Diabetic ketoacidosis

Description

Diabetic ketoacidosis is a serious complication of diabetes.

The condition develops when the body cannot produce enough insulin. Insulin plays a key role in helping sugar — an important source of energy for muscles and other tissues — enter cells in the body.

Without enough insulin, the body begins to use fat as fuel. This causes a build-up of acids in the blood called ketones. If left untreated, the accumulation can lead to diabetic ketoacidosis.

If you have diabetes or are at risk of diabetes, learn the warning signs of diabetic ketoacidosis, and when to seek emergency care.

Symptoms

Diabetic ketoacidosis symptoms often develop quickly, sometimes within 24 hours. For some, these symptoms may be the first sign of diabetes. Symptoms may include:

  • Being very thirsty
  • Frequent urination
  • The feeling of needing to vomit, and vomiting
  • Have stomach pain
  • To be weak or tired
  • Being short of breath
  • Have fruity-scented breath
  • Be confused

More-some signs of diabetic ketoacidosis — which can show up in the home of blood and urine of or kits include:

  • High level of sugar in blood
  • High levels of ketones in the urine

When to see a doctor

If you feel sick or stressed or have had a recent illness or injury, check your blood sugar level frequently. You might also try a test kit of ketones in the urine that you can get at a pharmacy.

Contact your health-care provider immediately if you:

  • You are vomiting and cannot keep food or liquids
  • Your blood sugar level is higher than your target range and does not respond to home treatment
  • Your level of ketones in the urine is moderate or high

Seek emergency medical attention if:

  • Your blood sugar level is higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L) for more than one test.
  • You have ketones in the urine and can not communicate with your health care provider for advice.
  • You have many of the symptoms of diabetic ketoacidosis. These include excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion.

Remember, untreated diabetic ketoacidosis can lead to death.

Causes

Sugar is a major source of energy for the cells that make up muscles and other tissues. Insulin helps sugar enter the cells in the body.

Without enough insulin, the body cannot use the sugar to get the energy you need. This causes the release of hormones that break down fat so that the body uses as fuel. This also produces acids known as ketones. Ketones accumulate in the blood and eventually spilling into the urine.

Diabetic ketoacidosis usually happens after:

  • A disease. An infection or other illness can cause the body to produce higher levels of certain hormones, such as adrenaline or cortisol. These hormones act against the effects of insulin and, at times, lead to diabetic ketoacidosis. Pneumonia and urinary tract infections are common diseases that can lead to diabetic ketoacidosis.
  • A problem with insulin therapy. Missed insulin treatments can leave very little production of insulin in the body. It is not enough therapy of insulin or an insulin pump that's not working well you can also leave very little to the production of insulin in the body. Any of these problems can lead to diabetic ketoacidosis.

Other things that can lead to diabetic ketoacidosis include:

  • Physical or emotional Trauma
  • Heart attack or a stroke
  • Pancreatitis
  • Pregnancy
  • Alcohol and drug abuse, especially cocaine
  • Certain medications, such as corticosteroids and some diuretics

Risk factors

The risk of diabetic ketoacidosis is higher if you:

  • You have type 1 diabetes
  • Often you forget to take a dose of insulin

Sometimes, diabetic ketoacidosis can happen with type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign of diabetes.

Complications

Diabetic ketoacidosis is treated with fluids, electrolytes such as sodium, potassium and chloride, and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are associated with this life-saving treatment.

The possible complications of the treatments

Treatment of the complications include:

  • Low blood sugar, also known as hypoglycemia. Insulin allows sugar to enter cells. This causes the level of sugar in the blood drop. If the blood sugar level falls too quickly, the fall can lead to low blood sugar.
  • Low potassium, also known as hypokalemia. Fluids and insulin for the treatment of diabetic ketoacidosis can cause potassium levels to drop too low. A low potassium level can affect the heart, muscles, and nerves. To avoid this, potassium and other minerals are usually with fluid replacement as part of the treatment of diabetic ketoacidosis.
  • Inflammation in the brain, also known as cerebral edema. Adjust the level of sugar in blood too quickly may cause the brain to swell. This seems to be more common in children, especially those with recent diagnosis of diabetes.

