From the Guidelines
Diabetic ketoacidosis (DKA) is primarily caused by insulin deficiency combined with increased levels of counterregulatory hormones, with the main causes including undiagnosed type 1 diabetes, insulin therapy omission in known diabetics, and physiological stress, as supported by recent guidelines 1. The main causes of DKA include:
- Undiagnosed type 1 diabetes
- Insulin therapy omission in known diabetics
- Physiological stress
- Infections, especially urinary tract infections and pneumonia, which trigger about 30-40% of DKA episodes by increasing insulin resistance through stress hormone release
- Cardiovascular events, such as myocardial infarction and stroke
- Medications, including glucocorticoids, thiazide diuretics, sympathomimetics, and antipsychotics
- Substance abuse, such as alcohol and cocaine
- Pancreatitis, trauma, surgery, and emotional stress In type 2 diabetes, certain conditions like severe illness or SGLT2 inhibitor use can occasionally precipitate DKA, as noted in recent studies 2. Physiologically, insulin deficiency leads to increased lipolysis, hepatic fatty acid oxidation, and ketone body production, while also promoting hyperglycemia through increased gluconeogenesis and decreased glucose utilization, ultimately resulting in the metabolic derangements characteristic of DKA, highlighting the importance of prompt and effective treatment to prevent morbidity and mortality 1.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency)
The causes of Diabetic Ketoacidosis (DKA) include:
- Omitting insulin or taking less than prescribed
- Eating significantly more than the meal plan suggests
- Developing a fever, infection, or other significant stressful situation
- Prolonged hyperglycemia in patients with type 1 or insulin-dependent diabetes [3] [4]
From the Research
Causes of Diabetic Ketoacidosis (DKA)
The causes of DKA can be attributed to several factors, including:
- Insulin non-adherence, which was seen in 51.2% of cases 5
- Pump/tubing related issues, particularly in patients using continuous subcutaneous insulin infusion (CSII), accounting for 55% of cases in this group 5
- Social factors, education, and insulin pump malfunction may also play a role in the etiology of DKA in young adults with type 1 diabetes, especially in CSII users 5
- Other precipitating events, such as infection, trauma, or medication non-adherence, can also contribute to the development of DKA 6
Pathogenesis and Risk Factors
DKA can occur in patients with both type 1 and type 2 diabetes, with the former being more commonly affected 7, 6, 8
- The pathogenesis of DKA involves a complex interplay of hyperglycemia, ketosis, and metabolic acidosis 7, 8
- Risk factors for DKA include poor glycemic control, infection, and certain medications, such as sodium glucose co-transporter inhibitors 6, 9
Diagnosis and Management
A diagnosis of DKA is confirmed when all three criteria are present: elevated blood glucose levels, high urinary or blood ketoacids, and a high anion gap metabolic acidosis 7, 9