Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication that stems from diabetes. If you don’t have enough insulin to help your body process sugars (glucose), your body will start burning fat to fuel itself. As a result, acids called ketone bodies build up in the body. If left untreated, these ketones bodies poison your body. DKA can occur if you have type 1 or type 2 diabetes, but it’s considered rare in those with type 2. DKA can also appear if you are at risk for diabetes but have not received a formal diagnosis. It can be the first sign of type 1 diabetes.

DKA can become a medical emergency. If you suspect this complication, immediately contact your physician or go to an emergency room.

The most common triggers for the breakdown of fat that causes DKA are:

• missing an insulin injection or not injecting enough insulin
• illness or infection that causes the body to produce adrenaline, resulting in the body producing less insulin than normal. Pneumonia and urinary tract infection are common triggers.

Your risk of developing DKA might be higher if you:

• have type 1 diabetes
• are under the age of 19
• have had some form of trauma, whether emotional or physical
• have a high fever
• have had a heart attack or stroke
• smoke
• abuse drugs or alcohol

Although DKA is rare in people who have type 2 diabetes, those who have type 2 diabetes and are of African-American or Hispanic descent are more likely to develop it than those who aren’t.

Symptoms of DKA can appear quickly and may include:

• frequent urination
• extreme thirst
• nausea
• vomiting
• abdominal pain
• confusion
• breath that smells fruity
• a flushed face
• fatigue
• rapid breathing
• dry mouth and skin

If you have access to urine or blood tests at home, they may show that you have high ketone levels in your urine and high blood sugar.

If left untreated, DKA can lead to a coma or death, so it is important to make sure you consult with your doctor if you experience:

• inability to keep food or liquid down
• blood sugar levels of 240 mg/dL or more that do not come down after treatment at home
• multiple signs of DKA

Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. Tests of blood acidity and sugar levels are also commonly done. Other tests your doctor may order are:

• potassium blood test—to assess metabolic function
• arterial blood gas—to determine the acidity of your blood
• amylase blood test—to test pancreatic function
• chest X-ray—to look for signs of an infection such as pneumonia

The treatment for DKA usually involves a combination of several approaches to normalize abnormal blood sugar and insulin levels. If you’re diagnosed with DKA but have not yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from reoccurring. If your DKA is a result of an infection or illness, your doctor will treat that as well, likely with antibiotics.

Fluid Replacement

Your physician will likely give you fluids (orally, if possible, or intravenously) to replace the fluid that is usually lost as a result of DKA. Fluid replacement is also helpful in diluting the amount of sugar in your blood.

Electrolyte Replacement

Lower than normal levels of insulin can cause the levels of electrolytes in your body to become abnormally low. Electrolytes are electrically charged minerals that help your body—including the heart and nerves—function properly. Electrolyte replacement is also commonly done intravenously.

Insulin Therapy

Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar levels are within an acceptable range, your physician may let you resume your normal insulin regimen.

There are many ways to prevent DKA. One of the most important is proper management of diabetes. Take your diabetes medication as directed, eat healthfully, and exercise regularly to help prevent DKA.

Additional preventive measures include:

• making sure that your blood sugar levels are within their normal range by checking them several times per day
• talking to your doctor about adjusting your insulin dosage levels based on your level of

activity, illnesses, or other factors, such as what you’re eating

• testing your urine for ketone levels during periods of high stress or illness. This can help you catch moderate to high ketone levels before they threaten your health.
• Seeking medical care if your blood sugar and ketone levels are higher than normal. Early detection is essential.