Diabetes is a common metabolic disorder worldwide and is characterized by chronic hyperglycemia or hypoglycemia due to defects in insulin secretion, insulin action, or both. Half of individuals affected by diabetes are not diagnosed, and it is estimated that they increase their susceptibility to diabetic complications.
Diabetic ketoacidosis (DKA) is the most common complication of glucose emergency in diabetic patients. It mainly occurs in patients with type 1 diabetes, but about a third of cases occur in people with type 2 diabetes. Diabetic ketosidosis requires immediate treatment as it can cause severe complications such as brain swelling, difficulty breathing, and infection.
Ketoacidosis is not the same as ketosis. Ketosis occurs from a diet that is very low-carb, a ketogenic diet, or fasting. Diabetic ketosidosis occurs only when the body does not have enough insulin to convert blood sugar into energy. This article covers everything from all symptoms and preventive care related to DKA to available treatment options.
What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes, marked by hyperglycemia, excessive ketones and acidic blood. It occurs due to insulin deficiency and prevents glucose from entering the cells for energy. If your somatic cells cannot use glucose for energy, it will lead to a state of hunger and starvation in the cells. To compensate, the liver rapidly produces ketones as an alternative fuel from fat, causing blood and urine accumulation, leading to blood acidification.
In dka, ketone bodies such as betahydroxybutyrate, acetone, and acetoacetate. Stressful situations during DKA, such as infections and injuries, cause the release of hormones such as glucagon, catecholamines, cortisol, and growth hormone. These hormones increase blood sugar levels by breaking down the body’s fat and proteins to produce glucose, worsening hyperglycemia.
summary
DKA is a severe complication of diabetes characterized by hyperglycemia due to insulin deficiency, excessive ketones, and acidic blood. Cells are unable to use glucose for energy, leading to the accumulation of ketones. Stressful situations like infections can cause hormone release and worsen blood sugar. Ketone bodies form betahydroxybutyrate-like forms during DKA, causing additional complications. Early detection and treatment is important to prevent life-threatening complications.
Symptoms of diabetic ketosidosis
DKA symptoms require urgent medical care due to their severity. The symptoms can manifest quickly and DKA can lead to coma or death without treatment. Early symptoms of DKA can include:
- Frequent urination
- Extreme thirst (polydipsia) or dry mouth
- Hyperglycemia levels (hyperglycemia)
- Increased levels of ketones in the urine
Newly diagnosed patients with type 1 diabetes and DKA often experience rapid weight loss. If you have type 1 diabetes and your blood glucose level is above 240 mg/dL, test ketones in your urine or blood. As diabetic ketosidosis progresses, symptoms may include:
- Nausea and vomiting
- Stomach pain
- Confusion or mild disorientation
- The bracelet smells fruity
- I washed my face
- I feel tired or weak
- Rapid breathing
- Reducing sweat
- Dry skin
- syncope
summary
Diabetic ketoacidosis requires immediate medical attention due to its severity, and symptoms escalate rapidly, putting coma and fatality at risk without treatment. Early signs include frequent urination, severe thirst, high blood sugar, and an increase in urine ketones. Newly diagnosed type 1 diabetes patients often suffer rapid weight loss. Assume your blood glucose level is above 240 mg/dL. Ketone test. As DKA progresses, symptoms expand to nausea, vomiting, stomach pain, confusion, fruity breathing, facial cleansing, weakness, rapid breathing, reduced sweat, dry skin, and fainting.
Causes and risk factors for diabetic ketoacidosis
DKA is more common in young children and teenagers with type 1 diabetes compared to adults. Although less common, even patients with type 2 diabetes can develop DKA. Common causes and risk factors for DKA include:
Injecting sufficient insulin or lacking insulin injections
Frequently, if you do not have insulin or other drug doses or receive the wrong dose your doctor has prescribed, you may deviate further from your target range. Expired or spoiled insulin may not function properly, leading to potentially ineffective glycemic control. Uncontrolled diabetes increases the risk of DKA.
Insulin pump
Insulin pump users are at a higher risk of DKA than those who use injections. This is because the pump only administers rapidly acting insulin without providing long acting insulin. Rapidly acting insulin starts working in 10-15 minutes and usually lasts only 4-5 hours.
If you use an insulin pump, there are a variety of products available. Make sure you have short-acting insulin, long-acting insulin, and needles in case of a pump malfunction.
Illness or infection
Common diseases such as urinary tract infections (UTIs), pneumonia, and pancreatitis can lead to DKA. Injuries and surgery can cause DKA by interfering with insulin due to stress hormones.
pregnancy
During pregnancy, your body processes sugar and nutrients differently. It also increases the risk of DKA.
Alcohol and medicine
Drugs like alcohol, cocaine, and certain drugs increase the risk of DKA. Corticosteroids, diuretics, and drugs for mental health conditions can also lead to DKA.
summary
DKA mainly affects young people with type 1 diabetes, but it can also develop it in type 2 diabetes patients. Causes include insufficient insulin, missed doses, expired insulin, and insulin pumps that use insulin without long-term action. Diseases such as UTIs and pneumonia, injuries, surgery, and pregnancy can cause DKA. Additionally, alcohol, cocaine, and certain drugs increase the risk.
