Your child had diabetic ketoacidosis (DKA) and was treated in the hospital. They are now stable and ready to continue treatment at home.

Your diabetes care team will support you and your child as you learn how to manage your child's diabetes and prevent DKA. Management includes checking your child's blood glucose levels (also called blood sugar levels) and giving insulin to keep blood glucose levels steady.

Here's how to care for your child.

Follow your diabetes care team's instructions for:

• Checking your child's blood glucose level
• How to adjust insulin doses, meals, or physical activity based on what the numbers show
• What to do if your child's glucose level is too high (hyperglycemia) or low (hypoglycemia)
• When to check your child's urine (pee) for ketones
• Any diet changes to make
• Whether to see a dietitian (food specialist) for meal-planning help
• When to follow up with the care team

Stay nearby when your child checks their blood sugar or takes insulin to make sure they're doing it right. This will also help them build good habits.

Your child:

• Has symptoms of hyperglycemia, such as peeing more than usual, feeling very thirsty, or feeling tired
• Has symptoms of hypoglycemia, such as tiredness, weakness, shakiness, sweating, or nightmares
• Often has high or low blood sugar levels
• Isn't eating or drinking as usual
• Has nausea, vomiting (throwing up), or ketones in the pee (These can all be early warning signs of DKA.)

Your child:

• Has high or low blood sugar that doesn't get better with treatment at home
• Has symptoms of DKA, such as:
  • Ongoing nausea, vomiting, or belly pain
  • Very high blood glucose levels
  • Fast or deep breathing
  • Breath that smells fruity
  • Confusion, exhaustion, or passing out
• Isn't drinking at all or has signs of dehydration (not enough water in the body), such as a dry or sticky mouth, sunken eyes, less pee or darker pee than usual, little or no tears when crying, or unusual sleepiness

What is diabetes? Diabetes happens when the pancreas (an organ in the belly) no longer makes insulin. Insulin is a hormone that helps move glucose (sugar) from the blood into the cells, where it is used for energy.

What happens in DKA? In DKA, someone with diabetes has a high blood glucose level (hyperglycemia) for a while. Since they don't have insulin to move the glucose into the cells, it stays in the blood and the body can't use it for energy. The body starts using fat for energy instead of glucose. This creates chemicals called ketones (KEE-tones). Ketones make the blood too acidic. This can cause serious damage to organs and even death. DKA is a medical emergency.

What causes DKA? DKA can happen if someone with diabetes:

• Doesn't take enough insulin
• Has an illness such as the “flu,” a urinary tract infection, or other infection (the body needs more insulin when someone is sick)

Sometimes someone who doesn't know they have diabetes goes without insulin for a while and goes into DKA. When they go to their healthcare provider or the hospital, testing shows that they have diabetes.

What are the symptoms of DKA? At first someone with DKA may:

• Have less energy/feel extremely tired
• Feel very thirsty
• Pee a lot
• Have ketones in the pee

The symptoms don't always happen all at once. They usually happen over several hours. More serious symptoms include:

• Dehydration
• Fast or deep breathing
• Nausea, vomiting, or belly pain
• Breath that smells fruity
• Confusion, exhaustion, or passing out