As a type 1 diabetic I am quite familiar (unfortunately) with the signs and symptoms of diabetic ketoacidosis. Diabetic ketoacidosis (DKA) results from lack of insulin associated with high blood levels and your body starts to produce high levels of blood acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body’s chemistry, which resolve with proper therapy.
This usually occurs in people with type 1 diabetes, but DKA can develop in any person with diabetes. Since type 1 diabetes typically starts before the age of 25, diabetic ketoacidosis is most common for this age group, but it may occur at any age with both males and females are equally affected. So is DKA something that we should be worried about? Lets take a closer look!
What Causes Ketoacidosis ?
So what’s the deal when our results come back showing ketones in urine? Circumstances arise for people with type 1 diabetes when the individual does not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When glucose is not available to feed our cells due to high blood sugars, fat is broken down and used as fuel vs glucose and this is particularly not a good thing. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are extremely poisonous. This condition is known as ketoacidosis.
Blood glucose levels rise (usually higher than 300 mg/dL) because the liver makes glucose to try to combat the problem. However, the cells cannot pull in that glucose without insulin.
DKA is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.
Although not common, people with type 2 diabetes can also develop DKA, but it is rare and typically triggered by a severe illness.
What Are The Warning Signs Of DKA?
DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms per the American Diabetes Association include the following:
- Thirst or a very dry mouth
- Frequent urination
- High blood glucose (blood sugar) levels
- High levels of ketones in the urine
Then, other symptoms appear:
- Constantly feeling tired
- Dry or flushed skin
- Nausea, vomiting, or abdominal pain
(Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than 2 hours, contact your health care provider.)
- Difficulty breathing
- Fruity odor on breath
- A hard time paying attention, or confusion
Any of these symptoms should immediately be discussed with your doctor and they will let you know the next course of action, including treatment options or better yet, a trip to the ER may be in order especially if you can flush them from your system. Speaking of treatment options, what can you expect? Lets take a closer look.
Treatment Options Ketoacidosis:
If you do suspect ketoacidosis in any way, it’s paramount you get to an urgent care center or emergency room at once or follow the instructions provided by your medical team. This condition can be very dangerous if left untreated. Depending on the severity of the problem and the outcome of various tests, individuals spilling ketones might be admitted to the hospital.
Treatment for diabetic ketoacidosis generally follows a three pronged approach. This combination approach gets to the root of the problem and begins to treat it promptly, before additional damage can occur.
Typically the treatment protocol is as follows:
- Replacing fluids – After battling a bout of DKA a couple of weeks ago, fluid replacement is an important part of any treatment for diabetic ketoacidosis as it helps flush ketones from you system. If you or a loved one has DKA, they will typically receive fluids, either orally or intravenously (most common) until proper hydration levels are achieved. Dehydration is a very dangerous thing for diabetics, and you should make it appoint to always stay properly hydrated, particularly if your sick and vomiting as your risk of diabetic ketoacidosis can increase dramatically. Proper hydration also helps flush ketones from your system. As for step 2?
- Electrolyte replacement – Electrolytes are important for normal bodily functions to begin with even if your not dealing with DKA, but replenishing electrolyte levels are particularly important for those dealing with DKA. Electrolyte replacement is a key part of the treatment plan as they will help keep you hydrated as well as replace any vital nutrients that were lost. For those dealing with a case of diabetic ketoacidosis, your doctor will typically administer (intravenously) electrolytes until proper balance is restored. As for step 3?
- Insulin therapy – since inadequate insulin levels play such a critical role in diabetic ketoacidosis, insulin therapy is a key component of treatment. Those battling a bout of DKA will receive insulin therapy to restore blood sugar levels to a normal levels and insulin is generally administered how you would normally handle any high blood sugar. If you or your loved one is newly diagnosed, your medical team with discuss with you the proper treatment plan and come up with a game plan in order to stabilize your numbers and avoid this situation all together.
After dealing with DKA and you are no longer spilling ketones, the focus shifts to determining what factors triggered the attack (sickness like the flu, bad infusion set, not enough basal insulin, etc).
For me it was the flu that decided to rampage my house a couple of weeks ago, but your doctor will work with you and adjust your insulin therapy plan (if needed) in order to keep your blood sugar levels under control and help prevent further complications from this very common condition.
Diabetic ketoacidosis is nothing to take lightly, so contact your doctor ASAP if you notice that you are spilling ketones. Most times, DKA can be closely monitored right from your home with frequent updates to your doctor but in severe circumstances where you are vomiting and can not keep down fluids or experiencing any of the warning signs listed above, a trip to the emergency room is definitely a better and safer option.
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