Overview
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body cannot produce enough insulin. Insulin is crucial for helping sugar enter cells in the body to be used as energy. Without enough insulin, the body starts breaking down fat for fuel, leading to a buildup of acids called ketones in the bloodstream. If left untreated, this buildup can result in diabetic ketoacidosis. Symptoms may include extreme thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, and fruity-scented breath. DKA can lead to a diabetic coma and even death if left untreated. It is most common in people with type 1 diabetes but can also occur in those with type 2 or gestational diabetes. It is essential to seek emergency care if experiencing these symptoms, as DKA can be life-threatening.
Understanding the disease
Symptoms
Symptoms of diabetic ketoacidosis include being very thirsty, urinating often, feeling a need to throw up and throwing up, having stomach pain, being weak or tired, being short of breath, having fruity-scented breath, and being confused. More-certain signs of diabetic ketoacidosis, which can show up in home blood and urine test kits, include high blood sugar level and high ketone levels in urine. If you feel ill or stressed or you've had a recent illness or injury, it's important to check your blood sugar level often. You should contact your healthcare provider right away if you're throwing up and can't keep down food or liquid, your blood sugar level is higher than your target range and doesn't respond to home treatment, or your urine ketone level is moderate or high. Seek emergency care if your blood sugar level is higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L) for more than one test, you have ketones in your urine and can't reach your healthcare provider for advice, or you have many symptoms of diabetic ketoacidosis.
Risk Factors
Risk factors for developing diabetic ketoacidosis include:
- Having type 1 diabetes.
- Often missing insulin doses.
- Certain medications, such as corticosteroids and some diuretics.
- Physical or emotional trauma.
- Heart attack or stroke.
- Pancreatitis.
- Pregnancy.
- Alcohol or drug misuse, particularly cocaine.
Development
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body cannot produce enough insulin. Insulin is a hormone that helps sugar enter cells to be used as energy. Without enough insulin, the body begins to break down fat for fuel, leading to a buildup of acids called ketones in the bloodstream. If left untreated, this buildup can result in DKA. Several factors can lead to DKA:
- Illness or infection: An infection or other illness can cause the body to produce higher levels of certain hormones that work against the effects of insulin, increasing the risk of DKA. Common illnesses that can lead to DKA include pneumonia and urinary tract infections.
- Problems with insulin therapy: Missing insulin doses, insufficient insulin therapy, or issues with insulin pumps can cause too little insulin in the body, increasing the risk of DKA.
- Physical or emotional trauma: Injury, surgery, or severe emotional stress can cause hormonal imbalances that increase DKA risk.
- Other factors: DKA can also be caused by physical or emotional trauma, heart attack or stroke, pancreatitis, pregnancy, alcohol or drug misuse (particularly cocaine), and certain medications such as corticosteroids and diuretics. It is essential for individuals with diabetes or those at risk of developing diabetes to be aware of the warning signs of DKA and to seek emergency care if necessary.
Assessment and Diagnosis
Triage
You should see a doctor if diabetic ketoacidosis is suspected when you experience any of the following symptoms: being very thirsty, urinating often, feeling a need to throw up and throwing up, having stomach pain, being weak or tired, being short of breath, and having fruity-scented breath. More-certain signs of diabetic ketoacidosis, which can be detected through home blood and urine test kits, include high blood sugar levels and high ketone levels in urine. If your blood sugar level is higher than your target range and doesn't respond to home treatment, or if your urine ketone level is moderate or high, contact your healthcare provider right away. Seek emergency care if your blood sugar level is higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L) for more than one test, or if you have many symptoms of diabetic ketoacidosis. Untreated diabetic ketoacidosis can lead to serious health complications and even death, so it's essential to seek medical attention promptly if you suspect you have this condition.
Diagnosis
Diabetic ketoacidosis can be diagnosed through a physical exam, blood tests, and other tests as necessary. Blood tests will measure blood sugar levels, ketone levels, and blood acidity. Other tests may include blood electrolyte tests, urinalysis, chest X-ray, and an electrocardiogram to check for complications. If you suspect ketoacidosis, you can check for excess ketones in your urine using an over-the-counter ketones test kit. If you have large amounts of ketones in the urine, contact your healthcare provider immediately or seek emergency care.
Management and Treatment
Complications
Treatment complications of diabetic ketoacidosis may include low blood sugar, hypokalemia (low potassium), cerebral edema (swelling in the brain), and in severe cases, loss of consciousness and death.
Home Remedies
It's important to emphasize that diabetic ketoacidosis is a serious medical condition that requires prompt medical attention. It's not appropriate to attempt home remedies for this condition. If you suspect you or someone you know is experiencing diabetic ketoacidosis, please seek emergency medical care immediately.
Treatment
The treatments for diabetic ketoacidosis typically involve addressing the underlying issue of insulin deficiency and addressing the symptoms caused by the buildup of ketones and acids in the bloodstream. The main treatment approach includes:
- Fluid replacement: Rehydration with an appropriate balance of electrolytes, such as sodium, potassium, and chloride, is essential for restoring normal fluid balance and correcting dehydration.
- Insulin therapy: Insulin is administered to help lower high blood sugar levels and promote the uptake of glucose into the cells, reducing the production of ketones.
- Electrolyte replacement: Formal electrolyte replacement, particularly potassium and other minerals, is necessary to address potential imbalances caused by the treatment.
- Management of underlying conditions: Identifying and treating any underlying factors contributing to the development of diabetic ketoacidosis, such as infections or non-compliance with diabetes management, is crucial for preventing recurrences. It is important to note that the specific treatment approach and medications may vary based on the individual's medical history and the severity of the condition. It is essential to seek medical attention promptly for proper evaluation and management of diabetic ketoacidosis.
Preparing for medical consultation
To prepare for an appointment for diabetic ketoacidosis (DKA), you should:
- Be aware of any pre-appointment restrictions: When you make the appointment, ask if you need to fast or follow any other specific preparations for blood tests or other diagnostic procedures.
- Write down symptoms: List all the symptoms you or your child are experiencing, including those that may seem unrelated to DKA. Be prepared to discuss the severity, duration, and any recent changes in the symptoms.
- Gather key personal information: Note any major stresses, recent life changes, and a detailed description of your or your child's daily diet and exercise routine.
- Make a list of medications: Include all prescription medications, over-the-counter drugs, vitamins, and supplements that you or your child is currently taking.
- Bring a support person: It can be helpful to have a family member or friend accompany you to the appointment to help remember important details and provide emotional support.
- Prepare a list of questions: Write down questions to ask the healthcare provider, such as the cause of DKA, appropriate treatment, any dietary recommendations, and if there are any restrictions to follow. Example questions to ask your healthcare provider:
- What is the most likely cause of my DKA?
- What are the best treatment options for me/my child?
- Are there any dietary recommendations or restrictions I should follow?
- Is my condition likely to be temporary or chronic?
- What are the potential complications of untreated DKA?
- How can I prevent future episodes of DKA? Remember to also discuss any concerns or questions that arise during the appointment. It's essential to work closely with your healthcare provider to ensure proper diagnosis and management of DKA.