WHAT IS DIABETIC KETOACIDOSIS?
Diabetic ketoacidosis is a severe complication of diabetes that occurs when your body produces high levels of blood acids known as ketones.
The condition develops when your body cannot produce adequate insulin. Insulin generally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body starts to break down fat as fuel. This process produces a buildup of acids in the bloodstream known as ketones, eventually leading to diabetic ketoacidosis if untreated.
If you have diabetes or are at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care.
DIABETIC KETOACIDOSIS SYMPTOMS
Diabetic ketoacidosis signs and symptoms usually develop quickly, sometimes within 24 hours. For some, these signs and symptoms might be the first indication of having diabetes. You might notice:
- Excessive thirst
- Frequent urination
- Nausea and vomiting
- Stomach pain
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
More-specific signs of diabetic ketoacidosis — which could be detected through home blood and urine testing kits — include:
- High blood sugar level
- High ketone levels in your urine
WHEN SHOULD YOU SEE A DOCTOR?
If you feel ill or stressed or you have had a recent illness or injury, check your blood sugar level often. You may also try an over-the-counter urine ketones testing kit.
Contact your doctor immediately if:
- You are vomiting and not able to tolerate food or liquid
- Your blood sugar level is greater than your target range and does not respond to home treatment
- Your urine ketone level is medium or high
Seek emergency care if:
- Your blood sugar level is constantly greater than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
- You have ketones in your urine and cannot contact your doctor for advice
- You have several signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion
Remember, untreated diabetic ketoacidosis could lead to death.
DIABETIC KETOACIDOSIS CAUSES
Sugar is the primary source of energy for the cells that make up your muscles and other tissues. Generally, insulin helps sugar enter your cells.
Without enough insulin, your body cannot use sugar properly for energy. This prompts the release of hormones that break down fat as fuel, which produces acids called ketones. Excess ketones accumulate in the blood and ultimately “spill over” into the urine.
Diabetic ketoacidosis is generally triggered by:
- An illness – An infection or other illness could cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — at times triggering an episode of diabetic ketoacidosis. Pneumonia as well as urinary tract infections are common culprits.
- A problem with insulin therapy – Missed insulin treatments or inadequate insulin therapy or a malfunctioning insulin pump could leave you with too little insulin in your system, triggering diabetic ketoacidosis.
Other possible triggers of diabetic ketoacidosis are:
- Physical or emotional trauma
- Heart attack or stroke
- Alcohol or drug abuse, especially cocaine
- Certain medications, like corticosteroids and some diuretics
DIABETIC KETOACIDOSIS RISK FACTORS
The risk of diabetic ketoacidosis is greater if you:
- Have type 1 diabetes
- Frequently miss insulin doses
Uncommonly, diabetic ketoacidosis could occur if you have type 2 diabetes. In some cases, diabetic ketoacidosis might be the first sign that you have diabetes.
Diabetic ketoacidosis is treated with fluids, electrolytes — like sodium, potassium, and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are associated with this lifesaving treatment.
Possible complications of the treatments
Treatment complications include:
- Low blood sugar (hypoglycemia) – Insulin enables sugar to enter your cells, causing your blood sugar level to drop. If your blood sugar level drops too quickly, you could develop low blood sugar.
- Low potassium(hypokalemia) – The fluids and insulin used to treat diabetic ketoacidosis could cause your potassium level to drop too low. A low potassium level could impair the activities of your heart, muscles, and nerves. To avoid this, electrolytes, including potassium are generally given along with fluid replacement as part of the treatment of diabetic ketoacidosis.
- Swelling in the brain (cerebral edema) – Adjusting your blood sugar level too quickly could produce swelling in your brain. This complication appears to be more common in children, particularly those with newly diagnosed diabetes.
Left untreated, the risks of diabetic ketoacidosis are much higher. Diabetic ketoacidosis could lead to loss of consciousness and, eventually, death.
DIABETIC KETOACIDOSIS PREVENTION
There is much you could do to prevent diabetic ketoacidosis and other diabetes complications.
- Commit to managing your diabetes – Make healthy eating and physical activity part of your everyday routine. Take oral diabetes medications or insulin as instructed.
- Monitor your blood sugar level – You might need to check and record your blood sugar level at least three to four times a day, or more frequently if you are sick or stressed. Careful monitoring is the only way to ensure that your blood sugar level stays within your target range.
- Adjust your insulin dosage as needed – Talk to your doctor or diabetes educator about how to adjust your insulin dosage in relation to factors like your blood sugar level, what you eat, how active you are, and whether you get sick. If your blood sugar level starts to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.
- Check your ketone level – When you are sick or stressed, test your urine for excess ketones with an over-the-counter urine ketones test kit. If your ketone level is medium or high, call your doctor right away or seek emergency care. If you have low levels of ketones, you might need to take more insulin.
- Be prepared to act quickly – If your blood sugar is high and you have excess ketones in your urine, and you think that you have diabetic ketoacidosis, ask for emergency care.
Diabetes complications are frightening. But do not let fear hold you back from taking good care of yourself. Follow your diabetes treatment plan cautiously. Ask your diabetes treatment team for assistance when you require it.
DIABETIC KETOACIDOSIS DIAGNOSIS
If your doctor suspects diabetic ketoacidosis, he or she will do a physical examination and order blood tests. In some cases, additional tests might be needed to help determine what triggered the diabetic ketoacidosis.
The blood tests used for the diagnosis of diabetic ketoacidosis will measure:
Blood sugar level – If there is not enough insulin in your body to enable sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to increase.
Ketone level – When your body breaks down fat and protein for energy, acids called ketones enter your bloodstream.
Blood acidity – If you have excess ketones in your blood, your blood will get acidic (acidosis). This could alter the normal function of organs throughout your body.
Your doctor might order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests may include:
- Blood electrolyte tests
- Chest X-ray
- Recording the electrical activity of the heart (electrocardiogram)
DIABETIC KETOACIDOSIS TREATMENT
If you are diagnosed with diabetic ketoacidosis, you could be treated in the emergency room or admitted to the hospital. Treatment generally involves:
- Fluid replacement – You will receive fluids — either by mouth or through a vein — until you are rehydrated. The fluids will replace those you have lost through excessive urination, as well as help dilute the excess sugar in your blood.
- Electrolyte replacement – Electrolytes are minerals in your blood that carry an electric charge, like sodium, potassium, and chloride. The absence of insulin could lower the level of several electrolytes in your blood. You will receive electrolytes via a vein to help keep your heart, muscles, and nerve cells functioning normally.
- Insulin therapy – Insulin reverses the processes responsible for diabetic ketoacidosis. In addition to fluids and electrolytes, you will receive insulin therapy — generally through a vein. When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you might be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.
As your body chemistry returns to normal, your doctor will consider additional testing to check for potential triggers for diabetic ketoacidosis. Depending upon the circumstances, you may require additional treatment.
For instance, your doctor will help you create a diabetes treatment plan. If a bacterial infection is found, he or she may prescribe antibiotics. If a heart attack seems possible, your doctor may suggest further evaluation of your heart.
If you or anyone you know is suffering from diabetic ketoacidosis, our expert providers at Specialty Care Clinics will take care of your health and help you recover.