Many people with diabetes can usually manage and tolerate minor blood sugar fluctuations on their own, but there is one situation that absolutely cannot be delayed, waited out, or endured at home, which isKetoacidosis。

This is not simply high blood sugar, but rather the body has already developedAcidosisIf delayed further, it could easily lead to coma, admission to the ICU, or even life-threatening consequences. I have personally experienced this ordeal and know all too well how terrifying it can be.

Ketoacidosis, how high does blood sugar have to be to be considered dangerous?

This is a very critical issue. Based on the latest consensus released by authoritative institutions such as the American Diabetes Association (ADA) in 2024,The blood glucose cutoff for diagnosing ketoacidosis is: ≥11.1 mmol/L (200 mg/dL)。

I put this number in your heart in the most direct way:

If blood sugar exceeds 11.1 mmol/L and is accompanied by symptoms such as nausea, vomiting, a fruity odor on the breath, extreme thirst, and severe weakness, do not hesitate to question whether it is high enough—seek emergency medical attention immediately.

But here is aThe life-saving knowledge that the vast majority of people with diabetes are unaware ofI must write this separately, emphatically, and repeatedly to make it clear:

There is a type of ketoacidosis where blood sugar levels are completely normal or even low

This is calledeuglycemic diabetic ketoacidosis。

What does it mean?Blood sugar is not even close to 11.1, only around 6 or 7 mmol/L, yet the body is already experiencing acidosis.

This situation is most likely to occur in two types of people:

• Currently takingSGLT2 inhibitors (gliflozin class of glucose-lowering drugs)patients;
• Prolonged fasting, very low-carbohydrate diets, or pregnant women.

A 2025 clinical study data shows that patients diagnosed with euglycemic diabetic ketoacidosis,Average blood glucose only 116 mg/dL (approximately 6.4 mmol/L)while the blood ketone concentration was as high as 6.1 mmol/L—the diagnostic criterion for ketoacidosis is a blood ketone level ≥3.0 mmol/L.

That is to say: even with normal blood sugar, acidosis can still occur, and coma can still happen.

Here is a more comprehensive diagnostic framework for you

Do not focus solely on the blood glucose number. The "official diagnostic triad" for diabetic ketoacidosis is:

1. Blood glucose ≥11.1 mmol/L, or a clear history of diabetes(This includes euglycemic diabetic ketoacidosis as well);
2. Blood ketone ≥3.0 mmol/Lor strongly positive urine ketone bodies;
3. AcidosisBlood pH < 7.3, or bicarbonate < 18 mmol/L.

The diagnosis is established when all three conditions are simultaneously met.

The severity of the condition is not determined solely by blood glucose levels. According to the 2024 consensus, the blood glucose thresholds for mild, moderate, and severe DKA are all>250 mg/dL (approximately 13.9 mmol/L)The key to distinguishing severity lies inBlood ketone concentration, degree of acidosis, and state of consciousnessrather than simply the blood glucose numbers.

Special note: Diabetic patients taking "gliflozin" class medications

In your previous article, you mentioned experiencing ketoacidosis firsthand. If you are a patient currently taking medications such as empagliflozin, dapagliflozin, or canagliflozin, please always remember:

Ketoacidosis induced by this type of medication often presents with normal or even completely normal blood glucose levels.

Many patients think they are fine when their blood sugar levels are "acceptable" and try to tough it out, only to be rushed to the hospital when they become confused. This is not an exaggeration. A 2025 study clearly documented such cases: with a blood sugar level of only 116 mg/dL, blood ketones had already reached 6.1 mmol/L, and the patient was already in a state of acidosis.

✅ Clear Recommendations for You

1. Keep blood ketone test strips at homeDo not rely solely on the blood glucose meter. Normal blood glucose levels do not indicate the absence of ketoacidosis.
2. Experiencing the symptoms described in the previous articleGeneralized weakness, fruity breath odor, nausea and vomiting, extreme thirstRegardless of blood sugar levelGo to the emergency department immediately.
3. Inform your doctor about all medications you are taking, especially if you are on SGLT2 inhibitors—this can help your doctor avoid many unnecessary detours.

That kind of discomfort is unforgettable once experienced.

I have no strength at all in my body. Sitting is uncomfortable, standing is uncomfortable, and lying down is uncomfortable too. My whole body feels like limp mud, and no matter how I position myself, it feels awkward. My heart is also racing and I feel terrible. That kind of torment still sends chills down my spine when I think about it now.

At the same time, it will alsoExtremely thirstyNo matter how much water I drank, the thirst remained unquenched; frequent trips to the bathroom with noticeably increased urine output. These were urgent alarms from my body, yet unfortunately, I failed to recognize the severity of the situation at the time.

These symptoms are the body's desperate cry for help

Ketoacidosis has several very typical manifestations, and if several of them appear, it is essential toHigh Alert：

Nausea, vomiting, stomach discomfortI can't eat anything at all, and I feel nauseous at the sight of food.

Breath with the odor of rotten applesThere is a noticeable strange sweet smell, like rotten apples, in the mouth and breath, which can be detected by both the individual and those around them.

Unexplained abdominal painSome people may also experience abdominal pain, which can easily be mistaken for gastrointestinal issues. Taking stomach medicine or drinking hot water at home can waste valuable time.

listlessness, slowed reactionIn severe cases, dizziness, drowsiness, and confusion may occur, as if the entire person is shrouded in a layer of fog.

These are not minor ailments, but rather the body desperately crying out for help.It must not be dismissed as ordinary discomfort.。

Why must you go to the hospital immediately?

Let me tell all my fellow diabetes patients a straightforward truth:Ketoacidosis requires hospitalization。

Relying on adjusting insulin at home, drinking more water, and getting more rest cannot solve the problem at all. It must be addressed throughIntravenous fluid replacement, 24-hour continuous intravenous insulin infusionUnder strict monitoring of blood glucose, ketones, and electrolytes, the body can gradually be corrected.

Procrastination and wishful thinking are gambling with life. I've seen diabetic patients who thought they could "hold on a little longer" end up being rushed to the hospital and directly admitted to the ICU. I've also heard of people who fell into a coma at home and never woke up again.

Life is only once, controlling blood sugar is important, but saving life is even more crucial.

Whether you are a newly diagnosed diabetic or a long-term patient like me, it is important to remember:

High blood sugar can be managed gradually, but ketoacidosis must not be delayed for a second.

Once symptoms such as general discomfort, extreme thirst, frequent urination, and a fruity odor appear,Do not hesitate, do not dwell, do not think "wait until dawn to decide."Go to the emergency room immediately and directly inform the doctor that you are a diabetic and suspect ketoacidosis.

Prompt treatment can correct the condition within days; delay may cost a life.

I write this not to frighten anyone, but sincerely hope that every person with diabetes can stay away from such dangers. On the journey of blood sugar control, we must learn to coexist peacefully with our glucose levels and also learn to recognize those emergency signals that cannot be ignored.

You only have one life, controlling blood sugar is important, but saving your life is even more crucial.