Everything You Need to Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious and sometimes lethal diabetes complication. If you have type 1 diabetes and use insulin, you are more likely to develop this condition if your blood sugar levels rise too high. It may, however, occur in persons with various types of diabetes, and it may even be one of the first symptoms for those who haven’t been diagnosed.

In the United States, nearly 200,000 instances of ketoacidosis are diagnosed each year. It is not something to be taken lightly, and it should be regarded as a medical emergency. If you experience DKA symptoms, you should seek treatment in a hospital.

What happens when you have diabetic ketoacidosis?

You’ll have high blood sugar and ketones in your urine and blood if you have this diabetes complication. This can happen in a matter of hours or in a matter of days.

You are at risk of DKA if you have type 1 diabetes and have not taken enough insulin or have missed one or more doses. When you don’t have enough insulin, you can’t use the glucose you consume for energy. In order to utilize fat as a source of energy, the liver breaks down fat into ketones.

Ketones are expelled in the urine as ketone production increases, and the blood becomes acidic. Ketoacidosis is the result of this fast process. When your diabetes is under control or you don’t have diabetes, the liver breaks down fat slowly, and the ketones created are needed by the heart and muscles.

DKA is caused by high blood sugar, fat breakdown that is too rapid, and ketones generation that is too high.

What causes ketoacidosis in diabetes?

When your blood sugar levels are greater than normal, you are diagnosed with diabetes. This acute and life-threatening disorder is caused by a number of reasons.

Diabetic ketoacidosis can develop for a variety of reasons, including:

• Not enough insulin in the body
• Certain medications that trigger DKA (steroids, antipsychotics)
• You don’t know that you have type 1 diabetes – DKA can be the first sign of insulin-dependent diabetes
• You experience some physical stress like infection or illness
• Stroke, heart attack, or pancreatitis can also cause DKA
• Drinking a lot of alcohol 
• Indulging in high doses of narcotic drugs like cocaine

If you have undetected diabetes, you should be on the lookout for signs and symptoms that could indicate the disease. If you have type 1 or type 2 diabetes, you should be aware of the warning signs of DKA so you can take action as soon as possible.

If you are ill or have a serious infection, tell your doctor about your diabetes right away. You should also be cautious about self-administering medicine and supplements, especially if they claim to be natural or herbal because they can interfere with diabetic prescriptions and create complications.

What are the warning signs of diabetic ketoacidosis?

Even though diabetic ketoacidosis can strike without warning, if you see several of these symptoms and know you have diabetes, call your doctor or go to the hospital at once. The following are some of the warning signs:

• Sudden abdominal pain 
• Extremely frequent urination
• Severe thirst
• Smelly urine that signifies the presence of ketones
• Fruity smelling breath
• Red or flushed face
• Hyperglycemia
• Fatigue
• Rapid breathing or panting for breath
• Dry skin
• Muscle pain
• Nausea and vomiting
• Confusion 
• Falling blood pressure

If you don’t know if you have diabetes, you should be extra cautious and consult your doctor or get a blood sugar test if you notice any symptoms.

What organs are affected by ketoacidosis?

Your body and your brain can be affected by DKA. As you continue to urine often, you can get dehydrated, and this can affect your kidneys and cause organ damage. DKA also affects the brain, causing confusion and irritability. You may act as if you are drunk and lose your sense of balance and control over your emotions. Your mental state may also be affected. 

Internal swelling can happen in your brain due to excess fluid build-up, resulting in cerebral edema or fluid in the brain. Fluid build-up can also affect your lungs, causing heavy breathing and shortness of breath. 

As ketones increase, you can suffer from a heart attack or stroke, or you can also fall into a coma. 

Before any of these complications happen, take steps to normalize your blood glucose levels. If you are in a bad state, rush to the emergency room or call 911.

Prevention of diabetic ketoacidosis

It is critical that you manage your diabetes, regardless of the kind. Avoid getting your sugar levels too high or too low as much as possible. You should, of course, do the following:

1. Monitor your blood sugar levels regularly. If you’re doing fine on your medications and insulin but experience any kind of stress or trauma, check your sugar. If you overeat, miss a meal, drink alcohol, or do anything that will affect your glucose levels, just check. You can get really small and portable monitors that you can keep with you. You can even get ones that use smartphones for checking and tracking. 
2. While exercise is very good to manage diabetes, make sure that you suddenly don’t over-exercise or indulge in strenuous physical activity. 
3. Eat regularly and have meals that are generally with a low glycemic load. 
4. Check ketone levels via a urine test, available at most pharmacies. Any time you feel that you are urinating very often or have ketones in the urine, just check. 
5. Adjust insulin intake if necessary. Or talk to your doctor if you note any symptoms of high blood sugar.

If you feel that your sugar levels are high, you don’t have access to a sugar monitor or insulin and experience symptoms of DKA, just go to the emergency room.

How is diabetic ketoacidosis diagnosed?

Apart from testing your blood sugar levels, you will probably have to undergo a number of tests for a definitive diagnosis:

• Blood sugar test to check the levels of blood sugar
• A urine test may show ketones in the urine
• Arterial blood test for gas in the blood may show that the blood is acidic
• Electrolyte level check
• Blood pressure is a basic test
• A chest x-ray for breathing-related problems and to rule out pneumonia
• Electrocardiogram to check the effect of ketoacidosis on the heart
• Kidney function test

These tests may be repeated as required and as your condition stabilizes and improves.

What are the treatment options of DKA?

Even if you’re treated in a hospital, you should be aware of the treatment protocols. The aim of the treatment is to get you out of diabetic ketoacidosis as quickly as possible. So you will be given fluids, either orally (if you can take them) or via I.V. so that your body is no longer dehydrated. Hydration is an important method to reduce hyperglycemia.

You will be given insulin so that your blood sugar levels normalize. These should be below 240mg/dL.

Electrolyte imbalance often occurs with DKA. As sodium and potassium levels are not normal, they can affect the functioning of your body. You will be given electrolytes, again via I.V.

Key takeaways:

• Diabetes invariably carries some risks – diabetic ketoacidosis is a complication when you are severely hyperglycemic. It can occur if you have undiagnosed or poorly controlled diabetes.
• Familiarize yourself with the symptoms of DKA – when you know what the signs of this complication are, you can take steps to save your health and prevent organ damage or worse.
• Always aim to keep blood sugar levels under control – balance your insulin or medications, your diet, and activity levels and monitor your blood sugar levels regularly, several times a day, if necessary, so that you can manage your diabetes better.