What are the causes of Diabetic Ketoacidosis (DKA)?

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Last updated: April 11, 2025 • View editorial policy

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

  • Management of DKA involves restoration of circulating volume, insulin therapy, electrolyte replacement, and treatment of any underlying precipitating event 7, 6

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

[Diabetic ketoacidosis].

Medicina (Kaunas, Lithuania), 2002

Research

Diabetic ketoacidosis.

Nature reviews. Disease primers, 2020

Research

Diabetic ketoacidosis.

Disease-a-month : DM, 2023

Research

Defining and characterising diabetic ketoacidosis in adults.

Diabetes research and clinical practice, 2019

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.