Can type 2 diabetics get DKA? Yes. The Centers for Disease Control and Prevention (CDC) says diabetic ketoacidosis (DKA) is most common in type 1 diabetes, but people with type 2 diabetes can also develop it. DKA is a medical emergency caused by too little insulin. Serious illness, missed medicine doses, and some medicines are among the triggers.
Key takeaways
- The CDC says DKA is most common in type 1 diabetes, but people with type 2 diabetes can also develop it. A 2024 consensus report says DKA can happen at any age and with any type of diabetes.
- Common triggers include infection, missed insulin doses, heart attack or stroke, alcohol or drug use, and some medicines, such as steroids.
- SGLT2 inhibitors, a class of diabetes medicines, raise DKA risk. The consensus report says DKA is still uncommon in people with type 2 diabetes who take them, but it can happen when blood sugar is not very high.
- Some adults with new diabetes first come to the hospital with DKA but turn out to have type 2 diabetes. This pattern is called ketosis-prone type 2 diabetes.
- Call 911 for trouble breathing, confusion, fruity-smelling breath, high ketones, or vomiting that keeps you from keeping food or drinks down.
Why Can People With Type 2 Diabetes Get DKA?
DKA develops when the body does not have enough insulin to let blood sugar into cells for energy, the CDC explains. The liver then breaks down fat for fuel, which makes acids called ketones. When too many ketones are made too fast, they build up and make the blood acidic.
This can happen in any type of diabetes. A 2024 consensus report on hyperglycemic crises from the American Diabetes Association (ADA) and four other diabetes organizations says DKA and a related emergency, hyperosmolar hyperglycemic state (HHS), can occur at any age in people with type 1, type 2, or any other type of diabetes. It adds that DKA is more common in young people with type 1 diabetes, and HHS is reported more often in older adults with type 2 diabetes. In the report, 70.6% of DKA events occurred in people with type 1 diabetes.
MedlinePlus says people with type 2 diabetes can develop euglycemic DKA, which is DKA without very high blood sugar, or HHS. It says these are usually triggered by long periods of high blood sugar, missed medicine doses, a side effect of some medicines, or a severe illness or infection. Our guide to hyperosmolar hyperglycemic state explains how HHS differs from DKA, and our main guide explains what diabetic ketoacidosis is.
The CDC also says DKA is sometimes the first noticeable sign of diabetes in people who have not been diagnosed. If you have not been diagnosed but have strong thirst and are urinating much more than usual, see our guide to symptoms of high blood sugar.
What Triggers DKA in Type 2 Diabetes?
DKA usually has a trigger. The sources below list the most common ones.
| Trigger | What the sources say |
|---|---|
| Infection | The consensus report says infection is the most common trigger of DKA worldwide, found in 14% to 58% of cases. |
| Other serious illness or injury | The CDC lists heart attack, stroke, and physical injury, such as from a car accident. The consensus report also lists pancreatitis and pulmonary embolism (a blood clot in the lungs). |
| Insulin problems | The CDC lists missed insulin shots, a clogged insulin pump, and the wrong insulin dose. The consensus report links insulin rationing because of cost to a higher risk of DKA. |
| Certain medicines | ADA 2026 lists glucocorticoids (steroids), antipsychotic medicines, immune checkpoint inhibitors, and SGLT2 inhibitors. The CDC also lists some diuretics (water pills). |
| Alcohol or drug use | The CDC and the consensus report both list alcohol and substance use. |
| Fasting or very low-carb eating | The ADA lists both as risk factors for ketones. The consensus report lists them as DKA risk factors for people with type 2 diabetes who take SGLT2 inhibitors. |
ADA 2026 also lists other long-term health conditions as a risk factor for hyperglycemic crises, particularly in people with type 2 diabetes. A high A1C, a past crisis, behavioral health conditions such as depression or eating disorders, and barriers to care are on the same list.
If you use insulin for type 2 diabetes, see whether type 2 diabetics require insulin and whether people with type 2 diabetes can use an insulin pump. If you take steroids, our guide to whether prednisone raises blood sugar explains what to ask.
Do SGLT2 Inhibitors Raise the Risk of DKA?
SGLT2 inhibitors are a class of diabetes medicines that help the kidneys pass sugar into the urine. Their generic names end in "-gliflozin." If you are not sure whether you take one, ask your pharmacist.
The consensus report says SGLT2 inhibitors have been found to raise the risk of DKA, most often in type 1 diabetes but also in type 2 diabetes. It also says DKA is uncommon in people with type 2 diabetes who take them, with an estimated 0.6 to 4.9 cases per 1,000 patient-years. One patient-year means one person taking the medicine for one year. The report says the risk is higher in people with type 2 diabetes who make very little insulin of their own.
