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.
Ever wonder why when we are severely dehydrated as diabetics or when we are dealing with an extreme high blood sugar our medical team tells us to make sure we replenish our electrolytes? I mean, what is an electrolyte anyway, what are the symptoms of low electrolytes and how can they help us as diabetics or if your just out mowing the lawn? Diabetic or not, they are extremely important when it comes to our overall health so lets take a closer look!
When dissolved in fluid, salts tend to break apart into their component ions, creating an electrically-conductive solution. For example, table salt (NaCl) dissolved in water dissociates into its component positive ion of sodium (Na+) and negative ion of chloride (Cl-). Any fluid that conducts electricity, such as this new saltwater solution, is known as an electrolyte solution: the salt ions of which it’s composed are then commonly referred to as electrolytes. So that leads us to the next question…
What Are Electrolytes?
There are several common electrolytes found in the body, each serving a specific and important role, but most are in some part responsible for maintaining the balance of fluids between the intracellular (inside the cell) and extracellular (outside the cell) environments. This balance is critically important for things like hydration, nerve impulses, muscle function, and pH levels.
With the correct body water balance, the electrolytes separate into positive and negative ions. When the body loses water or becomes dehydrated an electrolyte imbalance starts to occur. During heavy exercise, sodium and potassium electrolytes in particular are lost through sweating. To ensure constant electrolyte concentrations in the body, fluids must be regularly consumed.
To avoid an electrolyte imbalance which can cause lethargy and muscle twitching, athletes consume electrolyte solution drinks to make sure the electrolyte balance is maintained during and after exercise – this contributes to achieving optimum performance
You should drink frequently during strenuous physical activity. Thirst usually does not kick in until well after you have reached a state of dehydration, so consume plenty of fluid whether you feel like it or not. About 6 to 8 ounces every 15 minutes is sufficient. Help replace electrolytes by consuming a beverage that contains 0.7 milligrams of salt per quart of fluid. Consuming fruit slices, such as bananas, strawberries and oranges can help restore lost potassium, but obviously we still need to be careful here and a small bolus may be needed after exercise due to the sugar content in fruit.
7 Major Electrolytes & Their Function:
Let’s take a look:
- Sodium (Na+)
- Chloride (Cl-)
- Potassium (K+)
- Magnesium (Mg++)
- Calcium (Ca++)
- Phosphate (HPO4–)
- Bicarbonate (HCO3-)
So what do each of these to?
Sodium (NA+) is the major positive ion in fluid outside of cells (extracellular) and when combined with chloride the resulting substance is table salt. Some functions of sodium include the regulation of the total amount of water in the body and the transmission of sodium into and out of individual’s cells, which plays a role in critical body functions. Many processes in the body, especially in the brain, nervous system, and muscles require electrical signals for communication. The movement of sodium is critical in generation of these electrical signals. Too much or too little sodium can cause cells to malfunction and extremes in the blood sodium levels.
Potassium (K+) is the major positive ion found inside of cells. Some of the functions of K+ are the regulation of heartbeat and muscle function. The proper level of potassium is essential for normal cell function. Any seriously abnormal increase or decrease in K+ can profoundly affect the nervous system and increase change of irregular heartbeats.
Calcium (Ca++) is needed to build and maintain bones. It also plays a role in nerve impulse transmission and muscle contraction.
Magnesium (Mg++) is an essential mineral that is involved in more than 300 enzyme reactions in the body. Mg supports heart and nerve function. Mg is essential in the formation of bones and teeth and in converting blood sugar into energy.
Chloride (Cl-) is the major anion (negatively charged ion). CI- is found in the fluid outside of the cells and in the blood. The balance of chloride ion (CI-) is closely regulated by the body. Seawater has almost the same concentration of chloride ion as human body fluids. CI- plays a role in helping the body maintain a normal balance of fluids.
I fielded a question the other day on my Facebook page asking if I’ve ever head about a condition called HHNS or hyperosmolar hyperglycemic nonketotic syndrome.
HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly. What is HHNS though, and is it really similar to DKA or is it just your typical run of the mill high blood sugar? Lets take a closer look!
What Is HHNS?
People over the age of 65 with type 2 diabetes are at greater risk of hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Even though it is possible, it is very rare in people with type 1 diabetes can develop HHNS. HHNS is a medical emergency caused by a very high blood sugar, typically over 600 mg/dL due to poor control. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. This makes you urinate more and you lose too much body fluid, causing dehydration.
As you lose fluids, your blood becomes thicker and your blood sugar level gets too high for the kidneys to be able to fix. With the high blood sugar and dehydration there is also an imbalance of minerals, especially sodium and potassium in the blood. The imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death.
Signs & Symptoms Of HHNS?
As mentioned earlier, HHS can happen to anyone, but is more common in older individuals who have type 2 diabetes. Symptoms may begin gradually and worsen over a few days or weeks. A high blood sugar level is a warning sign of HHS. I also found it very interesting that the symptoms are very similar to diabetic ketoacidosis (DKA) so its extremely important to be aware and if you suspect anything out of the ordinary, its imperative that you call 911 or get yourself into your doctors office.
- excessive thirst
- high urine output
- dry mouth
- warm skin that doesn’t perspire
- nausea, vomiting
- weight loss
- leg cramps
- vision loss
- speech impairment
- loss of muscle function