Common Triggers of Diabetic Ketoacidosis: Causes and Risk Factors Explained

Understanding Diabetic Ketoacidosis (DKA): A Serious Complication of Diabetes

Diabetic ketoacidosis (DKA) is a life-threatening condition that primarily affects individuals with type 1 diabetes, although it can also occur in those with type 2 diabetes under certain circumstances. It develops when the body starts breaking down fat at a rapid rate due to insufficient insulin, leading to a buildup of acidic substances called ketones in the bloodstream. Recognizing the common triggers of DKA is essential for prevention and early intervention.

1. Insulin Omission or Interruption

One of the most frequent causes of DKA is the intentional or accidental interruption of insulin therapy. Many people with type 1 diabetes rely on daily insulin injections to regulate blood glucose levels. Skipping doses—even for a short period—can lead to a sharp rise in blood sugar. Without adequate insulin, cells cannot absorb glucose for energy, forcing the body to burn fat instead, which produces ketones. This metabolic shift can rapidly progress into ketoacidosis if not addressed promptly.

2. Acute Illnesses and Infections

Infections such as pneumonia, urinary tract infections (UTIs), and sepsis are significant physiological stressors that can trigger DKA. During illness, the body releases stress hormones like cortisol and adrenaline, which counteract insulin and elevate blood glucose levels. Common conditions like the flu or bacterial infections increase insulin requirements, and if patients do not adjust their treatment accordingly, the risk of developing DKA rises substantially.

3. Physical Trauma and Severe Injury

Serious physical trauma, including car accidents, major surgery, or extensive burns, can act as potent catalysts for DKA. The body's inflammatory response to injury increases insulin resistance and stimulates glucose production in the liver. Even individuals with well-managed diabetes may experience dangerous fluctuations in blood sugar during recovery, making close monitoring essential in hospital settings.

4. Psychological and Emotional Stress

Mental health should not be overlooked when discussing DKA triggers. Severe emotional or psychological stress—such as grief, anxiety, or trauma—can disrupt hormonal balance and impair glucose control. Stress-induced surges in glucagon and catecholamines reduce insulin effectiveness, potentially pushing vulnerable individuals into a state of metabolic crisis. Addressing mental well-being is a crucial component of comprehensive diabetes care.

5. Use of Hyperglycemia-Inducing Medications

Certain medications can interfere with glucose metabolism and increase the risk of DKA. Corticosteroids, often prescribed for inflammation or autoimmune disorders, are well-known for raising blood sugar levels. Similarly, diuretics, especially thiazide types, may contribute to dehydration and electrolyte imbalances, worsening insulin resistance. Other drugs, such as antipsychotics or certain immunosuppressants, can also alter glucose regulation. Patients should always consult healthcare providers about potential side effects and monitor their blood sugar more closely when starting new treatments.

Prevention and Early Recognition Are Key

While DKA is a medical emergency, it is largely preventable through consistent diabetes management, regular monitoring, and timely adjustments during periods of stress or illness. Educating patients about warning signs—such as excessive thirst, frequent urination, nausea, fruity-smelling breath, and confusion—can lead to earlier diagnosis and better outcomes. Staying informed and proactive plays a vital role in reducing the incidence of this serious complication.