Can Type 2 Diabetics Get DKA?

Type 2 Diabetes is often times associated with many conditions, but can type 2 diabetics get DKA? Well before I get to that, it’s important to understand how complications happen in diabetes.

When it comes to diabetes, high blood sugar is usually a sign of something going wrong in the body. And as a result, high blood sugar can lead to complications that can affect many organs and manifest itself in different ways.

But the key here when talking about high blood sugar is uncontrolled diabetes.

In type 2 diabetes, this is usually associated with insulin deficiency or beta cell dysfunction and insulin resistance. While with type 1, high blood sugar levels usually are the result of insulin deficit. The pancreas just doesn’t produce enough insulin.

What is DKA

Diabetic Ketoacidosis or DKA occurs in patients with type 1 diabetes when insulin is absent or insufficient. Insulin is the key that unlocks the door or your cells to allow glucose (sugar) in. Without sugar to use for your energy needs, your body begins to burn fat for energy that the cells of your body need to survive. As a result of fat metabolism, acids called ketones are released into your urine.

These ketones can be found in your urine and may also be smelled on your breath. In large amounts ketones are toxic.

DKA is a life-threatening condition with a 10% mortality rate that is triggered usually by a stressor like an illness or infection. But can also happen as a result of missed insulin doses, or not enough insulin. This condition is more common in people with uncontrolled type 1 diabetes than in type 2. Usually people with DKA have high blood sugar in the 250-600 mg/dl range.

Every year about 2-5% of patients with type 1 diabetes will experience DKA. And this condition is usually seen in people who have already been diagnosed with diabetes but can also be the first sign of diabetes. Especially in children. DKA develops over several days of illness.

Can Type 2 Diabetes Get DKA

The answer to this question is usually no. And the reason is because when the body can still make insulin, the beta cells (the cells of your body that produce insulin) prevent ketones from forming. A condition that is more common with type 2 diabetes is called Hyperglycemic Hyperosmolar State or HHS.

HHS is a rare complication of type 2 diabetes which happens when blood sugar levels are very high. Usually blood sugars are twice as high as DKA in the 600-1200 mg/dl range. HHS commonly presents as dehydration, mental impairment, frequent urination, seizures may be present, some insulin is on board which prevents ketone bodies from forming. HHS has a greater than 50% mortality rate.

HHS is often times started by a serious illness such as stroke, infection, or heart attack.

For both of these conditions, the treatment is rehydration, insulin administration, electrolyte replacemnt and treating the underlying cause.


DKA is a condition that usually happens in uncontrolled type 1 diabetes and is rare in type 2. A dangerous and potentially deadly condition that can happen with uncontrolled type 2 diabetes is Hyperglycemic Hyperosmolar State or HHS. Both of these conditions are very dangerous and require immediate medical attention. They both also present in a slightly different manner, but both are treated with hydration, insulin, and addressing the underlying cause.

Prior to using any of this information please consult with your physician.

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