Diabetic ketosidosis diagnosis
The doctor diagnoses DKA through a physical examination and cross-checks symptoms and medical history. They test your blood sugar, ketone levels in your urine and blood, and blood pH and bicarbonate levels. Diagnostic tests include:
- Basic Metabolic Panel: Check the function of the kidneys, liver and pancreas and the levels of chemicals such as electrolytes.
- Blood pH: Measures the acidity of the blood. Levels below 7.3 indicate acidity due to ketones.
- Blood glucose test (A1C): Assess blood glucose control over several months.
- Urine test: Measure ketones, sugar and other nutrients in the urine. It also checks urine output and infection.
summary
To diagnose DKA, your doctor will look at you, check your medical history, and run a test. These include checking ketone glucose, urine, blood, blood pH, and bicarbonate levels. A basic metabolic panel assesses kidney, liver, and pancreas function. Glucose tests and urine tests assess blood glucose control and ketones.
Prevention of diabetic ketosidosis
Prevention of diabetic ketosidosis (DKA) and other diabetic complications is important to maintain overall health and well-being. Here are some effective ways to prevent DKA and manage diabetes.
1. Integrated diabetes management and blood glucose monitoring: Diabetes management is more than just following diet and exercise routines. Diabetes management is the creation of a lifestyle that consistently supports blood glucose stability. Regular checks of glucose levels form the backbone of effective diabetes management. This dual approach helps to identify deviations from normal levels early, allowing timely adjustments to diet, exercise and medication.
2. Monitoring of insulin dosage and ketones: It is important to adjust the dose of insulin according to your blood glucose readings. Be especially wary when you’re sick or stressed, and check your blood sugar levels more frequently. At the same time, it is essential to keep an eye on ketone levels, especially if you are experiencing symptoms such as nausea and fatigue. These symptoms may indicate the development of diabetic ketosidosis.
3. Proactive response: Act quickly on the first signs of increased blood sugar or ketone levels. Immediate medical intervention can save lives, as diabetic ketoacidosis can escalate quickly. Consulting with your healthcare provider and planning a “sick day” can be extremely beneficial during unexpected illnesses and stress.
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summary
Prevention of diabetic ketoacidosis involves diligent management of diabetes by promoting healthy lifestyle choices, regular monitoring of blood glucose and ketone levels, timely insulin adjustments, and medical diagnosis of high illness or ketone levels. Working closely with your healthcare team and following your treatment plan will help you effectively prevent DKA and maintain optimal health.
Treatment of diabetic ketosidosis
Treatment of DKA includes various methods to stabilize blood glucose and insulin levels. Those who have not vomited or are very ill can be treated at home or in an outpatient facility with appropriate supervision. However, children who are vomiting in particular may need IV fluid in the emergency department.
Drug therapy
Drug therapy involves administering normal and analogous human insulin to correct hyperglycemia, unless bovine or pork insulin is the only option available. Called insulin supplementation, ketogenesis is stopped by administering insulin. It stops the breakdown of proteins and fats while promoting glucose absorption and utilization, and normalizes blood sugar levels. You may receive insulin via IV until your blood sugar levels fall below 200-250 mg/dl.
If insulin levels drop too much, the body’s electrolytes can also be abnormally reduced. In these situations, electrolyte replacement is also required, often administered via IV.
The following medications for managing DKA via medication:
- Short-acting or regular insulin
- Rapid action insulin (insulin aspert, insulingurysine, insulin lispro)
- Electrolyte supplement (potassium chloride)
- Alkalinizing agent (sodium bicarbonate)
Fluid replacement
During DKA treatment, you may receive intravenous fluid to aid in rehydration. Usually, normal saline (0.9%) is used to restore volume and replace deficits. Liquid therapy helps replenish lost fluid, restore normal blood flow and deal with dehydration. However, closely monitoring fluid levels is essential, especially in children. It is important to maintain a careful balance to prevent too little hydration or too much balance.
To avoid a sudden drop in glucose and hypoglycemia, 5% glucose is added to the IV solution when glucose levels reach 300 mg/dL (17 mmol/L). A convenient approach is to use the “two bag system.” One bag is used 10% dextrose and the other bag is used without dextrose.
summary
Treatment of DKA means stabilizing blood glucose and insulin levels. Some people can treat them at home or at an outpatient center where they are supervised, unless they get sick. The medications include insulin, which lowers blood sugar levels, and fluids for hydration. IV insulin is the standard treatment until blood glucose levels fall below 200-250 mg/dL. You may also need to replace the electrolyte. Liquids like normal saline can help you stay hydrated. Careful balance is essential to avoid overhydration and dehydration. Sometimes glucose is added to the IV fluid to prevent hypoglycemia. This is usually done in a “two-bag system” containing liquids with or without glucose.
thrivedailywellness Suggestions
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The final words
Diabetes poses a serious health risk, and diabetic ketoacidosis (DKA) is a severe complication. It is important to recognize the symptoms early and seek prompt consultation from a doctor. Treatment includes restoring fluid balance, administration of insulin, and thorough monitoring of blood glucose levels. Lifestyle adjustments, such as maintaining a balanced diet and abstaining from alcohol, play an important role in preventing DKA. Regular monitoring and expert guidance can help individuals manage diabetes effectively and reduce the risk of complications like DKA.
