DIABETIC KETOACIDOSIS | CASEY JOHNSON DIABETES | CAUSES, SYMPTOM, DIAGNOSIS AND TREATMENT OF DIABETIC KETAOCIDOSIS

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Causes of Diabetic Ketoacidosis

With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body’s cells need in order to take glucose in from the blood. Glucose – a simple sugar we get from the food we eat – is necessary for making the energy our cells need to function. People with type 1 diabetes can’t get glucose into their cells, and so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL), while insulin levels are very low.

Since glucose isn’t available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood causing it to become more acidic. As a result, many of the enzymes that control the body’s metabolic processes aren’t able to function as well. A higher level of ketones also affects levels of sugar and electrolytes in the body.

DKA may occur with insulin deficiency, under the following circumstances:

* during an infection or illness
* after stressful events or trauma (including heart attack or stroke)
* inadequate insulin treatment (for instance, by an undiagnosed individual)

Symptoms and Complications of Diabetic Ketoacidosis

High levels of ketones usually build up gradually in blood and urine, causing the symptoms of DKA:

* abdominal pain (especially in children)
* confusion
* decreased perspiration
* deep and rapid breathing (a later symptom)
* dry cool skin
* excessive thirst and urination
* fatigue
* high blood glucose
* nausea and vomiting
* presence of ketones in the urine
* rapid weight loss
* sweet, fruity odour on the breath (it may smell like nail polish remover)

As ketones accumulate in the blood, more ketones will be passed in the urine, taking sodium and potassium salts out with them. Over time, levels of sodium and potassium salts in the body become depleted, which can cause nausea and vomiting. The result is a vicious cycle.

Dehydration is another complication of DKA. High levels of ketones are associated with high sugar levels in the blood and urine. More water is drawn into the urine, resulting in frequent urination. Combined with vomiting – from an upset stomach, or possibly due to a flu or illness – the body quickly loses too much water and electrolytes. Dehydration can occur rapidly (within hours) and is very serious.

Diagnosing Diabetic Ketoacidosis

The amount of ketones in the urine should be checked if a person with diabetes has:

* symptoms of DKA
* fasting blood glucose levels above 14 mmol/L (252 mg/dL) for 24 hours
* an infection or illness

Ketone levels can be easily measured at home; a positive test requires immediate medical attention. A doctor or health care professional can show you how to measure the amount of ketones in your urine.
Treating and Preventing Diabetic Ketoacidosis

Treatment for DKA must absolutely be done in consultation with a doctor or medical team, most often in a hospital setting. For mild cases, fluid supplementations and extra insulin injections are needed approximately every 3 hours until ketones in the urine have either disappeared or fallen to low levels. Blood glucose and ketone levels should also be closely monitored during this period.

Dehydration will only make the progression of DKA worse, so it’s important to maintain a steady intake of fluids.

For moderate-to-severe cases of DKA, hospitalization with fluid and electrolyte replacement is required. Blood glucose and acid levels will be monitored frequently and electrolytes such as potassium brought back into balance. Urine output will be monitored until your vital signs (temperature, pulse, breathing, blood pressure) are normal. Appropriate medications will be used if it was an infection that triggered the episode of DKA.

Even with careful attention to insulin treatment, ketone levels may still go up once in a while. Missing even a single insulin injection can also lead to tissue “starvation,” fat metabolism, and ketone accumulation. People are especially susceptible when they’re ill.

Rarely, with over-rapid rehydration, swelling of the brain can occur. This is called cerebral edema, and is often fatal.

The most important prevention strategies are to monitor blood glucose levels routinely, keep blood glucose levels controlled, and to detect ketones early on. When blood glucose levels exceed 14 mmol/L – or during illness – people with type 1 diabetes should be testing their urine or blood at least twice a day for ketones. This way, excess ketones can be dealt with quickly, before the symptoms of DKA progress and worsen.

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