Diabetic Ketoacidosis – Symptoms, causes, risk factors, prevention and more

DIABETIC KETOACIDOSIS

What is Diabetic Ketoacidosis?

Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes that occurs when your body does not produce adequate insulin. It primarily occurs when your body produces high blood acids known as ketones. Excess ketones result in severe body damage and may sometimes lead to death.  

The main reason for this condition is insufficient production of insulin which allows blood sugars to enter the cells. It is often seen in people who are diagnosed with type 1 and type 2 Diabetes. Inadequate insulin leads to the breakdown of fat as fuels, thereby forming ketones that ultimately lead to Diabetic Ketoacidosis in the future if left untreated.

In this article, we have elaborated on the complete details of DKA from top to bottom. Do spend a few minutes to get to know more precise information on DKA and its causes.

General symptoms of Diabetic Ketoacidosis

The common factor about DKA is it develops gradually. However, the symptoms of DKA appear sooner and are also a sign of Diabetes. These symptoms include:

Dry mouth  

This is a condition where salivary glands present in your mouth do not produce enough saliva to keep your mouth wet. It is also known as Xerostomia.  

Dry skin  

Dry skin is an atypical skin condition where the skin does not have enough moisture and looks dry.   

Feeling very thirsty  

Thirstiness generally occurs due to excess sugar present in the blood. Excessive thirst is one of the signs of Diabetes. This also indicates the presence of Diabetic Ketoacidosis in your body.   

Frequent peeing  

Repeated peeing is a strong indication of Diabetes and its complication. Make sure to consult a doctor if you suffer from this condition immediately.   

Nausea or vomiting  

A patient may experience nausea or vomiting if they are seriously affected by Diabetes. It is also said that Diabetic Ketoacidosis also causes nausea or vomiting in the affected person.  

Weakness  

If you are affected by DKA, you may often experience weakness and soreness in your body. This typically happens when the cell does not receive sufficient glucose from the body.   

Fatigue  

Fatigue is one of the important symptoms of high blood sugar levels. Often, it is exhibited in people who are diagnosed with DKA.  

Confusion or less alertness

If you have confusion problems often, then you have to watch out for the symptoms of DKA. It may affect your brain due to the presence of high levels of blood acids called Ketones.  

Flushed face  

Facial flushing is an important thing to look out for if you suspect the presence of DKA.   

Headache 

Headaches can affect people with Diabetes due to faltering blood sugar levels. DKA also has come up with headache symptoms.  

Muscle ache

Muscle ache is nothing but the pain experienced in body parts of the muscle. Muscle pain can also be called Myalgia. DKA-affected people face muscle aches more often.   

Sweet-smelling breath  

Sweet-smelling breath normally may indicate the presence of any problems/allergies in the body.  

Belly pain  

Belly pain is the pain you feel anywhere between the chest and groin. It is very similar to abdominal pain. DKA patients have admitted that they had faced belly problems during the initial stage of the disease.  

Shortness of breath  

Shortness of breath is nothing but difficulty in breathing. DKA often faces this problem. Fluctuation in glucose causes lung and breathing problems, especially Diabetes problems.

You can also determine the signs of DKA through urine test kits and home blood that includes:

  • High ketone levels in urine
  • High blood sugar levels

Generally, people diagnosed with type 2 Diabetes are less likely to get affected by DKA.

Causes of Diabetic Ketoacidosis

DKA initially occurs due to poor insulin content in the body, i.e., your body cannot use sugar to produce energy; instead, it uses fat. The burning of fats leads to the production of ketones. Low insulin level and High blood sugar is the optimal reason for the cause of DKA.  

However, the most commonly acknowledged causes of DKA include:

  • Illness
  • Infection
  • Clog in the insulin pump
  • Avoiding Insulin injection
  • Heart attack
  • Stroke
  • Alcohol addiction
  • Physical injuries
  • Pancreatitis

The reasons that trigger Diabetic Ketoacidosis are:

Illness

Illness triggers your body to manufacture hormones of certain levels known as cortisol and adrenaline. These hormones counter the insulin effect and lead to DKA. To add more information to this, diseases like the urinary tract and pneumonia also occur in this way.  

Insulin therapy problems

Improper insulin therapy and avoiding insulin treatments or poor function of the insulin pump paves the way for the cause of Diabetic Ketoacidosis.  

When to see a doctor?

