The initial symptoms of diabetic ketoacidosis can develop quite suddenly and will continue to get worse if not treated.

Early symptoms

In the early stages, the main signs of diabetic ketoacidosis are:

• passing large amounts of urine
• severe thirst
• feeling sick
• tiredness
• abdominal (tummy) pain 
• shortness of breath

You may also develop other symptoms of dehydration, such as a dry mouth.

If you have your own device or kit to measure your blood sugar and/or ketone levels, you may notice that the levels of both of these are higher than normal.

Advanced symptoms

Left untreated, more advanced symptoms can develop, such as:

• rapid heartbeat (tachycardia)
• rapid breathing, where you breathe in more oxygen than your body actually needs (hyperventilate) 
• vomiting
• dizziness
• a smell of ketones on your breath, which can smell like pear drops or nail varnish remover 
• confusion
• drowsiness or loss of consciousness (coma)

In some cases, life-threatening complications of diabetic ketoacidosis can also develop.

When to seek medical advice

If you think you or your child are experiencing early symptoms of diabetic ketoacidosis, and self-testing shows you have a high blood glucose and/or ketone level, you should immediately contact your diabetes care team or GP for advice.

If this isn't possible, call your local out-of-hours service or NHS 111.

If you or someone in your care appears to be experiencing more advanced symptoms, go immediately to your nearest accident and emergency (A&E) department.