A Young Athlete’s Story: The Essential Role of Ketone Checks in Preventing DKA
Living with Diabetes: A Daily Balancing Act
With roughly 16% of adults in the U.S. are living with diabetes[1] –about 1 in 6 people – many know the constant balancing act associated with managing it. The daily routine of monitoring glucose, carefully planning meals, staying on top of medications, and, for some, adjusting insulin dosages is a non-stop job that can be challenging. While many people with diabetes as well as caregivers navigate diabetes management effectively, life happens –even just a change in routine can put one at risk of a medical emergency. One of the most serious emergencies associated with diabetes is diabetic ketoacidosis (DKA).[2]
What is diabetic ketoacidosis (DKA)?
DKA is a potentially life-threatening complication that can strike at any age in people with Type 1 or Type 2 diabetes who use insulin.2 Many people with diabetes and their caregivers aren’t familiar with DKA,[3] but it’s a leading cause of death among children and adults with Type 1 diabetes under 58 years of age2 and is one of the most common high blood sugar emergencies.[4]
DKA occurs when the body doesn’t have enough insulin to get nutrients to its cells. As a result, the body begins to break down fat for energy, leading to a buildup of ketones in the blood.[5] When ketone levels get too high, they make the blood acidic and are harmful to the body.[6]
The most common triggers for DKA can be unpredictable, and symptoms of an impending DKA emergency are often mistaken for less serious illnesses like the stomach flu or food poisoning[7] – all of which can result in misdiagnosis and missed chances to prevent DKA.[8] A simple change in routine –such as travel, summer camp, or the end of the school year – can result in missed, mistimed, or insufficient insulin doses,2 which can lead to elevated ketones and, ultimately, DKA.
Symptoms of DKA include5:
- Abdominal pain
- Nausea
- Vomiting
- Severe thirst
- Confusion
- Fruity-smelling breath[9]
- Rapid, shallow breathing
The risk of DKA can increase with insulin pump challenges such as infusion site issues and the use of medications like SGLT-2 inhibitors.2
To better understand the real impact of DKA, we sought a first-person perspective with Trinity Lindblade, who has Type 1 diabetes. She shares her experience living with diabetes as a college athlete, including how she keeps on top of her diabetes management on and off the court, and provides insights into DKA warning signs, prevention, and the importance of ketone checks.
Trinity’s Story: A Personal Encounter with DKA
*Disclaimer: views expressed in this Q&A are Trinity’s own.
Q: Tell us about how your diabetes journey was going before your DKA episode. How do you best manage it now with your daily life and sports?
A: Before my DKA episode, I was not very good at managing my condition. My parents tried their best to help me manage, but there were plenty of moments when I ate high-carb food over other options. If I was getting ready to play sports, I would make sure that my blood sugar was around 200 to give some cushion so I’d fall into the normal range if it began to drop. Now, I do my best to stay on top of my blood sugar by watching what I eat, making sure I do appropriate carb counting, and remembering that it is an everyday thing, so I cannot slack even on days where it feels impossible.
Q: Can you share with us your experience with your first episode of DKA? Did you initially think your symptoms were something else?
A: Because I have never experienced something like that before, I thought my symptoms were something else. It wasn’t until I noticed my breath was starting to smell like fruit that I realized something was wrong. My first episode was scary. I was in school, and I felt like I was going to throw up. I had to run to the bathroom and when I was finally able to contain myself, I told my teacher I had to go see my dad who was also a teacher at the school. I started throwing up again and knew something was wrong. I told my dad he needed to take me to the hospital immediately, which he did.
Q: Were you familiar with DKA before your episode? What do you wish you knew about DKA before your event?
A: I was familiar with DKA before my episode. I knew that people had to go to the hospital if their blood sugar was too high for prolonged periods of time, but I never really understood the severity of it until that day. I wish I knew how important it is to take care of yourself to prevent something like that. It’s terrifying not only for you but for your family to see you in a condition like that.
Q: How has your experience with DKA impacted your day-to-day diabetes management?