Consider repeatedly checking your blood sugar level if you have stress problems, injury, or any illness. Untreated DKA guarantees death. Listed below are the reasons why and when you should consult a doctor:

  • Frequent vomiting
  • Intolerance of food and liquids
  • High blood sugar levels
  • Your body does not respond to home treatments
  • Urine ketone level is high and moderate

Emergency care is required in the following cases:

  • The blood sugar level is higher than 300 (mg/dL) or 16.7 millimoles per litre.
  • High level of ketones in the urine.
  • Signs like excessive thirst, frequent urination, nausea, vomiting, weakness and confusion.  

Risk factors of Diabetic Ketoacidosis

Type 1 Diabetes  

Miss a meal  

Do not miss a meal. Failing to eat at regular intervals may cause serious problems to the body, especially in DKA-affected patients.  

Sick or stressed  

People with Type 1 Diabetes may often feel sick or stressed, and it may also be due to DKA problems.  

Have an insulin reaction  

Insulin reaction occurs only under circumstances where a person becomes unstable and unconscious due to Hypoglycemia caused by either oral diabetic medications or insulin.   

Haven’t injected any insulin  

If you have Diabetes problems and irregular blood glucose levels and not getting administered any injections may cause DKA episodes.  

Type 2 Diabetes  

Missing your insulin dose often

If your glucose levels are high and if you miss an insulin injection, it may have serious consequences on your body.   

Not taking your insulin as prescribed  

If you take insulin regularly without any gap but taking wrongly prescribed insulin may aggravate the diabetic conditions in the body.   

Stomach illness  

High blood pressure in the body may lead to gastroparesis and stomach illnesses. If you have Diabetes accompanied by a stomach illness, then you also have a chance of acquiring Diabetic Ketoacidosis.  

Infections  

If you have had Diabetes problems for years, then you have the problem of reduced blood flow and nerve problems which may lead to a serious infection in the future.  

Heart disease, such as a heart attack  

Heart diseases can occur in people who have high blood sugar content in the body. This fluctuation in the blood may cause a severe threat to DKA-affected people.  

Recent stroke  

Stroke is the major cause of diabetic-related disorders. It causes serious problems, including cardiac arrest and DKA in the patients.   

Blood clots in your lungs  

A person may rarely experience the trauma of blood clots, more precisely in the lungs, due to high ketones present in the body.  

Serious illness or any trauma  

Serious illness is nothing but a complication of illness. DKA patients must be very prudent in taking insulin doses, or else it may cause alarming threats to their bodies in the future.   

Pregnancy  

The presence of high blood sugar in the body always affects women, especially during the phase of pregnancy.  

Surgery  

Sometimes surgery may cause side effects for people who have complications of Diabetes. Maintaining food discipline and eating low sugar foods is the only way to prevent DKA infection.

Medicines like steroids 

Suppose you consume steroids on a regular basis without your doctor’s consent. Then you may have to face the effect of increasing ketone levels, leading to DKA complications.

Using illegal drugs, such as cocaine

Cocaine is a dangerous and addictive drug. It is strictly prohibited for Diabetes patients.

However, there are certain medications that drastically increase the risk of DKA. They are:

  • Corticosteroids
  • Thiazide diuretics
  • Anti-psychotic medications like clozapine, olanzapine and risperidone

Treatment of Diabetic Ketoacidosis

Once you are diagnosed with DKA, it is your obligation to treat it immediately or else it may lead you to coma or death. You must immediately get admitted to a hospital for immediate treatment.  

The following are the vital treatments given for Diabetic ketoacidosis patients:

  • Insulin to bring down the ketone levels.
  • Hydration is done through fluids to bring back the blood chemistry.
  • Electrolyte replacement technique to bring back the minerals like sodium, chloride and potassium. This is fundamentally done to make sure the heart, nerves and muscles are working properly.

The treatment is primarily done to normalise blood sugar and insulin levels. If you are diagnosed with DKA due to infections, then your doctor can help you cure this condition through antibiotic medication.  

Below are some of the exclusive treatments given for treating DKA:

Insulin therapy 

Insulin can be administered through IV to you until your sugar level drops to the rate of 200 to 250 mg/dL and your blood sugar is no longer acidic. The team will closely watch out for the blood test results to determine whether you still need insulin therapy. Insulin helps to reverse the process that causes DKA. Your doctor will help you to avoid DKA in the future when your blood sugar levels and test ranges are normal.

