What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis is a life-threatening complication of diabetes (diabetes) that occurs when the body breaks down its own fats too quickly. You can find more information below.

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.

Related article: All about diabetes

This condition develops when your body cannot produce enough insulin. Insulin normally plays an important role in getting sugar (glucose) into cells, which is an important source of energy for your muscles and other tissues. Without enough insulin, your body starts breaking down fat for fuel. This process creates a buildup of acids called ketones in the bloodstream and eventually leads to diabetic ketoacidosis if left untreated.

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

diabetic ketoacidosis during pregnancy

The occurrence of diabetic ketoacidosis in pregnancy endangers both the fetus and the mother. It usually occurs in the later stages of pregnancy and is also seen in patients with type 1 diabetes.

Related article: All about type 1 diabetes

Although incidence rates and outcomes have improved over the years, it still remains a major clinical problem, as it tends to occur at lower blood glucose levels and more rapidly than in nonpregnant patients, often resulting in delayed diagnosis.

What causes diabetic ketoacidosis?

Sugar is the main source of energy for the cells that make up your muscles and other tissues. Normally, insulin helps sugar get into cells.

Without enough insulin, your body cannot properly use sugar for energy. This causes the release of hormones that break down fats for fuel and produce acids known as ketones. Excess ketones accumulate in the blood and are eventually excreted in the urine.

Diabetic ketoacidosis is often triggered by:

  • An illness: An infection or other illness can cause your body to produce higher levels of hormones such as adrenaline or cortisol. Unfortunately, these hormones counteract the action of insulin – sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits.
  • A problem with insulin therapy: Missing insulin treatments or insufficient insulin therapy can leave too little insulin in your system, triggering diabetic ketoacidosis.
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Other possible triggers of diabetic ketoacidosis include:

  • physical or emotional trauma
  • Heart attack
  • Alcohol or drug use, especially cocaine
  • Certain medications, such as corticosteroids and some diuretics

Who is at risk?

The following situations are a cause of risk:

  • if you have type 1 diabetes
  • If you frequently miss insulin doses

Rarely, diabetic ketoacidosis can occur if you have type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign that a person has diabetes.

Related article: All about type 2 diabetes

What are the symptoms of diabetic ketoacidosis?

Symptoms of diabetic ketoacidosis usually develop quickly, sometimes within 24 hours. For some, these symptoms may be the first sign of diabetes, and you may notice:

  • extreme thirst
  • frequent urination
  • Nausea and vomiting
  • Stomach ache
  • Weakness or fatigue
  • Shortness of breath
  • fruity-scented breath
  • Confusion

More specific signs of diabetic ketoacidosis that can be detected with home blood and urine test kits include:

  • High blood sugar level (hyperglycemia)
  • high ketone levels in your urine

When should you see a doctor?

If you are feeling sick and stressed, if you have a recent illness or injury, you should check your blood sugar levels frequently. You can also try the over-the-counter urine ketones test kit.

You should contact your doctor immediately if:

  • If you are vomiting and cannot tolerate food or liquids
  • If your blood sugar level is higher than your target range and you are not responding to home treatment
  • If your urine ketone level is moderate or high

You should seek emergency help if:

  • If your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL) or 16.7 millimoles per liter (mmol/L)
  • If you have ketones in your urine and can’t reach your doctor for advice
  • If you have multiple signs and symptoms of diabetic ketoacidosis (excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, smelly breath, confusion)

Remember, untreated diabetic ketoacidosis can be fatal.

How is diabetic ketoacidosis diagnosed?

If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional testing may be needed to determine what triggers diabetic ketoacidosis.

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blood tests

The blood tests used to diagnose diabetic ketoacidosis will measure:

  • Blood sugar level: If your body does not have enough insulin to allow sugar to enter cells, your blood sugar level will rise (hyperglycemia). Your blood sugar level will continue to rise as your body breaks down fat and protein for energy.
  • Ketone level: As your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream.
  • Blood acidity: If you have excess ketones in your blood, your blood becomes acidic (acidosis). This can change the normal function of organs in your body.

Additional tests

Your doctor may order tests to identify any underlying health problems that may have contributed to diabetic ketoacidosis and to check for complications. Tests may include:

  • blood electrolyte tests
  • Urine test
  • chest x-ray
  • Recording of the electrical activity of the heart (electrocardiogram)

How is diabetic ketoacidosis treated?

If you are diagnosed with diabetic ketoacidosis, you may be treated in the emergency room or admitted to the hospital. Treatment usually includes:

  • Fluid exchange: In this case, you take fluids by mouth or through a vein (intravenously). Fluids will replace what you lose through excessive urination and help dilute the excess sugar in your blood.
  • Electrolyte exchange: Electrolytes are minerals in your blood that carry an electrical charge, such as sodium, potassium, and chloride. The absence of insulin can lower the levels of several electrolytes in your blood. You receive electrolytes through a vein to help your heart, muscles, and nerve cells function normally.
  • Insulin therapy: Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you will usually receive insulin therapy through a vein. Once your blood glucose level has dropped to approximately 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you can stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.

Once body chemistry returns to normal, your doctor will consider performing additional tests to check for possible triggers for diabetic ketoacidosis. Depending on the circumstances, you may need additional treatment.

For example, your doctor will help you create a diabetes treatment plan. If a bacterial infection is found, he or she may prescribe antibiotics. If a heart attack seems possible, your doctor may recommend further evaluation of your heart.

Can diabetic ketoacidosis be prevented?

There is much you can do to prevent diabetic ketoacidosis and other diabetes complications:

  • Don’t fail to manage your diabetes: Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
  • Monitor your blood sugar level: You may need to check and record your blood sugar level at least three to four times a day. Careful monitoring is the only way to ensure your blood sugar levels stay within your target range.
  • Adjust your insulin dosage as needed: Talk to your doctor or diabetes educator about how to adjust your insulin dose based on your blood sugar level, what you eat, how active you are, whether you’re sick or not, and other factors. If your blood sugar level starts to rise, follow your diabetes treatment plan to return your blood sugar levels to your target range.
  • Check your ketone levels: If you’re sick or under stress, test your urine for excess ketones with an over-the-counter urine ketone test kit. If your ketone level is moderate or high, contact your doctor immediately or get emergency help. If you find higher than normal amounts of ketones, you may need to take more insulin.
  • Be prepared to act fast: Get emergency help if you suspect you have diabetic ketoacidosis, if your blood sugar levels are high, and if you have excess ketones in your urine.
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Diabetes complications are scary. But don’t let fear stop you from taking good care of yourself. Follow your diabetes treatment plan carefully and seek help from your diabetes treatment team when you need it.

Complications of diabetic ketoacidosis

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 related to this lifesaving treatment.

Possible complications of treatments

Treatment complications include:

  • Low blood sugar (hypoglycemia): Insulin allows sugar to enter cells, causing your blood sugar levels to drop. If your blood sugar level drops too quickly, you may develop low blood sugar.
  • Low potassium (hypokalemia): Fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to be too low. Low potassium levels can impair the activity of your heart, muscles, and nerves.
  • Swelling in the brain (cerebral edema): Adjusting your blood sugar level too quickly can cause swelling in your brain. This complication appears to be more common, especially in children with newly diagnosed diabetes.

If left untreated, the risks are much greater. Diabetic ketoacidosis can lead to unconsciousness and eventually be fatal.

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