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Diabetic ketoacidosis (DKA) is a serious but potentially preventable and treatable complication of diabetes
Diabetic ketoacidosis (DKA) is a serious but potentially preventable and treatable complication of diabetes. The mortality rate for DKA is about 2%. Mortality rates in older individuals are higher, at about 10%-20%, due to existing comorbidities.
Because it typically takes hours for DKA to become life-threatening, you can survive the condition by acting quickly and receiving timely medical treatment.
Depending on the severity of the DKA, it may take several days before it is fully treated. However, it is often corrected (blood sugar less than 200 mg/dL and blood pH higher than 7.3) within 24 hours of appropriate treatment.
What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) can develop when there is an absolute insulin deficiency in the body. This causes blood sugar levels to spike to a dangerous level and leads to an overload of blood ketone levels due to the rapid breakdown of fats by the liver, causing metabolic acidosis. This causes progressive multiple organ dysfunction.
People with type I diabetes are mostly affected, but people with type II diabetes who are on insulin can also develop DKA. DKA is more common in women, young adults, and children.
How does diabetic ketoacidosis occur?
The two major causes of diabetic ketoacidosis (DKA) in people with type I diabetes are high blood sugar levels and low insulin levels.
- Insulin is the hormone that assists the entry of sugar molecules into the cells. In the absence of insulin, cells cannot utilize glucose as an energy source.
- Without enough insulin, the liver undergoes a rapid fat breakdown (for fuel production), a process that produces acids called ketones, making the blood acidic (low pH).
- These ketones are usually used by muscles and the heart. When ketones are produced too quickly and accumulate in the blood, they can be toxic to the body and eventually lead to ketoacidosis.
- Because the cells in the body can only function in a narrow range of pH, any acidotic change hampers cell metabolism and can trigger shock-like symptoms.
Other causes of DKA include:
- Heart attack or stroke
- Pancreatitis
- Missed insulin doses
- Infections
- Physical injury or surgery
- Alcohol or drug use
- Certain medicines, such as some diuretics and corticosteroids
- Heatstroke
DKA in people with type II diabetes is less severe and usually triggered by prolonged uncontrolled blood sugar, missing medication doses, or a severe illness or infection. This is because even in those who are insulin-dependent in type II diabetes, tiny amounts of insulin are still mostly being released in the body.
What are the signs and symptoms of diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) can develop acutely, meaning that it has a severe and sudden onset. Sometimes, it is the first sign of diabetes in people who have not yet been diagnosed.
Early symptoms may include:
- Increased thirst
- Dryness of the mouth
- Frequent urination
- High blood glucose (blood sugar) levels
- High levels of ketones in the urine
If untreated, more severe symptoms can appear quickly, including:
- Nausea, vomiting, or abdominal pain
- Dry or flushed skin
- Excessive dryness of mouth
- Constant fatigue
- Fruity-smelling breath
- Headache
- Blurred vision
- Muscle stiffness or aches
- Fast, deep breathing
- Confusion or difficulty paying attention
When to see a doctor for diabetic ketoacidosis
Elevated ketones are a sign of diabetic ketoacidosis (DKA), which is a medical emergency and needs to be treated immediately.
You can detect ketones with an over-the-counter ketone test kit, a simple urine test that can be taken every 4-6 hours when:
- You have symptoms of DKA
- Blood glucose is higher than 240 mg/dL
- You have been fasting for a long period of time
- You have a cold or the flu
- Your blood sugar stays at 300 mg/dL or above
- Your breath smells fruity
- You are vomiting and cannot keep food or drinks down
- You are having trouble breathing
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How is diabetic ketoacidosis treated?
Diabetic ketoacidosis is treated in the emergency room or hospital. Treatment will likely include:
- Fluid replacement
- Electrolyte replacement
- Insulin therapy
- Medicines for any underlying illness
Can you prevent diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a serious condition, but you can take steps to help prevent it:
- Manage your blood sugar levels through diet, exercise, medications, and self-care
- Monitor your blood sugar often, especially when you are sick
- Try to keep your blood sugar levels in the target range as much as possible
- Take medicines as prescribed, even if you feel fine
- Check ketone levels when you are ill or stressed
- Stay hydrated
- Exercise regularly
- Check for insulin leaks and expired insulin
- Talk to your doctor to adjust your insulin dosage based on your diet, activity level, or overall health
- Be prepared to seek emergency care if your blood sugar is high and you have excess ketones in your urine