Diabetic Ketoacidosis

What is Diabetic Ketoacidosis?

This is a serious difficulty of diabetes which happens when the body is unable to use the glucose or sugar in the system. This is since the body is unable to metabolize glucose because there is no insulin being produced. In order for the cells to have energy, the cells of the body begin to breakdown fat instead. The byproducts of this fat breakdown are toxic acids called ketones and ketones build up to very high levels in the blood.

Diabetic ketoacidosis occurs in people who have Type-1 or juvenile diabetes mellitus but it can occur in any person with diabetes.

Ketoacidosis Signs and Symptoms

The symptoms or should we say, warning signs, which mean that you are becoming very ill include:

• Dry mouth and skin
• Flushed face
• Deep, rapid breathing
• Vomiting and nausea
• Stomach pains
• Fruity odor on breath

Other signs that also can occur:

• Frequent urination or thirst for 24 hrs or more
• Fatigue
• Mental stupor progresses to a coma
• Shortness of breath
• Muscle aching and stiffness
• Breathing difficulty when lying down
• Abdominal pain
• Decreased appetite
• Headache
• Decreased consciousness

The immediate objective of treatment is to lower the high blood glucose level as quickly as possible by giving insulin. The loss of fluid by excess urination and vomiting needs to be replaced. A diabetic may recognize the early warning signs and can make the needed corrections at home before the condition becomes worse.

If this situation becomes severe, the subject needs to be taken to the emergency room as quickly as possible. At the emergency room they will do the following:

• Fluids and electrolyte replacement
• Insulin replacement will be given
• The reason for the condition, such as an infection, will be found and treated

Those who have Type-1 diabetes do not produce enough insulin to metabolize glucose. Those times that glucose is unavailable, the body starts breaking down fat. As the fat becomes used, acids known as ketones begin to be made in the urine and blood and in high levels this is a poisonous situation.

Blood glucose levels will rise as the liver makes glucose in order to battle the problem. But the cells are unable to use that glucose because there is no insulin.

Diabetic ketoacidosis is sometimes the first symptoms that a person has Type-1 diabetes as it may be the incident which causes them to seek a doctor’s help or lands them in the hospital. But it can happen just as easily to someone who is already diagnosed with Type-1 diabetes. Diabetic ketoacidosis can be caused by infection, heart attack, trauma, or surgery. Insulin doses which are missed can also cause this condition.

It can also occur in those already diagnosed as Type-2 diabetics but this is very rare and is usually brought on by a very severe illness.

Ketoacidosis Tests

Testing for ketone can be used as a screen for early signs of ketoacidosis for Type-1 diabetes. This test is measured with urine samples. Testing for ketones is also done when:

• Blood sugar level over 240 mg/dL
• Pregnancy
• When nausea or vomiting occurs
• Illnesses such a pneumonia, stroke or heart attack

Other tests use to identify ketoacidosis are

• Blood glucose test
• Measurement blood pressure
• Arterial blood gas
• Amylase blood test
• Blood test for potassium

Acidosis does lead to death or severe illness, but better treatment for young adults with Type-1 diabetes has had an effect on the rate of death from this complication by decreasing it. It still can remain a risk especially in those who are elderly or in those who become comatose when treatment is delayed.

For those with diabetes, prevention can occur by learning to know the warning signs of ketoacidosis. For those who are on insulin pump therapy or have an infection measuring the ketones in urine often offers more information than glucose monitoring alone. Those using insulin pumps should check very often to make sure that insulin is flowing thru the tubing – and that there are no disconnections, blockages, or kinks.

Ketoacidosis Complications

Severe complications that can develop are:

• Heart attack
• Death of bowel tissue because of blood pressures too low
• Fluid buildup in the brain – also known as cerebral edema
• Renal failure

This complication can quickly become an emergency. You need to call your doctor if you notice any early signs of diabetic ketoacidosis. Call 911 or get to an emergency room if you notice:

• Decreased consciousness
• Mental stupor
• Fruity breath
• Difficulty breathing
• Vomiting
• Nausea