The report lists these added DKA risk factors for people with type 2 diabetes who take an SGLT2 inhibitor:
- Very low-carb diets and prolonged fasting
- Dehydration
- Drinking too much alcohol
- Autoimmunity, when the immune system attacks the body's own cells
DKA linked to these medicines may not come with very high blood sugar. In one series described in the consensus report, 35% of people taking SGLT2 inhibitors who came in with DKA had blood sugar below 200 mg/dL. In another, 71% had 250 mg/dL or lower. A reading that looks normal does not rule out DKA. Our guide to euglycemic DKA explains more.
Surgery matters too. ADA 2026 says SGLT2 inhibitors should be held for 3 to 4 days before planned surgery. Your surgical team sets the timing, so tell them about every medicine you take. Never stop an SGLT2 inhibitor or any other medicine on your own.
What Is Ketosis-Prone Type 2 Diabetes?
The consensus report says several studies have found that more than half of Black and Hispanic adults with newly diagnosed diabetes who come in with DKA that has no clear trigger have type 2 diabetes. In medical research, this pattern is called atypical diabetes or ketosis-prone type 2 diabetes.
The report says people with this pattern often have:
- High rates of obesity
- A strong family history of diabetes
- Some ability to still make their own insulin
- No autoimmune markers of the kind seen in type 1 diabetes
- The ability to stop insulin during follow-up
The first episode looks like classic DKA in type 1 diabetes, the report says. After treatment and a short course of insulin, it is often possible to keep blood sugar near normal for a long time, because the insulin-making cells and the body's response to insulin recover. Insulin is then stopped gradually, and blood sugar goals are kept with medical nutrition therapy and non-insulin medicines. A clinician guides each of these steps.
A past DKA episode is still a risk factor for ketones, according to the ADA, so keep up with follow-up care even when blood sugar is in range. To learn how the types of diabetes differ, see type 1 vs. type 2 diabetes and what LADA diabetes is.
What Are the Warning Signs, and Should You Check Ketones?
The warning signs are the same in type 2 diabetes as in type 1. The CDC says DKA usually develops slowly, starting with strong thirst and urinating a lot more than usual. If it is not treated, more severe symptoms can appear quickly, including fast, deep breathing, dry skin and mouth, a flushed face, fruity-smelling breath, headache, muscle aches, being very tired, nausea and vomiting, and stomach pain. The ADA also lists confusion.
ADA 2026 says a hyperglycemic crisis should be considered in anyone with signs such as frequent urination, strong thirst, weight loss, vomiting, dehydration, and a change in thinking. Not everyone has every sign. For more on two of these, see whether diabetes causes dry mouth and whether diabetes causes weight loss.
Ketone checks. Ask your care team whether you should keep ketone strips or a blood ketone meter at home. The ADA lists taking insulin or an SGLT2 inhibitor, a past DKA episode, and pregnancy among the risk factors for ketones. The CDC advises checking your blood sugar every 4 to 6 hours and checking for ketones if you are sick or your blood sugar is 250 mg/dL or higher, and also if you have any DKA symptoms. ADA 2026 says people at risk for DKA should check ketones when they have symptoms or a possible trigger, such as illness or missed insulin doses, particularly if blood sugar is above 200 mg/dL.
Our guides to checking your blood sugar at home and when to check blood sugar cover the basics.
What Should You Ask After a DKA Hospital Stay?
ADA 2026 recommends that clinicians review any history of DKA or HHS at every visit for people at risk. It also recommends structured education on recognizing, preventing, and managing these emergencies for people with type 2 diabetes who have had one.
DKA can come back. The consensus report says 10% to 20% of people are readmitted to the hospital after DKA or another hyperglycemic crisis, mostly within 2 weeks of going home. ADA 2026 advises a follow-up visit within 1 month of leaving the hospital, or within 1 to 2 weeks if diabetes medicines were changed. It also says people who have had DKA or HHS should be screened for barriers such as trouble getting insulin, other diabetes medicines, or glucose monitoring supplies.
Medicines may change after DKA. The consensus report says SGLT2 inhibitors are stopped when someone is admitted with DKA. It says restarting them after DKA in type 2 diabetes is not routinely recommended because there is not enough safety data. Your care team decides which medicines fit you now, so do not restart or stop any medicine on your own.
Questions to bring to your follow-up visit:
- What caused this episode, and how can we lower the chance it happens again?
- Did any of my medicines change, and why?
- Should I keep ketone strips or a blood ketone meter at home, and when should I use them?
- What is my sick-day plan, and when should I call you or 911?
- Can I see a diabetes educator?
- What can I do if I have trouble paying for insulin or supplies?
If you do not have a regular diabetes clinician, our guide to finding a diabetes doctor near you explains where to start. Writing down readings, symptoms, and sick days before the visit can help. Our blood sugar journal prompts offer a simple way to begin.
How Can People With Type 2 Diabetes Lower Their Risk?
These steps come from the CDC and the ADA:
- Take medicines as prescribed, even if you feel fine, as the CDC advises.
