Published on 24 Apr 2024

Diabetic Ketoacidosis: Exploring Diabetic Complications

Diabetes is a common metabolic disorder worldwide, characterised by chronic hyperglycemia or hypoglycemia due to deficiencies in insulin secretion, insulin action, or both. It is estimated that half of individuals affected by diabetes remain undiagnosed, thus increasing their susceptibility to diabetic complications.

Diabetic ketoacidosis (DKA) is the most common complication of blood sugar emergency in people with diabetes. It mostly happens to those with type 1 diabetes, but about a third of cases occur in people with type 2 diabetes.  Diabetic ketoacidosis requires immediate treatment, as it can lead to severe complications like brain swelling, breathing difficulties, and infections. 

Ketoacidosis isn’t the same as ketosis, which happens from a very low-carb diet, like a ketogenic diet, or from fasting. Diabetic ketoacidosis only occurs when there’s not enough insulin in your body to turn blood sugar into energy. This article covers everything about DKA, from its symptoms and prevention care to available treatment options.

What is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening diabetes complication marked by high blood sugar, excess ketones, and acidic blood. It occurs due to insulin deficiency, which prevents glucose from entering cells for energy. When your body cells are unable to use glucose for energy, it leads to a state of cellular hunger and starvation. To compensate, the liver rapidly produces ketones as an alternate fuel from fat, causing their buildup in the blood and urine, resulting in blood acidification.

Ketone bodies, like beta-hydroxybutyrate, acetone, and acetoacetate, form during DKA. Stressful situations during DKA, like infections or injuries, trigger the release of hormones like glucagon, catecholamines, cortisol, and growth hormone. These hormones raise blood sugar by making the body break down fats and proteins to produce glucose, worsening hyperglycemia.

Summary

DKA is a severe complication of diabetes characterised by high blood sugar, excess ketones, and acidic blood due to insulin deficiency. Cells can’t use glucose for energy, leading to ketone buildup. Stressful situations like infections trigger hormone release, worsening blood sugar. Ketone bodies like beta-hydroxybutyrate form during DKA, causing further complications. Early detection and treatment are crucial to prevent life-threatening complications.

Symptoms of Diabetic Ketoacidosis

The symptoms of DKA require urgent medical care due to its severity. Its symptoms can manifest rapidly, and if untreated, DKA can result in coma or death. Early symptoms of DKA can include:

  • Frequent urination
  • Intense thirst (polydipsia) or dry mouth
  • High blood sugar levels (hyperglycemia)
  • Increased levels of ketones in the urine

Newly diagnosed patients with type 1 diabetes and DKA often experience rapid weight loss. If you have type 1 diabetes and the blood sugar is over 240 mg/dL, test for ketones in your urine or blood. As diabetic ketoacidosis progresses, symptoms may include:

  • Nausea or vomiting
  • Stomach pain
  • Confusion or mild disorientation
  • Breath smells fruity
  • Flushed face
  • Feeling tired or weak
  • Rapid breathing
  • Decreased perspiration
  • Dry skin
  • Fainting

Summary

Diabetic ketoacidosis demands immediate medical attention due to its severity, with symptoms escalating rapidly and risking coma or fatality if untreated. Early signs include frequent urination, intense thirst, high blood sugar, and increased ketones in urine. Newly diagnosed type 1 diabetes patients often undergo rapid weight loss. Suppose blood sugar exceeds 240 mg/dL, test for ketones. As DKA progresses, symptoms expand to nausea, vomiting, stomach pain, confusion, fruity breath, flushed face, weakness, rapid breathing, reduced sweat, dry skin, and fainting.

Causes and Risk Factors of Diabetic Ketoacidosis

DKA is more common in young children and teenagers with type 1 diabetes compared to adults. While less common, even patients with type 2 diabetes can develop DKA. The common causes and risk factors for DKA are:

Not Injecting Enough Insulin or Missing an Insulin Injection

Missing doses of insulin or other medications frequently or receiving incorrect doses prescribed by your doctor can result in blood sugar levels deviating further from your target range. Expired or spoiled insulin may not function properly, potentially leading to ineffective blood sugar control. Poorly managed diabetes increases the risk of DKA.

