Diabetes and Your Child: Preventing Diabetic Ketoacidosis (DKA)

Diabetes and Your Child: Preventing Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a rare but serious condition. It can happen if your child’s diabetes is not managed properly. Left untreated, DKA can cause your child to go into a coma. In some cases, it can even cause death. But you can take action to keep your child from having DKA. 

Understanding Ketones

The body’s cells need glucose to burn for energy. If glucose is not getting into the cells, the body has to burn fat instead. But burning fat produces a waste product called ketones. Ketones can build up dangerously in the blood and urine. Your child’s body can’t handle large amounts of ketones.

What Are the Causes of DKA?

When large amounts of ketones build up in the blood, it can cause diabetic ketoacidosis. This means that the chemical balance of the blood is upset. DKA may be more common in children with type 1 diabetes than in children with type 2. The following are the most common causes of DKA:

  • A lack of needed insulin in your child’s blood (this can happen if your child misses his or her insulin shots)

  • Illness (flu, cold, or infection)

  • An insulin pump that is broken or not working properly

  • Insulin that has expired or has not been stored properly

What Are the Symptoms of DKA?

Often, symptoms of DKA can look like the flu. Contact your child’s healthcare provider or seek emergency care right away if you notice any of these symptoms:

  • Ketones present in urine or blood (see “How to Check for Ketones” below)

  • Nausea

  • Vomiting

  • Fruity-smelling breath

  • Stomach cramps

  • Very dark urine or no urine in 6 hours

  • Rapid, deep breathing

  • Thirst or very dry mouth

  • Drowsiness or trouble concentrating

When to Check for Ketones

Always check for ketones when your child has any of the above symptoms, or has:

  • Blood sugar above 240.

  • 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 healthcare provider

How to Check for Ketones

Ask your child’s healthcare provider to show you how to check for ketones at home. Ketone testing is most often done with urine test strips. For a baby or toddler, 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. For older children, follow the directions on the test strip package. Some blood glucose meters may also be used to check for ketones in your child’s blood. Ask your child’s healthcare provider for more information. If ketones are present in the blood or urine, call your child’s healthcare provider right away. 

Preventing DKA

Woman giving glass of water to girl lying in bed. Diabetes kit is on bed.
Follow your child’s sick-day plan to help prevent DKA.

DKA can 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 healthcare 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 every 4 hours when he or she is sick. Ask the healthcare 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

  • Can of soup

  • Crackers

  • Juice boxes

  • Flavored gelatin, such as Jell-O, with and without sugar (these can be kept in the refrigerator)

  • Frozen juice bars with and without sugar (these should be kept separately in the freezer)

  • Suppository medication to stop nausea and vomiting, if needed

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

Call your child’s healthcare provider right away if your child has:

  • Vomiting or diarrhea

  • 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 healthcare provider

  • Blood sugar of 240 or higher that does not lower after your child receives insulin

  • Blood sugar under 70

  • Ketones present in blood or urine


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

NOTE: This sheet does not give all the information you need to care for your child with diabetes. Ask your child’s healthcare provider for more information.