A: Now, I try to stay on top of it better. Every day, I am learning more about my body and how it reacts to changes, especially from certain foods. Paying attention to the little things is very important to prevent something like that from happening again.
Q: Do you have a plan in place for if/when you detect elevated ketones?
A: The first part of my game plan is to make sure I do not also have high blood sugar. Although you can have your blood sugar in range, you may still have ketones in your body lingering from when it was too high. After that, I start drinking a lot of water to help push the ketones through and out of my body before they cause too much damage. In elementary school, I had a fun school nurse who would challenge me to a water chugging contest if she knew I did not want to drink water. She knew how competitive I was, so of course I wouldn’t say no.
Q: What would you like to share with the diabetes community and the loved ones of people living with diabetes about DKA?
A: Every day is a new day, some days are going to be harder than others, but I believe God only gives you what you can handle. It’s okay to feel like you can’t manage your condition because it’s hard. But it is important not to give up and try your best. If you do not see the results you want to see, keep working at it until you do, and then learn to maintain.
Something I would like to share with the loved ones of people living with diabetes is to do your best to support them. What they are going through is not easy, and it makes it even harder if there are no people in your corner cheering you on through this journey. It means a lot to people with diabetes to have people around us who work to understand us and what we are living with.
Preventing DKA: Your Health is in Your Hands
Trinity’s story is a powerful reminder of the seriousness of DKA and the importance of managing all the dimensions of diabetes. But the good news – and what her story shows – is that DKA can be avoidable if you know the signs and symptoms and have a good game plan in place, such as checking ketone levels and adjusting insulin dosages.
To prevent DKA, know when to check ketones – if you or your loved one are feeling unwell, miss an insulin dose, have high blood sugar, or are injured or stressed. Stay prepared by ensuring at-home ketone blood and/or urine test strips are accessible and not expired, even if you or your loved one haven’t needed them in a while. They can be extremely useful in unexpected situations.
Continue to educate yourself or your loved one about DKA by regularly talking with a healthcare provider about risks, symptoms, and how to manage elevated ketones. Understanding DKA, having a good support system, and an emergency plan in place can make all the difference.
*Ketones can still be high even if your glucose isn’t.
[1] Centers for Disease Control and Prevention. (2024, October 9). Provisional estimates for early childhood overweight and obesity based on the 2022–2023 National Survey of Children’s Health. National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db516.htm#xd_co_f=NWJjMmNlOTMtZmUxZS00MzViLTllZGUtZDViNzVjNzg5ZTI4~
[2]Umpierrez, G., Davis, G., ElSayed, N., & Fadini, G. P. (2024, July 25). Hyperglycemic crises in adults with diabetes: A consensus report | diabetes care | american diabetes association. Diabetes Care. https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A
[3] Hepprich, M., Roser, P., Stiebitz, S., Felix, B., Schultes, B., Schmitz, D., Rutishauser, J., Schubert, S., Aberle, J., & Rudofsky, G. (2023). Awareness and knowledge of diabetic ketoacidosis in people with type 1 diabetes: a cross-sectional, multicenter survey. BMJ open diabetes research & care, 11(6), e003662. https://doi.org/10.1136/bmjdrc-2023-003662
[4] Nguyen, K. T. Journal of Diabetes Science and Technology (2022). https://doi.org/10.1177/19322968211042656.
[5] CDC– Diabetic Ketoacidosis, accessed May 2025 from: https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html
[6] Diabetes & DKA (ketoacidosis). Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention. (n.d.-a). https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones#:~:text=Constantly%20feeling%20tired,time%20paying%20attention%2C%20or%20confusion
[7] Lizzo, J. M. StatPearls (2024). https://www.ncbi.nlm.nih.gov/books/NBK560723.
[8] Virdi, N. Diabetes Technology & Therapeutics (2023). https://doi.org/10.1089/dia.2023.0149.
[9] What are the signs of DKA?. Cleveland Clinic. (2025, April 21). https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka