Diabetic Ketoacidosis: Symptoms, Causes, Risk Factors, and Prevention

Introduction to Diabetic Ketoacidosis: Symptoms & Prevention Strategies

Persistent fatigue, stomach pain, and breathlessness, combined with an unusual sweet breath odor, are symptoms that, at first glance, appear to be those of the flu. But in people with diabetes, these can be symptoms of a potentially life-threatening and serious complication called diabetic ketoacidosis (DKA).

Now, the good news is that with proper information, DKA is preventable and manageable. So, stay tuned as we are going to discuss all about Diabetic Ketoacidosis, equipping you with the information you need to act quickly to tackle this severe medical condition.

What is Diabetic Ketoacidosis?

Diabetic ketoacidosis is a serious medical condition that occurs when the body cannot generate enough insulin. Since glucose cannot be allowed into muscle cells to be utilized as energy without insulin, the body has to resort to fat metabolism as an alternative.

This increased fat-focused metabolic shift results in the generation of ketones, acidifying compounds which build up in the blood and cause ketoacidosis. If not controlled, this condition can progress to coma or even death.

Now let’s discuss the diabetic ketoacidosis pathophysiology:

• Insulin Deficiency: Insulin deficiency prevents glucose from entering the cells, leading to raised blood sugar levels, or hyperglycemia.
• Generation of Ketone Bodies: Insulin deficiency results in fatty acid breakdown, and in an attempt to counteract, there is excess ketone body production, mainly acetoacetate, beta-hydroxybutyrate, and acetone.
• Metabolic Acidosis: Because ketones are acidic in nature, their accumulation disrupts the acid-base equilibrium of the body and leads to metabolic acidosis, a feature of DKA.
   

The pathophysiological phenomena exhibited by these events in diabetic ketoacidosis require immediate medical intervention.

What are the Common Diabetic Ketoacidosis Symptoms?

The onset of the symptoms of DKA usually occurs acutely, within 24 hours. Thus, to effectively manage this medical condition, its symptoms require timely diagnosis.

Common signs and symptoms are:

• Extreme Thirst: Dehydration occurs due to the high ketone levels in the blood, leading to extreme thirst.   
• Hyperglycemia: Serial concentration, which is generally >250 mg/dL, can anticipate an oncoming attack of DKA.
• Nausea and Vomiting: When the blood becomes acidic, it can interfere with the digestive system's operations.
• Abdominal Pain: Among the symptoms of electrolyte imbalance, abdominal pain is frequently encountered and can be quite severe.
• Sweet-smelling Breath: Happens due to acetone, one of the ketones the body releases.
• Hyperventilation (Kussmaul respiration): The body's response to acidosis often involves shallow or rapid breathing, known as Kussmaul respiration, which aims to reduce carbon dioxide levels.
• Weakness and Confusion: Low brain glucose results in changes in the mind, pronounced weakness, and continual brain fog.
   

These symptoms may escalate quickly. Immediate treatment is necessary for any diabetic ketoacidosis patient presenting with these signs.

What are the Main Diabetic Ketoacidosis Causes?

Understanding the causes of diabetic ketoacidosis can help identify triggering factors and prevent future occurrences. Check them out below:

• Missed or Poor Insulin Treatment: Skipped doses of insulin are the most prevalent cause of DKA in type 1 diabetics.
• Infection or Disease: Pneumonia or urinary tract infections may increase the body's need for insulin, which can initiate DKA.
• Poor Control of Diabetes: Poor blood glucose management can gradually result in DKA.
• Physical or Emotional Stress: Diabetic ketoacidosis can result from physical or emotional stress, including surgery, trauma, or extreme psychological pressure, as these conditions stimulate stress hormones that resist insulin's action.
• Alcohol or Drug Abuse: These substances can alter glucose metabolism, particularly in individuals who do not even realize they have diabetes.
• New-onset Diabetes: Some individuals who have been diagnosed with type 1 diabetes are affected by DKA, as they have missed the early signs of type 1 diabetes.
   

These diabetic ketoacidosis causes should be monitored in proximity, particularly in times of stress or illness.

Who is at Risk of Developing Diabetic Ketoacidosis?