Untreated, diabetic ketoacidosis can lead to loss of consciousness and, eventually, death.

Prevention

There are many ways to prevent diabetic ketoacidosis and other complications of diabetes.

  • Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Taking diabetes medications or insulin as directed.
  • Control your blood sugar level. You might need to check and record your blood sugar level at least 3 to 4 times a day, or more often if you are ill or stressed. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
  • Adjust your insulin dose as required. Talk with your doctor or diabetes educator about how to make their dose of insulin to work for you. Consider factors such as the level of sugar in the blood, what you eat, how active you are, and if you're sick. If your blood sugar level begins to rise, follow your treatment plan for diabetes to return to their level of blood sugar in your target range.
  • Check your ketone level. When you are sick or stressed, test your urine for excess ketones with a test kit of ketones in the urine. You can buy test kits at a drug store. If the ketone level is moderate or high, contact your health care provider immediately or seek emergency care. If you have low levels of ketones, you may need to take more insulin.
  • Be prepared to act quickly. If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency medical attention.

The complications of Diabetes are scary. But don't let that fear prevents you from taking good care of yourself. Follow your treatment plan for your diabetes care. Ask your diabetes treatment team for help when you need it.

Diabetic ketoacidosis

Diagnosis

A physical exam and blood tests can help diagnose diabetic ketoacidosis. In some cases, other tests may be needed to help find what caused the diabetic ketoacidosis.

Blood tests

Blood tests used in the diagnosis of diabetic ketoacidosis is measured:

  • Level of sugar in the blood. If there is not enough insulin in the body to allow the sugar to enter the cells, the blood sugar level rises. This is known as hyperglycemia. As the body breaks down fat and proteins for energy, the blood sugar level will go up and up.
  • Ketone level. When the body breaks down fat and protein for energy, acids known as ketones to enter the bloodstream.
  • The acidity of the blood. A very high blood ketone level will cause the blood to become acidic. This can change the shape of the organs of the entire body of work.

Other tests

Tests that can help find health problems that could have contributed to diabetic ketoacidosis, and check for complications may include:

  • Tests of electrolytes in the blood
  • Analysis of urine
  • Chest X-ray
  • A recording of the electrical activity of the heart, also known as an electrocardiogram

Treatment

If you are diagnosed with diabetic ketoacidosis, which can be treated in the emergency room or in the hospital. Treatment usually involves:

  • Fluids. The fluids to replace those lost through a lot of urinate. Also dilute the sugar in the blood. Fluids can be given by mouth or through a vein. When administered through a vein, called the IV fluids.
  • The replacement of electrolytes. Electrolytes are minerals in the blood, such as sodium, potassium, and chloride, which carry an electric charge. Too little insulin can reduce the level of electrolytes in the blood. IV electrolytes help keep your heart, muscles and nerve cells work as it should.
  • The insulin therapy. Insulin reverses the diabetic ketoacidosis. In addition to fluids and electrolytes, insulin is given, usually through a vein. A return to regular therapy with insulin may be possible when the blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and the blood is no longer acidic.

Preparing for your appointment

Diabetic ketoacidosis is life-threatening. If you develop mild symptoms, contact your health care provider immediately.

Call 911 or the local emergency number if:

  • You cannot communicate with your care provider
  • Your symptoms are getting worse.
  • Your symptoms are very bad

A health care provider who sees you for possible diabetic ketoacidosis need answers to these questions as soon as possible:

  • What are your symptoms?
  • When did your symptoms develop? They are getting worse?
  • Have you been diagnosed with diabetes?
  • Have you recently checked your blood sugar level?
  • Have you recently checked your ketone level?
  • You have lost your appetite?
  • You can keep your liquids?
  • Are you having trouble breathing?
  • Do you have pain in the chest?
  • Has had a recent illness or infection?
  • Have you had recent stress or trauma?
  • You have recently used alcohol or recreational drugs?
  • How close you have been following your treatment plan for diabetes?
  • How well have you been to the management of their diabetes before these symptoms started?
Symptoms and treatment of Diabetic ketoacidosis