How To Treat Ketoacidosis

  • Immediately drink a large amount of non-caloric or low caloric fluid. Continue to drink 8 to 12 oz. every 30 minutes. Diluted Gatorade, water with Nu-Salt™ and similar fluids are good because they help restore potassium lost because of high blood sugars.
  • Take larger-than-normal correction boluses every 3 hours until the blood sugar is below 200 mg/dl (11 mmol) and ketones are negative. It will take much more rapid insulin than normal to bring blood sugars down when ketones are present in the urine or blood. Often, one and a half to two times the normal insulin dose for a high blood sugar will be necessary. Higher insulin doses than these will be needed if there is an infection or other major stress.
  • If nausea becomes severe or lasts 4 hours or more, call your physician.
  • If vomiting starts or you can no longer drink fluids, have a friend or family member call your physician immediately, then go directly to an emergency room for treatment.
  • Never omit your insulin, even if you cannot eat. A reduced insulin dose might be needed, but only if your blood sugar is currently low.

When high blood sugars or ketoacidosis happen, it is critical that you drink lots of fluid to prevent dehydration. Take extra amounts of Humalog, Novolog or Regular insulin to bring the blood sugars down. Children with severe ketoacidosis lose 10-15 % of their previous body weight (i.e., a 60 lb. child can lose 6 to 9 lbs. of weight) due to severe dehydration. The replacement of fluids should be monitored carefully.

The dehydration is caused by excess urination due to high blood sugars and is quickly worsened when vomiting starts due to ketoacidosis. The start of vomiting requires immediate attention at an ER or hospital where IV fluid replacement can begin. If only nausea is present and it is possible to drink, start with a large quantity of water or other noncaloric or low caloric fluid, then continue to drink at least 8 ounces every 30 minutes until the blood sugar is again normal. Sports drinks like Gatorade or water with a pinch of potassium-based Nu-Salt are helpful for replacing potassium lost during ketoacidosis.

To correct ketoacidosis, it helps to know how far your Blood Sugar Drops on each unit of Humalog, Novolog or Regular insulin so you know how much extra insulin to give. If the urine test shows that moderate or large amounts of ketones are present, much larger doses of insulin than usual may be needed, often one and a half to two times the usual doses. Check your blood sugar hourly until control has been regained. Be sure to check with your physician for the doses of Regular insulin to take and how often to take them.

If nausea or vomiting keeps you from drinking fluids, call your physician and immediately go to an emergency room for treatment. Check your urine for ketones whenever blood sugars go over 300 mg/dl (16.7 mmol). Ask your physician what action you should take with each ketone strip reading.

Anytime ketoacidosis happens, it should raise a red flag unless there is a clear reason, such as an illness or an infection. Insulin doses may be too low or you may need to know more about how to use insulin for blood sugar control. Discuss any problems you have regarding high blood sugars or ketoacidosis with your physician so problems can be quickly resolved and prevented from happening again.


It’s important to take insulin to bring down very high blood sugars.
But staying hydrated is as important at the start!


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