Ask the Diabetes Educator Archive

I was told by a physician that when a patient is in DKA only approximatley 30% of the population can actually smell acetone on the patient's breath. Is this true? Why can some smell and most can not? Your answer will be very helpful to a family member with diabetes.

I do not know specifically why some smell "fruity" breath and others not. However, there are other signs of DKA (diabetic ketoacidosis), especially if a person has a history of this. With DKA, insulin is not making it into the cells, so you will often begin to see some of the "starvation" signs: frequent urination, thirst and perhaps hunger. Blood sugars in Type 1's may only be around 500. Other signs may be those of high blood sugar: fatigue, lack of focus, headaches, etc. There are Keto sticks you should keep on hand that can readily show you from a urine dip if one is spilling ketones and how high they are. This would be one of your best "tools" if you are dealing with this. Call your practitioner immediately if you see ketones. It is often wise to work out a plan ahead so that you know how much insulin to give for what level of noted ketones. This could head off a bout with DKA.

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