Dr. Ahmed
Diabetic ketoacidosis or DKA is a potentially fatal condition that occurs when too much glucose (sugar) is in the bloodstream. It is characterized by frequent urination, excessive thirst, fatigue, nausea, confusion, and excessive hunger.
Diabetic ketoacidosis is caused by a lack of insulin in the bloodstream. If the person has not taken enough insulin to keep their blood glucose levels under control, ketones will form in their body at an elevated level.
This occurs because the body tries to metabolize fatty acids as a source of energy. Ketoacids are basically breakdown products of fatty acids.
Accumulation of keto-acids may occur as a result of starvation or lack of insulin in the bloodstream.
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How do you know if you have Diabetic ketoacidosis (DKA)?
The first way to find out is to realize that it often happens after a person has been fasting for a long period of time.
Fasting for a long time, decreases the amount of glucose in the body, causing ketones to form when there is not enough insulin in the bloodstream to break down the glucose.
Diabetic ketoacidosis (DKA) commonly occurs in persons with diabetes type 1 or in elderly patients with long-standing diabetes mellitus type 2.
In young individuals, it is mostly due to poor adherence to the treatment. So, a person who has missed his/ her insulin dose is likely to develop diabetic ketoacidosis.
DKA occurs in patients with severe Insulin deficiency
Elderly people with diabetes mellitus type 2 often develop diabetic ketoacidosis when they have a concomitant infection or undergo a stressful event such as trauma or surgery.
Most elderly people develop diabetic ketoacidosis when they have a chest infection or urinary tract infection.
Individuals with diabetic ketoacidosis develop symptoms of dehydration, nausea, vomiting, abdominal pain, thirst, drowsiness, lethargy, and obtundation.
The condition may progress to stupor and coma if not treated timely.
DKA may have symptoms ranging from nausea and vomiting to stupor and coma
It is important to check blood glucose at home with a glucometer as most patients have blood glucose exceeding 250 mg/dl (14 mmol/L).
Type 1 diabetes patients especially those who have brittle diabetes and frequent episodes of diabetic ketoacidosis should also have a ketometer at home to check for blood ketones.
Ketones can also be checked by using a simple urine dipstick.
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How to Avoid Diabetic Ketoacidosis (DKA)?
The best way to avoid Diabetic ketoacidosis is to keep your glucose levels stable by eating regular, healthy meals every three hours.
Be sure to avoid sugary and high-carbohydrate foods as much as possible. You should also maintain good hydration and drink plenty of fluids, especially in summer to maintain an adequate fluid balance.
The next very important step to avoid diabetic ketoacidosis is to administer your insulin at the prescribed time. Avoid missing a single dose if you have diabetes mellitus type 1.
Promptly treat any concomitant infection. Chest infections, urinary tract infections, and gastroenteritis in diabetic patients can rapidly result in diabetic ketoacidosis.
If you have a fever, nausea, vomiting, and don’t feel like eating, it is likely that you are going to miss your insulin dose. This happens with most patients who miss their insulin dose intentionally to avoid hypoglycemia.
In such situations, apart from treating the underlying condition and maintaining adequate hydration, frequent monitoring of blood glucose is important.
You may consider administering a lower dose (such as half the usual dose) but missing the dose can be fatal.
Don’t miss your Insulin dose!
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How is diabetic Ketoacidosis Treated?
The goals of treating diabetic ketoacidosis are:
- Correct hyperglycemia with intravenous regular insulin
- Correct dehydration with intravenous fluids (oral fluids may be administered once the patient is stable)
- Correct acidosis by administering lots of fluids and insulin, however, if the acidosis is very severe or the person has concomitant kidney disease or heart disease, sodium bicarbonate may be administered.
- Correct the underlying condition such as chest infection, urinary tract infection, or gastrointestinal infection.
Always teach the patient how to inject insulin and what to do in hypo and hyperglycemia.
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Take the Quiz at the end: Test your knowledge!
- Question of
Diabetic Ketoacidosis is due to excess of Insulin.
- Yes
- No
- Question of
Diabetic Ketoacidosis only occurs in T1DM patients.
- Yes
- No
- Question of
Diabetic Ketoacidosis is Treated with Intravenous Insulin.
- Yes
- No
- Question of
Diabetic Ketoacidosis is treated commonly with Sodium Bicarbonate.
- Yes
- No
- Question of
Diabetic Ketoacidosis can be Deadly.
- Yes
- No