- Check your blood sugar more often when you are sick. The CDC says to check it often, especially during illness.
- Make a sick-day plan with your care team that covers ketone checks, fluids, medicines, and when to call. Our diabetes sick day rules guide explains what to ask.
- Stay hydrated with water or sugar-free fluids, as the ADA suggests.
- Ask before fasting or very low-carb eating, especially if you take an SGLT2 inhibitor. See whether fasting lowers blood sugar.
- Talk with your care team about alcohol. The CDC lists alcohol use as a cause of DKA. See whether diabetics can drink alcohol.
- Tell every clinician which diabetes medicines you take, especially before surgery or a procedure.
ADA 2026 says structured diabetes self-management education that includes problem-solving is effective at reducing DKA admissions. Our guide to diabetes self-management education and support explains how to find a program.
When Should You Get Help?
Emergency: Call 911 or go to the emergency room for high ketones, trouble breathing, fruity-smelling breath, confusion or decreased alertness, or vomiting that keeps you from keeping food or drinks down. The CDC also advises emergency care if your blood sugar stays at 300 mg/dL or higher or you have several signs of DKA. The ADA says blood ketones of 1.6 mmol/L or higher need emergency care.
Same day: Contact your care team right away if a home test shows ketones, as MedlinePlus advises. Also call if you are sick and your blood sugar stays above your target, or if you take an SGLT2 inhibitor and feel unwell while eating or drinking much less than usual.
Prompt appointment: After any DKA hospital stay, book a follow-up visit within 1 month, or within 1 to 2 weeks if your medicines changed, as ADA 2026 advises. Also book a visit to make a sick-day plan, review your medicines before surgery, or talk about trouble paying for insulin or supplies.
Frequently Asked Questions
How common is DKA in type 2 diabetes?
The CDC says DKA is most common in type 1 diabetes, but people with type 2 diabetes can develop it too. A 2024 consensus report found that 70.6% of DKA events occurred in people with type 1 diabetes. It also says DKA is uncommon in people with type 2 diabetes who take SGLT2 inhibitors.
Which medicines raise the risk of DKA?
ADA 2026 lists glucocorticoids, antipsychotic medicines, immune checkpoint inhibitors, and SGLT2 inhibitors. The CDC also lists some diuretics, also called water pills, and corticosteroids. Never stop a prescribed medicine on your own. Ask your care team or pharmacist whether any of yours raise your risk.
Can you get DKA with normal blood sugar in type 2 diabetes?
Yes. This is called euglycemic DKA. ADA 2026 says about 10% of people with DKA have blood sugar below 200 mg/dL. The 2024 consensus report says SGLT2 inhibitors now account for most cases of euglycemic DKA.
What is ketosis-prone type 2 diabetes?
It is a pattern in which an adult with newly diagnosed diabetes comes to the hospital with DKA but turns out to have type 2 diabetes. The consensus report says many have obesity and a family history of diabetes, still make some insulin, and lack the autoimmune markers of type 1 diabetes. It is often possible to stop insulin gradually later, under a clinician's care.
Should people with type 2 diabetes check for ketones?
Ask your care team. The CDC advises checking for ketones if you are sick or your blood sugar is 250 mg/dL or higher, and if you have any DKA symptoms. The ADA lists taking insulin or an SGLT2 inhibitor, a past DKA episode, and pregnancy among the risk factors for ketones.
Can DKA happen again?
Yes. The ADA lists a past DKA episode as a risk factor for ketones. The consensus report says 10% to 20% of people are readmitted to the hospital after DKA or another hyperglycemic crisis, mostly within 2 weeks. A prompt follow-up visit and a written sick-day plan can help you prepare.
References
- Centers for Disease Control and Prevention. “Diabetic Ketoacidosis.” Accessed October 2026.
- American Diabetes Association. “DKA: Signs, Symptoms, and Treatment.” Accessed October 2026.
- American Diabetes Association. “Managing Ketones with Diabetes.” Accessed October 2026.
- MedlinePlus. “Diabetic Ketoacidosis.” Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. “16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S339–S355. Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. “6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S132–S149. Accessed October 2026.
- Umpierrez GE, Davis GM, ElSayed NA, et al. “Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.” Diabetes Care. 2024;47(8):1257–1275. Accessed October 2026.
- Banerji MA, Chaiken RL, Huey H, et al. “GAD antibody negative NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4. Flatbush diabetes.” Diabetes. 1994;43(6):741–745. Historical context only. Accessed October 2026.
Next Steps
Write down every diabetes medicine you take, including whether any is an SGLT2 inhibitor, and bring the list to your next visit. Ask your care team for a written sick-day plan that says when to check ketones, what to drink, and when to call 911.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program offers a holistic approach to diabetes type 2 that organizes learning about meals, movement, sleep, and stress. It does not diagnose or treat DKA or diabetes, interpret ketone or glucose results, change medicines, or replace emergency or clinical care.