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Type 1 Diabetes and Your Child: Preventing Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. It can lead to coma or death. A child with DKA has:

  • High blood sugar (hyperglycemia)

  • An imbalance of chemicals in the blood (metabolic acidosis)

  • High levels of ketones in the blood and urine

Ketones are the waste product when the body breaks down fat for energy. This happens when there isn't enough insulin and the body isn't able to use sugar (glucose). Ketones can build up in the blood and then in the urine. Ketosis is a warning sign of DKA.

DKA is more common in children with type 1 diabetes. But, it can also occur in children with type 2 diabetes. DKA is a medical emergency.

If your child has high ketones and symptoms of DKA described below, call 911 or take him or her to the hospital emergency department.

What are the causes of DKA?

The most common causes of DKA are:

  • Missing a dose of insulin

  • Illness (flu, cold, or infection)

  • An insulin pump that is not working properly

  • Insulin that has expired or has not been stored properly

What are the symptoms of DKA?

If your child has high ketones in the blood or urine and symptoms of DKA, call 911 or go to the hospital emergency department. Symptoms of DKA include:

  • Nausea

  • Vomiting

  • Fruity-smelling breath

  • Stomach cramps

  • Very dark urine or no urine in 6 hours

  • Fast breathing

  • Thirst or very dry mouth

  • Drowsiness or unresponsiveness 

When to check for ketones

Check for ketones in your child's urine or blood as instructed by his or her health care provider. In general, check for ketones when your child has any of the above symptoms, or has:

  • Blood sugar above 250 mg/dL.

  • Diarrhea or vomiting.

  • Fever of 100.4°F (38°C) oral or 101.4°F (38.5°C) rectal or higher, or as directed by your child's health care provider

How to check for ketones

Ask your child’s health care provider to show you how to check for ketones at home. Ketone testing is most often done with urine test strips. Some blood glucose meters may also be used to check for ketones in the blood. Ask your child's health care provider for m ore information.

  • For babies or toddlers. You can put a cotton ball in your child's diaper to absorb urine. Then, put the moist cotton ball onto a test strip to check for ketones. Follow the directions on the test strip package.

  • For older children. Follow the directions on the test strip package.

Preventing DKA

Woman giving glass of water to girl lying in bed. Diabetes kit is on bed.

DKA can usually be prevented. The best way to do this is to give your child insulin as directed. Be sure to follow your child’s treatment plan as given to you by the health care provider. When your child’s blood sugar is high, treat him or her right away. Remember that your child’s blood sugar can be harder to manage when he or she is sick. To be safe, check your child’s blood sugar more often when he or she is sick. Ask the health care provider for sick-day guidelines. This includes learning to adjust your child’s insulin dose safely. And always keep a “sick-day” box available. This box should include:

  • Ketone strips

  • Thermometer

  • Cans of soup

  • Crackers

  • Juice with or without sugar

  • Flavored gelatin with and without sugar

  • Frozen juice bars with and without sugar (in the freezer)

Be sure to check the expiration dates sick-day box items once a month. Replace items as needed.

Call your child’s health care provider

Contact your child's health care provider right away if:

  • You're not sure how much insulin to give when your child is sick.

  • Your child's blood sugar is higher than usual or over 250 mg/dL and doesn't go down after getting insulin.

  • Your child's blood sugar level is lower than usual or less than 70 mg/dL.

  • Your child's blood or urine has ketones.

If you test your child for ketones and think he or she has ketoacidosis, call 911 or take him or her to the hospital emergency department right away.


For more information about diabetes, visit these websites:

  • American Diabetes Association

  • Children with Diabetes

  • Juvenile Diabetes Research Foundation

  • American Association of Diabetes Educators

  • American Association of Clinical Endocrinologists

  • National Diabetes Information Clearinghouse


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