Diabetic Ketoacidosis

Diabetic ketoacidosis (also known under the acronym DKA) is a complication of regular diabetes that can be lethal. It is the end result of a severe metabolic dysfunction, when although the blood stream is full of sugar in the form of glucose, the amount of insulin is insufficient to make it available to the cells. As a result, the cells don't get enough glucose, so they lack energy. The human body then starts an emergency response, converting its fat reserves and then the muscle tissue into energy. However, ketones are produced during this phase, which cause a metabolic acidosis named ketoacidosis, a severe disturbance of the metabolic system. Another problem is that the sugar in the blood stream can't be converted and burned as energy and remains there. The kidneys process some of the excess sugar and it is eliminated from the body in urine.

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Ketones are toxic to the body and cause diabetic ketoacidosis when they accumulate in high amounts. Any person who suffers from diabetes can get DKA eventually, but it rarely develops in type 2 diabetes.

DKA is a severe condition that can cause death. It is very important for diabetes patients to monitor their urine and blood in order to identify the signs of this condition. Even if the actual treatment will be administered in a hospital, detecting the warning signs can save your life.

The disease has a slow progress and usually the first major symptom is vomiting. However, it can evolve very quickly after this step and cause death after a few hours.

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It is very important to detect the first symptoms of diabetic ketoacidosis, before it's too late. Some of them, like unusually frequent urination or excessive thirst, don't require any testing. Others can be detected by medical tools and include a very high amount of sugar in the blood or high levels of ketones found in urine.

More severe signs follow up later. There are varied and can happen individually or at the same time. Some of these symptoms are: nausea, dry skin, the sensation of tiredness over a long period, stomach pain, difficult or very smelly breath, confusion or difficult concentration.

Vomiting is one of the distinctive warning signs of diabetic ketoacidosis but keep in mind it's a common condition that can be the result of many diseases, most of them are not severe. If vomiting is caused by diabetic ketoacidosis, it will usually persist for a long period of time.

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If it happens for more than two hours, you must go to the hospital.

What causes diabetic ketoacidosis?

Both types of diabetes are caused by the lack of an essential hormone named insulin, which is used to transfer glucose from the blood to every cell in the body. The severe form of diabetes is type 1, when the pancreas can't produce insulin at all. Type 2 diabetes is a condition where the pancreas produces some insulin, but not enough to meet the metabolic demands.

Glucose is a simple type of sugar digested by our body from the food. It is the main fuel used by the cells, which burn it to generate energy. The problem of people who suffer from diabetes is that lack of insulin prevents glucose from reaching their cells. This is dangerous for two separate reasons: the body is forced to use other energy sources while sugar builds up in the blood. Blood analysis on people with diabetic ketoacidosis has revealed massive amounts of glucose of over 22 mmol/L and very low levels of insulin.

Without glucose, the body turns to its fat reserves for energy. However, breaking down fat cells has the unwanted side effect of producing ketones. Their level builds up in the blood stream, raising its acidity. When the blood becomes too acid, some of the enzymes needed to regulate other functions of the body are unable to work. Ketones also have other bad effects, such as affecting the balance of electrolytes and carbohydrates.

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People who suffer from diabetes and have a deficiency of insulin are always at risk of developing diabetic ketoacidosis but it usually happens in some particular conditions. The most common one is a severe lack of insulin, which can happen if one or more doses are skipped during treatment, or if a person has not been diagnosed at all. DKA can be triggered by other diseases, usually by infections of the urinary or respiratory tracts. It can also start after serious shocks like heart attacks, surgery or even major emotional stress.

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The first thing to do in case of diabetic ketoacidosis is to provide fluids for proper hydration, regardless of the patient's location. Usually this is done intravenously, in the hospital or a doctor office. Oral hydration is required at home, which will be less effective but still helpful. It is important to replenish the liquids that are lost due to constant urination. The body is able to remove some of the blood sugars in the urine, so replacing the fluids is very important.

Restoring lost electrolytes is also a must. These are a group of compounds that are important in the normal operation of the body and include chloride and minerals such as sodium and potassium. Their level in the blood is normally regulated by insulin but the body doesn't have enough of it during diabetic ketoacidosis, which prevents a number of normal functions. Electrolytes are usually provided intravenously but there are also some beverages available for this purpose.

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Of course, the main medical counter for diabetic ketoacidosis is a treatment based on insulin. This will restore the flow of glucose to the cells, reducing blood sugar level and its overall acidity. Insulin is injected, usually by a nurse or doctor.

Diabetic ketoacidosis causes excessive urination, which in turn leads to dehydration. This can be very dangerous and can be prevented by drinking big quantities of water or any other liquid without a high content of calories. It is important to do it at the first warning signs of diabetic ketoacidosis.

If intravenous replacement of electrolytes is not possible, the alternative is to drink at least 8 ounces of liquid every half an hour. A very good idea is to mix water with beverages that are rich in electrolytes. These can be drinks for kids or the ones made for athletes, such as Powerade or Gatorade.

In a hospital, a patient with diabetic ketoacidosis will receive potassium supplements in order to replace the lost amounts. The level of blood sugar will be carefully monitored, as well as the acidity.

Additional things you may do

The best advice if you suffer from diabetes is to listen to your doctor and take the medication on time. However, it is your duty to take every insulin dose on time and to monitor your symptoms. You have to know what the warning signs for increased blood sugar levels are.

If you feel bad, make a urine test at home using one of the available kits. These tests can reveal an increased level of glucose in the blood or too many ketones, which can point to a higher risk of diabetic ketoacidosis. If you detect any of these warning signs or if you feel sick without knowing the exact cause, it would be wise to go to the hospital or contact your doctor to prevent more dangerous developments.

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