Electrolyte replacement 

When your insulin levels are low automatically, your body electrolytes also get dropped significantly. Electrolytes are electrically charged materials that help your body and the body’s vital organs function properly. The other important fact is the replacement of electrolytes, which can also be done through IV. Electrolytes present in the blood carry electric charges such as sodium, potassium and chloride. The absence of insulin lowers the electrolyte content in the body.

Fluid replacements

Fluid replacements can be done either via vein or mouth until your body gets hydrated and helps to restore blood flow level. These replacements are particularly done for those who have high blood sugar levels and urine problems. During DKA, your body may lose fluids which results in the reduction of blood flow.

Medications for Diabetic ketoacidosis

Medications used for the treatment of DKA include the following:

Rapid-acting insulins

Some common examples of rapid-acting insulins include insulin lispro, insulin glulisine and insulin aspart.

Electrolyte supplements

Electrolyte supplements like potassium chloride are used as one of the medications for treating DKA.

Short-acting insulins

Short-acting insulins are nothing like regular insulins that are used as a medication for DKA.

Alkalinising agents

Alkalinising agents like sodium bicarbonate can also be recommended for DKA treatments.

Testing for ketones

Here are some of the ways where you can effectively test ketones.  

When to test?

You can test ketones under the following conditions:

  • If you are extremely sick
  • If you have common symptoms of DKA
  • If your blood glucose level is 240 mg/dL or higher
  • Make sure to test your blood every 4 to 6 hours

How to test?

To evaluate the presence of ketones, a urine test is taken via urine test strips which shows the result through colour change. For this, you need to urinate on the strip of the container. The indicator present in the strip will change colour. Now, compare the strip with the resulting chart to know the difference.  

Blood ketone testers are also used to measure both the glucose as well as ketone levels. For this, you need to send a small sample of blood to the test strip. The test strip is then inserted into the monitor device to check the presence of ketones in the blood.

You can take your doctor or pharmacist’s piece of mind to know how to use home ketone tests.

Prevention of Diabetic Ketoacidosis

There are multiple ways available for the prevention of DKA. You can easily avoid DKA problems by strictly adhering to diabetic treatment plans.  

The following are the important measures to prevent DKA problems in the future:

Drink a lot of water or sugar-free, nonalcoholic beverages

Do not drink contaminated and high sugar beverages. Instead, drink litres of water and sugar-free beverages.  

Take your medicines as directed  

Do not miss medicines and injections as they may lead to multiple risks to your body.  

Follow your meal plan closely  

Do not avoid or miss your meals. Eat only the foods suggested by your health care professional.  

Keep up with your exercise program  

Follow proper exercise plan and maintain consistency. Any workout without consistency does not bring any significant results to the body.  

Test your blood sugar regularly  

Check your blood sugar levels at least twice a month. This ensures your body is under control without any restrictions.  

Check for expired insulin  

Before taking insulin, double-check whether the insulin has not expired. By doing this, you can make sure your insulin functions well in your body.  

Other than this, some preventive measures could avoid DKA in the future.   

  • Make sure to test your blood consistently to detect problems
  • Frequently check your dosage levels regularly after eating
  • Do not exercise if your ketone level is high
  • Follow a healthy diet and regular exercise plans
  • Check your ketone level often, especially during illness
  • Seek emergency medical under serious conditions
  • Talk to your doctor when your blood sugar levels are high

Summing up

The people who are diagnosed with this condition must bear the important fact that DKA is a threatening condition, but it can be prevented. Stick to the treatment plan and be cautious about your health. If the medications do not favour you, tell your doctor and he/she may modify the treatment plans concerning your body condition.  

FAQ

1. What are the warning signs of Diabetic Ketoacidosis?

Warning signs of Diabetic Ketoacidosis include frequent urination, shortness of breath, nausea, stomach pain, confusion and excessive thirst.

2. What causes Diabetic Ketoacidosis?  

Inadequate insulin is the main reason for the cause of diabetic Ketoacidosis.

3. How is Diabetic Ketoacidosis diagnosed?

Diabetic Ketoacidosis can be diagnosed in the following ways:
1. Ketone test
2. Blood pressure test
3. Arterial blood gas test
4. Osmolality blood test
5. Blood glucose test

4. How long can you live with ketoacidosis?

It depends on the condition and severity of the disease. However, the mortality rate of ketoacidosis drops down after intensive care unit treatment.

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