<P> DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances . Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids . DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies . DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine . </P> <P> The primary treatment of DKA is with intravenous fluids and insulin . Depending on the severity, insulin may be given intravenously or by injection under the skin . Usually potassium is also needed to prevent the development of low blood potassium . Throughout treatment blood sugar and potassium levels should be regularly checked . Antibiotics may be required in those with an underlying infection . In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended . </P> <P> Rates of DKA vary around the world . In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year . DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal . The risk of death with adequate and timely treatment is currently around 1--4% . </P> <P> The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours . Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe . In severe DKA, breathing becomes rapid and of a deep, gasping character, called "Kussmaul breathing". The abdomen may be tender to the point that a serious abdominal condition may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation . Vomiting blood that resembles coffee grounds occurs in a minority of people and tends to originate from erosion of the esophagus . In severe DKA, there may be confusion or a marked decrease in alertness, including coma . </P>

Untreated chronic ketone body production will lower blood ph levels