Insulin Pump

Insulin pump users face a higher risk of DKA compared to those who use injections. That is because pumps only administer rapid-acting insulin without providing long-acting insulin. Rapid-acting insulin starts working in 10 to 15 minutes and typically lasts only 4 to 5 hours.

If you use an insulin pump, keep a range of supplies available. Ensure you have short-acting insulin, long-acting insulin, and needles in case your pump malfunctions.

Illness or Infection

Common illnesses like urinary tract infections (UTIs), pneumonia, and pancreatitis can lead to DKA. Injuries or surgery may also trigger DKA by interfering with insulin due to stress hormones. 

Pregnancy

During pregnancy, your body processes sugars and nutrients differently. It also creates a higher risk of DKA.

Alcohol and Medications

Alcohol, drugs like cocaine, and certain medications increase the risk of DKA. Corticosteroids, diuretics, and drugs for mental health conditions may also lead to DKA. 

Summary

DKA primarily affects young people with type 1 diabetes, but type 2 diabetes patients can also develop it. Causes include insufficient insulin, missed doses, expired insulin, and insulin pump use without long-acting insulin. Illnesses like UTIs and pneumonia, injuries, surgeries, and pregnancy can trigger DKA. Additionally, alcohol, cocaine, and certain medications raise the risk. 

Diabetic Ketoacidosis Diagnosis

A doctor will diagnose DKA through a physical exam and cross-checking your symptoms and medical history. They’ll test your blood sugar, ketone levels in your urine and blood, and your blood pH and bicarbonate levels. Diagnostic tests include:

  • Basic metabolic panel: Checks kidney, liver, and pancreas function and levels of chemicals like electrolytes.
  • Blood pH: Measures blood acidity. Levels below 7.3 indicate acidity due to ketones.
  • Blood glucose test (A1C): Assesses blood sugar control over months.
  • Urinalysis: Measures ketones, sugar, and other nutrients in urine. Also checks urine output and for infections.

Summary

To diagnose DKA, doctors examine you, review your medical history, and perform tests. These include checking blood sugar, urine and blood for ketones, blood pH, and bicarbonate levels. A basic metabolic panel assesses kidney, liver, and pancreas function. Blood glucose tests and urinalysis evaluate blood sugar control and ketones.

Diabetic Ketoacidosis Prevention

Prevention of diabetic ketoacidosis (DKA) and other diabetes complications is crucial for maintaining overall health and well-being. Here are some effective ways to prevent DKA and manage diabetes:

1. Integrated Diabetes Management and Blood Sugar Monitoring: Managing diabetes is not just about following a diet or exercise routine. Diabetes management is about creating a lifestyle that consistently supports blood sugar stability. Regularly checking your glucose levels forms the backbone of effective diabetes management. This dual approach helps identify any deviations from normal levels early, allowing for timely adjustments to your diet, exercise, and medication.

2. Insulin Dosage and Ketone Monitoring: Tailoring your insulin dosage in response to blood sugar readings is crucial. During times of illness or stress, be extra vigilant and check your blood sugar more frequently. Simultaneously, keeping an eye on ketone levels is essential, especially if you are experiencing symptoms like nausea or fatigue. These symptoms could indicate the onset of Diabetic Ketoacidosis.

3. Proactive Response: Act swiftly at the first sign of elevated blood sugar or ketone levels. Diabetic Ketoacidosis can escalate quickly, so immediate medical intervention can be lifesaving. Having a ‘sick day’ plan in place, in consultation with your healthcare provider, can be incredibly beneficial during unexpected illness or stress.

Preventing Diabetic Ketoacidosis with HealthifyMe’s Comprehensive Approach

In managing and preventing Diabetic Ketoacidosis, HealthifyMe offers a comprehensive solution that works in alignment with your healthcare regimen. 

With HealthifyMe’s personalised diabetes management plan, you get access to expert nutritionists. These nutritionists help create customised dietary plans that align with your medical needs and personal preferences. These customised plans help enhance your ability to maintain more stable blood sugar levels and prevent the onset of conditions like Diabetic Ketoacidosis.

