Within how many hours without insulin can I go into DKA?

Curious, because I recently had DKA, and didn’t know the cause until I eventually removed my pod and saw the straw was all bent backwards into the pod. I’m trying to recall how many hours it was, but I had to take the batteries out of my pod in the Emerg to stop it from beeping and when I reset it the info was gone.

The longest I’ve gone totally without insulin (pump disconnected) has been five hours on several occasions. That’s long enough to leave me feeling nauseated with blood sugar well into the 20s mmol/L and high ketones. I don’t think it would take much more time for DKA to develop in earnest.

Yeah, I am trying to recall, but I think it was about 7 hours?? Maybe longer before I started puking. I read online it takes 12-24 hours, but I’m pretty sure it wasn’t that long for me…

Do you know if there is any way to avoid DKA when this happens?? Like once I start puking…it’s EMERG time… or can I somehow get outta DKA on my own??

One lesson learned…I’ll never put a new pod on before bed…I’ll do it in the a.m. so I know if there’s an issue with it.

Your question has no general answer.

You might be able to come up with an answer specific to you. But there is really no guarantee that whatever number you come up with will continue to be pertinent for you as time moves on and your body possibly changes further.

I’ll say it yet again. People tend to come to places like TuDiabetes out of a need to share. They are looking for community with people who share their experience. But what you should also take away, after spending some time here, is how different we all are. We do not share one common experience of D.

So, while you may come up with a (temporary ?) answer to your question, it won’t necessarily apply to others. And the answers others may have won’t necessarily apply to you.

So what’s the answer? It depends … What’s the context?

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I’m pretty sure when I started on the pump I was told (or read) that DKA could develop within four to eight hours. Lots of Type 1s have some small amount of insulin production and therefore it may take them longer to go into DKA. If you were diagnosed as a kid, then you’re less likely to have any insulin production and so things could develop much faster. I don’t think I would be able to go 12 hours without insulin without going into DKA, judging by how I’ve felt (and how high my blood sugar and ketones have been) after just five hours.

Yeah, you’re sure right about us all being different. I was just curious more so if like I was unusually prone to DKA or something, because I seem to remember it being more like 6-7 hours than what I was reading online like 12-24… I can’t imagine being 24 hours no insulin!!!

DKA means that the acidity level of your blood has been affected by ketones. Once that happens, you need to go to the hospital to have it treated and be monitored. However, if you just have high blood sugar and ketones, you can treat that at home with lots of insulin and water and monitoring. I think once puking starts, I’d head to emergency if it happened more than once (if it were me).

The only way to prevent DKA is to make sure that you always have enough insulin in your system. If your pump isn’t delivering it properly, you need to deliver it with a syringe or pen. If you’re sick or stressed, you need to take more. If you’re on a pump, then you’re right that you shouldn’t change infusion sets before bed—I was told this during my pump training.

Thanks for that explanation… so is there any way for me to test the acidity level of my blood affected by ketones? SOrry if that’s a dumb question…I just never want to go thru this again!!!

No, not that I know of. But there are meters (such as the Precision Xtra and Precision Neo) that can test the level of ketones in the blood, just like you can test the level of blood glucose. I keep one of these in a little backup kit that I carry in my purse so that I can check ketones if my blood sugar is unexpectedly high.

As I said, we all differ. I have never been to an ER for DKA. Of course, I also never test for ketones, so I can’t say whether or not I have had DKA in the past. I think I may have probably been in that neighborhood, but I just have no way to know.

I can (vaguely) remember my BG being high in the past, but the one time I went to an ER for D it was because I was found unconscious from hypoglycemia. That was, uh, 38? 39? years ago.

I am pretty sure I am a LADA. I was still producing some insulin when I was diagnosed when I was around 24. I doubt that I still generate any insulin now. If I do, it is an insignificant amount.

About 2 years (?) ago I did not properly reconnect my pump to my infusion site after showering. I noticed this a few (?) hours later when I felt unexpectedly “tired”, tested and got a meter BG reading over 500.

While I was near home, I really didn’t want to rush home to change the site or inject. So I made sure the site was as “properly” reconnected as I could, gave myself a correction bolus, and waited to see what would happen. It took an hour or so, but my BG eventually plateaued and then started to drop.

At that point I knew I had most likely fixed the problem and it was just a matter of waiting for my BG to get back to a more “normal” range.

As I said, for different people, the specifics of D can be different.

I think DKA is a good reason to never turn your back on your blood sugar monitoring. If you do not a have a CGM, you should, in my opinion, be fingersticking before/after meals, before/after infusion set changes, before and during any driving, upon waking and before going to bed. You should also fingerstick if you feel “off,” are sick, or have undergone any stress. You should never let 8 hours pass while awake, before you check your blood sugar.

Any significant rise, say above 200 mg/dl, after changing an infusion set should immediately raise a question about the quality of the new set/site. If in doubt, swap it out!

If you’re above 300 mg/dl, deliver insulin separately via a syringe.

I know all this robust monitoring seems overly hyper to some. Diabetes is a dangerous foe that can and does kill! Don’t turn your back on diabetes without checking. I’ve had T1D for 32 years and have not experienced an episode of DKA. That could be due to my vigilance, just plain luck, or some low level of residual natural insulin production.

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If you have never been to the hospital for DKA, then you have likely never had DKA. DKA Is not the same as just having high blood sugar and high ketones—those are warning signs that DKA may be developing, but they are not DKA. My understanding is that once your blood’s pH level is affected (which is what DKA is), the only way to correct it is by going to the hospital.


You can buy ketone testing strips at pretty much any pharmacy, they’re not expensive usually. I keep a bottle of them in my bathroom just in case.

Yes, I’ve been in DKA twice and there was no mistaking it! You literally feel like you are dying (because you ARE dying). It’s like your body is suffocating and drying up and there is nothing you can do about it. Imagine having the flu times 20.

Yes, exactly. I think a lot of people refer to “DKA” to mean “high blood sugar and high ketones”—but that isn’t DKA, just the first step down that road. DKA means that the actual acidity level of your blood has been affected by the ketones, which is what is literally killing you. I was only in (or near, not sure) DKA when I was diagnosed at age 9. I’ve had other times (as mentioned above) where I’ve brushed close from hours without insulin but, fortunately, I haven’t experienced DKA again in the 24+ years I’ve had diabetes.


Everyone is different, not to mention it would matter if you had recently eaten and how much carbohydrate was in that meal. Without eating, I’m guessing that I’d be in DKA within about 6 hours if I ripped off my pump.