Common Health Issues

Diabetic Ketoacidosis

• By Rich Health Editorial Team
• November 01, 2021

Diabetic ketoacidosis (also known as DKA) is a life-threatening condition that usually occurs in people with type 1 diabetes. However, people with type 2 diabetes can also develop diabetic ketoacidosis. Diabetic ketoacidosis begins when there is too little insulin in the blood and too much of the hormones that increase glucose levels in the blood. 

 

When this happens, the body can’t use the glucose in the blood for energy and instead starts to break down fat and protein. When fat breaks down, ketones are produced that can accumulate and lead to difficulty in breathing, shock, pneumonia, seizures, coma and even death

 

DIABETIC KETOACIDOSIS SYMPTOMS

If you regularly monitor your blood glucose levels, the most important warning signs of diabetic ketoacidosis are consistently high blood glucose levels—250mg/dl or above. You may also experience a lack of appetite, stomach pains, nausea, vomiting, blurry vision, fever, a sensation of feeling flushed, difficulty breathing, feelings of weakness, drowsiness, a fruity odor on your breath, intense thirst, dry mouth or the need to urinate frequently

 

DIABETIC KETOACIDOSIS RISKS

Twenty percent of all people hospitalized for diabetes have diabetic ketoacidosis. The actual incidence of diabetic ketoacidosis among people with diabetes is even higher, because milder cases can be treated outside the hospital. Diabetic ketoacidosis is more likely to develop in females and in those under the age of 15. 

However, because there are more older people with diabetes, doctors are seeing episode of diabetic ketoacidosis in people over the age of 45.

 

Diabetic ketoacidosis is more likely to occur in people with diabetes who have not yet been diagnosed than in people who are aware they have diabetes and are taking insulin and keeping their blood glucose levels under control. If you already know you have diabetes, diabetic ketoacidosis can be triggered if you stop taking your insulin for one reason or another. 

 

Teenagers who may be embarrassed about having diabetes may not adhere to diet and insulin schedule. Young women with eating disorders who may skip meals and insulin injections are especially prone to diabetic ketoacidosis.

 

Diabetic ketoacidosis is also more likely to occur during periods of emotional or physical stress or illness. You may not feel like eating and think it’s okay to skip your insulin injection. But this is the worst thing you could do. When you have an infection, for example, or find yourself in a stressful situation, your body releases hormones that cause the liver to release stored glucose. This increases the glucose levels in your blood. Even if your insulin levels are normal, if your blood glucose shoots up, you may not have enough insulin to handle the available glucose. People with diabetes who abuse alcohol are also at high risk for developing diabetic ketoacidosis.

 

Diabetic ketoacidosis is a life-threatening condition that should be taken seriously. If untreated, it could result in coma and even death. Cerebral edema, a rare complication of diabetic ketoacidosis in young children, can also occur. Warning signs include headache, drowsiness, and lethargy, which can lead to seizures and sometimes even death.

Adults may develop hypoxemia, a condition marked by low oxygen levels in the blood. This is thought to occur as a result of water accumulation in the lungs and decreased lung function, which can lead to respiratory distress. This is more likely to occur in people with other complicating conditions such as infection.

 

WHAT YOU SHOULD DO WHEN YOU HAVE DIABETIC KETOACIDOSIS

If you have any of the signs of diabetic ketoacidosis listed above, check your blood glucose level immediately. If your blood glucose level is over 250mg/dl, call a member of your health care team at once. You should also test your urine for the presence of ketones. 

Trace amounts of ketones are probably no cause for alarm, but if your urine has moderate or large amounts of ketones, call your health care team immediately. You will first want to take action to lower your blood glucose and ketone levels. You will probably need to take fast-acting insulin, but check with your health care team to figure out how much and what kind of insulin to take. 

 

You should also drink plenty of water to prevent dehydration. Also, avoid exercise. Exercise counters the effects of taking extra insulin and just causes the body to burn more fat. Keep checking your blood glucose and ketone levels. If the levels of ketones in your urine do not decrease right away or if you are vomiting, get emergency help at once.

 

DIABETIC KETOACIDOSIS TREATMENT

If you require emergency care, you will be given insulin to bring blood glucose levels and urine ketone levels within normal range. How a patient responds to insulin can vary widely, but good glucose levels should decrease from 600mg/dl to 250-300mg/dl in 4 to 6 hours. Once glucose levels are in this range, insulin administration should continue. Even with continued insulin administration, it can take as much as 12 hours to treat diabetic ketoacidosis.

 

In addition to insulin therapy, you will also be given fluids to treat dehydration and replace all the water you have lost. How much fluid you are given will depend on how much you have lost. Your health care team will carefully monitor fluid intake and urine output. 

 

In addition to fluids, you will also need to get your electrolytes back in balance and will most likely be given potassium. Usually potassium therapy is not begun until you are producing a normal amount of urine. You may also be given other salts and electrolytes to bring everything back into balance.

 

Most patients hospitalized for diabetic ketoacidosis will recover in 24 hours. However, depending on the severity of the episode, the underlying causes, and any other complicating factors, you may need hospitalization for several days or weeks. Once you leave the hospital, your doctor will most likely want to follow up your progress at frequent intervals.

 

DIABETIC KETOACIDOSIS PREVENTION

Given the severity of diabetic ketoacidosis, it is critical to prevent it from happening in the first place. The most important tool for preventing diabetes is to monitor blood glucose levels regularly and maintain good blood glucose control. 

 

Ask your health care team members how to make adjustments in your meal plan and insulin should your blood glucose levels rise unexpectedly. If you are taking insulin, never skip an insulin dose. Make sure your insulin has not expired and that it is properly stored. If you are using a pump, check that your pump is working properly and free of clogs.

If you are sick or under stress, monitor your blood glucose frequently and test your urine for ketones. Do both test every 4 hours, at least, until you are feeling better. Any time you are feeling queasy or are vomiting, check your urine for ketones. 

 

Make sure to do this even if your blood glucose levels are normal. Also, be prepared: discuss in advance with your health care team what you should look for as early warning signs of diabetic ketoacidosis and what you should do if an episode occurs. Make sure that those close to you also know how to recognize the warning signs of diabetic ketoacidosis and know what they can do to help.

Sources and References

• The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

• Diabetic Ketoacidosis by Katherine Cashen and Tara Petersen

 

• Diabetic Ketoacidosis: Update on Management by Kate Evans