Disclaimer: The purpose of this article is to disperse knowledge and raise awareness. I am not going to replace medical advice from experts. For more information, please contact a certified dietitian here.
Source of research
1. Insulin pump therapy is associated with a higher incidence of mild diabetic ketosidosis compared to injection therapy.
2. Liquid therapy for pediatric patients with diabetic ketosidosis: a current perspective
3. Comprehensive review of diabetic ketosidosis: Update
4. Dietary intake and hospitalization due to hypoglycemia in patients with diabetic ketosidosis and type 1 diabetes
Frequently asked questions (FAQ)
Q: What is diabetic ketosidosis?
A: Diabetic ketosidosis (DKA) occurs when ketones, certain chemicals accumulate in the blood due to insulin resistance. This condition primarily affects patients with type 1 diabetes. There, the body does not produce enough insulin. In rare cases, people with type 2 diabetes may also experience ketoacidosis.
Q: How long does it take to recover from diabetic ketosidosis?
A: Diabetic ketoacidosis patients usually recover fully within 24 hours with appropriate treatment. However, in some cases, recovery may take longer.
Q: What is the treatment for diabetic ketosidosis?
A: DKA requires immediate treatment to replenish significant losses of liquids and electrolytes. This treatment is performed via the IV line inserted into the arm or hand. Additionally, they receive insulin to allow the cells to use more glucose. This reduces both ketones and sugar levels in the blood.
Q: What do you eat after diabetic ketoacidosis?
A: Stick to your regular diabetic diet plan and prioritize healthy food options. We aim to reduce the amount of saturated fat and salt. Keep hydrated with drinking water or other sugar-free liquids. Maintain a healthy diet by including low-GI fruits, vegetables, whole grains and legumes.
Q: How does diabetes cause ketoacidosis?
A: When cells lack the glucose needed for energy, the body burns fat to produce energy, leading to the formation of ketones. It occurs when insulin is insufficient to utilize glucose, the body’s normal energy source. High levels of ketones are harmful to the body and lead to DKA development.
Q: Can diabetic ketoacidosis cause renal failure?
A: Acute renal failure is rare, but is a potentially fatal complication of diabetic ketosidosis (DKA). However, the severity varies greatly depending on the severity of the renal injury. Early recognition and treatment of ARF during DKA is necessary for better results.
Q: What are the warning signs of diabetic ketosidosis?
A: DKA usually starts slowly, but if vomiting occurs, it can get worse quickly within a few hours. Early signs include thirst, frequent urination, hyperglycemia, and urinary ketones. Later symptoms may include constant fatigue, dryness or flushing, nausea and stomach pain. If vomiting lasts for more than two hours, it can be a sign of something serious.
Q: How can I manage diabetic ketoacidosis at home?
A: Incorporate healthy diet and regular physical activity into your daily routine. Follow your doctor’s instructions to take diabetic medication or insulin. If your health deteriorates, such as an increase in blood glucose, increased urinary ketone levels, or worsening symptoms, seek immediate hospitalization.
Q: Is diabetic ketoacidosis fatal?
A: If left untreated, diabetic ketoacidosis will lead to loss of consciousness and ultimately death. Therefore, it is important to quickly recognize the symptoms and respond promptly. With timely treatment, the risk of death ranges from 1% to less than 5%.
Q: What is non-diabetic ketosidosis?
A: NDKA, or non-diabetic ketoacidosis, is ketoacidosis without the presence of diabetes. The prognosis of NDKA cases tends to be superior compared to cases of diabetic ketoacidosis. It is a rare condition that is often caused by starvation. Without consuming the carbohydrates you need, your glucose levels will be insufficient. It pushes the body into ketogenesis, causing metabolic acidosis.
Q: How can I detect diabetic ketosidosis?
A: Blood tests allow you to check your ketones and monitor your glucose levels. Doctors can also test urine for these substances. Additionally, blood tests measure plasma osmotic pressure, electrolyte levels such as sodium and potassium, red and white blood cell counts, and renal function. You may also need an electrocardiogram (EKG) to check the rhythm of the heart, as changes in blood electrolyte levels can affect your heart.
Q: What increases diabetic ketosidosis?
A: High levels of ketones in the blood can cause ketoacidosis. This can occur if you have diabetes but don’t realize it. Or if you have diabetes but are not properly managed, such as not taking medication as directed.
