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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.