While DKA is a potential complication for anyone with diabetes, some individuals are more susceptible:

• Individuals with Type 1 Diabetes: DKA is more frequent in such patients because of absolute insulin deficiency.
• Teenagers and Young Adults: Hormonal transition and insulin non-adherence put them at greater risk.
• People with Recurrent Infections: Illness requires more insulin, and any inability to adjust dosage can cause DKA.
• Pregnant Diabetic Women: Gestational changes make them susceptible to blood sugar fluctuations.
• Uninsured or Economically-Backward Patients: Inability to obtain regular care and insulin augments risk.
• Patients with Insulin Pumps: A dislodged or kinked insulin pump catheter can stop insulin infusion, leading to DKA in hours.
   

Identification of these risk groups can help in proactive management and prevent diabetic ketoacidosis.

How is Diabetic Ketoacidosis Diagnosed?

Early diabetic ketoacidosis diagnosis is needed in an attempt to prevent serious complications. Diagnosis usually relies on both the patient's clinical signs and symptoms, as well as laboratory test results.

The following tests are performed to diagnose diabetic ketoacidosis:

• Blood Glucose Screen: More than 250 mg/dL is typically associated with DKA.
• Urine or Blood Ketone Test: Elevated ketones confirm and indicate a shift towards fat metabolism.
• Arterial Blood Gas (ABG): This is used to measure blood acidity (pH). If the pH is less than 7.3, acidosis is present.
• Electrolyte Levels: Potassium, sodium, and chloride levels are measured as they tend to be imbalanced.
• Anion Gap Calculation: When unmeasured anions, like ketones, lead to metabolic acidosis, it assists in diagnosis.
   

All these tests combined define what diabetic ketoacidosis is and distinguish it from other diseases with similar presentation.

What are the Management and Treatment Options for Diabetic Ketoacidosis?

Diabetic ketoacidosis is a hospitalization-necessitating medical emergency. The diabetic ketoacidosis supportive therapy focuses on fixing the root problem and bringing the body's metabolism back into balance.

Let's have a look at some of the critical components of the treatment and management of this medical condition:

• Fluid Replacement Therapy: IV fluids are given to correct dehydration, usually starting with saline fluids.
• Insulin Therapy: Regular insulin is delivered intravenously to lower blood glucose and stop ketone production.
• Electrolyte Correction: Potassium is routinely supplemented as levels decrease when insulin therapy is initiated.
• Correction of Underlying Cause: Infection or other precipitants are diagnosed and treated with antibiotics or other appropriate drugs.
• Monitoring and Supportive Therapy: Supportive therapy of diabetic ketoacidosis includes ongoing observation of heart rate, breathing, and kidney function.

How Can You Prevent Diabetic Ketoacidosis?

Prevention is always better than a cure. Being aware and proactive can help avoid this dangerous condition. Some of the best practices to prevent diabetic ketoacidosis are :

• Maintain your insulin dosage and avoid skipping injections, particularly during illness. Talk with your doctor about adjusting doses if you are ill. Use reminders or apps when needed.
• Monitor your blood glucose and ketones, especially when ill or stressed. Early detection of raised sugar or ketones before they become full-blown DKA is key.
• Drink lots of fluids so that your kidneys can get rid of excess sugar and ketones from your body.
• Educate others and yourself. Caregivers and family members should understand how to recognize diabetic ketoacidosis symptoms and when to call for help.
• Have emergency supplies like glucose testing kits, ketone strips, additional insulin, and your physician's numbers always within reach.
   

By doing these, people can reduce the possibility of developing diabetic ketoacidosis.

Diabetic ketoacidosis may progress overnight, but with increased vigilance, prompt intervention, and the right strategy, it may be preventable. Awareness of prodromal symptoms, familiarity with possible precipitants, and a precise treatment strategy may be the sole difference vitally required in preventing DKA formation.

Furthermore, under such situations, having a comprehensive health insurance plan can be a lifesaver as it can provide access to treatment without delay. For instance, the policies offered by Star Health facilitate cashless treatment access to 14,000+ network hospitals, ambulance cover, home lab sample pickups, telemedicine services and more.

Call us today for more details!