knowledge of DKA significantly lower than their physicians did (p<0.0001)2.

You may not be aware of the symptoms of rising ketones.3

Many symptoms of rising ketones are similar to common illnesses like the flu. It’s easy to see why people with diabetes may not recognise them and may miss the opportunity to test ketone levels early before they progress into later symptoms of DKA.3

THIRST OR A VERY DRY MOUTH

FREQUENT URINATION

HIGH BLOOD GLUCOSE

HIGH LEVELS OF KETONES IN BLOOD

NAUSEA, VOMITING, OR ABDOMINAL PAIN

CONSTANT FATIGUE OR TIREDNESSOR

DRY OR FLUSHED SKIN

DIFFICULTY BREATHING

FRUITY ODOR ON BREATH

CONFUSION OR A HARD TIME PAYING ATTENTION

“Before my first DKA experience, I didn’t know what the symptoms were. I was feeling very nauseous. I would have to urinate every five minutes, and I would have that funky smell in my breath. I didn’t know I should have sought help—I just thought this is what happens when you have high blood sugar.

— Gibran lives with type 1 diabetes

SETTING A PLAN

Set and review a plan to help you stay on top of rising ketones.5,9,10,11

It can be helpful to talk with your healthcare professional about managing ketones for a more complete approach to their diabetes care. This may help you feel more prepared to prevent DKA and know how to act quickly if you experience it.

Sign up, then click on the 'Rising Ketones' tile

  • Recognise
    Be aware of the early symptoms of rising ketones and the later symptoms of DKA.
  • Check
    Make sure you know how and when to test your ketone levels.
  • Act
    Revisit what to do when ketones rise and in case of a DKA.

DKA=diabetic ketoacidosis; SGLT-2=sodium-glucose cotransporter-2; T1D=type 1 diabetes; T2D=type 2 diabetes.

1. Umpierrez, G. E. Diabetes Care (2024).  https://doi.org/10.2337/dci24-0032.
2. Hepprich, M. BMJ Open Diabetes Research & Care (2023).  https://doi.org/10.1136/bmjdrc-2023-003662.
3. Virdi, N. Diabetes Technology & Therapeutics (2023).  https://doi.org/10.1089/dia.2023.0149.
4. Centers for Disease Control and Prevention. “About Diabetic Ketoacidosis.” Accessed November 12, 2025.  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html.
5. Nguyen, K. T. Journal of Diabetes Science and Technology (2022).  https://doi.org/10.1177/19322968211042656.
6. Sherr, J. Diabetes Technol Ther (2024).  https://doi.org/10.1089/dia.2024.2525.abstracts.
7. Lizzo, J. M. “Adult Diabetic Ketoacidosis” In StatPearls. Treasure Island (FL): StatPearls Publishing, July 10, 2023.
8. American Diabetes Association. “Diabetes & DKA (Ketoacidosis).” Accessed November 12, 2025.  https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones.
9. ADEA. 2025. Clinical guiding principles for sick day management of adults with type 1 diabetes or type 2 diabetes: a guide for health professionals. Diabetes Australia NDSS. https://www.ndss.com.au/about-diabetes/resources/find-a-resource/sick-day-management-for-health-professionals/ Accessed 16  December 2025.
10. Phelan H, Hanas R, Hofer SE, et al. Sick day management in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(7):912-925. doi: 10.1111/pedi.13415.
11. Huang, J. Journal of Diabetes Science and Technology (2024).  https://doi.org/10.1177/19322968231152236.

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