Diabetic ketoacidosis is a life threatening complication. It is common in people with Type 1 Diabetes because their pancreas does not produce insulin. But, it can also happen in individuals with Type 2 Diabetes when their blood sugar reaches critical level.
During episodes of DKA, the body runs low on insulin so it burns fats as an alternative energy source. This process produces high level of ketone acids causing the following symptoms:
- Nausea
- Vomiting coffee-ground color
- Excessive thirst and urination
- Severe abdominal pain which may be cause by pancreatitis, GI tract perforation
- Kussmaul respiration (a deep and laborious breathing)
- Confusion
- Lethargy
- Dehydration
- Elevated heart rate (tachycardia)
- Comatose (severe cases)
- Blurring of the vision
- Fruity breath odor
Diabetic ketoacidosis has four characteristics that result in the development of the symptoms: hyperglycemia, acidosis, dehydration, and electrolyte imbalance.
- During hyperglycemia, which causes the blurry vision, the glucose accumulates in the blood. The lack of insulin prevents glucose from entering the cells (hepatic glucose overproduction). The production of counter regulatory hormones such as catecholamines, cortisol, and glucagon, also increases. Gluconeogenesis and glycogenolysis take place. Insulin resistance increases during this stage. This makes it more difficult for the tissues to absorb glucose.
- The increase in counter-regulatory hormone levels and insulin resistance cause the release of glycerol and fatty acids. The liver starts oxidizing free fatty acids producing high levels of ketone acids. This process leads to ketoanemia.
- The ketone acids break down into hydrogen ions and ketone anions. The body then tries to bind the hydrogen ions by using up its alkali reserves causing acidosis.
- To address acidosis, the respiratory system works harder to take in more carbon dioxide, thus the Kussmaul respiration. Acetone ketones fill the air that the person exhales during Kussmaul respiration. This explains the fruity acetone odor.
- While the kidneys excrete the excess ketone acids through the urine (ketonuria), osmotic diuresis and dehydration also take place. Acidosis and dehydration explains the abdominal pain.
This reaction is a long a complicated one, but you got the idea. You will know it is not good just by reading it. So, there are four possibilities: acidosis, shock, comatose, and death.
Diabetic ketoacidosis can also happen in non-diabetics as initial presentation of diabetes.
Understanding the risks
Diabetic ketoacidosis is an emergency case. You end up either in the ER or ICU. It’s one of the worst things that can happen if we fail to maintain the right blood glucose level in our body.
Kids and adults who experience diabetic ketoacidosis can suffer from cerebral edema or the swelling of the brain. This may lead to death if left untreated. This is the reason why doctors perform hourly or half-hourly check for ketone levels in the body as well as Glasgow Coma Score (GCS).
Doctors also check for infections that may have caused the DKA. They perform several tests such as X-ray, CT scan, and ultrasound. There’s also frequent urinalysis to check for the presence of ketones and glucose in the urine.
Other causes
Several underlying medical conditions lead to diabetic ketoacidosis other than Diabetes. These include flu, gastroenteritis, pneumonia, urinary tract infection, myocardial infarction, stroke, or pregnancy.
People with eating disorder, particularly anorexia, are also prone to diabetic ketoacidosis. Weight gain scares them so much that they try to avoid sugary foods.
Meanwhile, ketosis-prone Type 2 Diabetes often occurs in African-Americans and Hispanics.
Treatments
Recognizing the signs of mild to severe diabetic ketoacidosis will help you determine when to seek hospitalization and when to treat at home.
- Provide proper ventilation to reduce Kussmaul respiration.
- Although insulin therapy is so important, doctors recommend the administration of electrolytes first. Electrolyte replacement will make insulin therapy more effective. Potassium is the key player in restoring electrolyte imbalance, then sodium and phosphate.
- Insulin therapy follows immediately after re-hydration and electrolyte replacement. This will address the acidosis and correct cell metabolism.
- As a diabetic, make it your responsibility to learn about the early signs of diabetic ketoacidosis. Keep track of your blood glucose level.
- Discuss with your doctor the effective ways to better manage your symptoms. Seek advice from a dietician, endocrinologist, and/or diabetes coach.
- If you want to avoid trouble, never miss your dose of insulin.
- Be aware about medications and substances that can affect carbohydrate metabolism. These include antidepressants, corticosteroids, loop diuretics, thiazides, anti-hypertensive, sympathomimetics, anti-histamines, ecstasy, and cocaine. Ask your doctor about the safety of the legal drugs and stop doing the illegal and harmful types.
Save yourself the trouble of hospital confinement, not to mention the ugly outcomes of diabetic ketoacidosis. Frequent check-up is paramount to know more about the possibilities your condition can bring. I am not a doctor or a nurse so I encourage you to explore all possibilities with help from professionals.
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