HealthifyPro offers a Continuous Glucose Monitoring (CGM) device, an innovative tool that provides continuous insight into glucose levels. It helps minimise the need for frequent finger pricks and offers a detailed view of how your life choices affect your blood sugar levels.

Beyond just diet and exercise, HealthifyMe encourages a holistic lifestyle overhaul. It helps you focus on enhancing your stress management, sleep quality and regular physical activity. These are all crucial to preventing Diabetic Ketoacidosis.

So, start your proactive journey in managing diabetes with HealthifyMe. Embrace a life where diabetic ketoacidosis is preventable, not inevitable. Join us today and let HealthifyMe be your partner in navigating the path to better health and diabetes management.

Click here to Healthify your diabetic journey to a holistic, wholesome and transformative one.

Summary

Preventing diabetic ketoacidosis involves diligent management of diabetes through healthy lifestyle choices, regular monitoring of blood sugar and ketone levels, timely insulin adjustments, and prompt medical attention during illness or high ketone levels. Working closely with your healthcare team and following your treatment plan can help you effectively prevent DKA and maintain optimal health.

Treatment for Diabetic Ketoacidosis

Treating DKA involves various methods to stabilise blood sugar and insulin levels. People who aren’t vomiting or very sick can be treated at home or in an outpatient facility with proper supervision. However, those, especially children who are vomiting, may need IV fluids in the emergency department.

Pharmacotherapy

Pharmacotherapy involves administering regular and analogue human insulins to correct hyperglycemia, except when bovine or pork insulin is the only option available. It is called insulin replacement, which halts ketogenesis by administering insulin. It stops the breakdown of proteins and fats while promoting glucose absorption and utilisation, leading to normalised blood sugar levels. You’ll likely receive insulin through an IV until your blood sugar reading falls below 200 to 250 mg/dL. 

When insulin levels drop too low, your body’s electrolytes may also decrease abnormally. In these situations, electrolyte replacement is also necessary, often administered through an IV.

Medications for managing DKA through pharmacotherapy include:

  • Short-acting insulins or regular insulin
  • Rapid-acting insulins (insulin aspart, insulin glulisine, insulin lispro)
  • Electrolyte supplements (potassium chloride)
  • Alkalinising agents (sodium bicarbonate)

Fluid Replacement

During a DKA treatment, you may receive intravenous fluids to aid rehydration. Normal saline (0.9%) is typically used to restore volume and replace deficits. Fluid therapy helps replenish lost fluids, restore normal blood flow, and address dehydration. However, monitoring fluid levels closely is vital, especially in children. It’s crucial to maintain a careful balance to prevent either too little or too much hydration. 

To avoid a sudden drop in glucose and hypoglycemia, 5% glucose is added to IV fluid when glucose levels reach 300 mg/dL (17 mmol/L). A convenient approach is to use a ” two-bag system”, with one bag containing 10% dextrose and the other without dextrose.

Summary

Treating DKA means stabilising blood sugar and insulin levels. If not too sick, some can be treated at home or in outpatient centres with supervision. Medications include insulins to lower blood sugar and fluids to rehydrate. IV insulin is a standard treatment until blood sugar drops below 200-250 mg/dL. Electrolytes may need replacing, too. Fluids like normal saline help rehydrate. Careful balance is essential to avoid overhydration or dehydration. Sometimes, glucose is added to IV fluids to prevent low blood sugar. This is usually done with a “two-bag system” containing fluids with and without glucose.

HealthifyMe Suggestion

Diabetic ketoacidosis is common and can cause serious illness, but there are numerous ways to avoid it. Being aware of the warning signs can be quite beneficial since the sooner you notice you may be impacted by DKA, the sooner you can take efforts to prevent it or obtain treatment, depending on how close you are to collecting it. Multivitamins and mineral supplements can help ensure that your body receives all of the nutrients it requires to function properly. Vitamin C appears to be a promising treatment for DKA due to its antioxidant properties in reducing superoxide radicals produced by oxidative stress. This can minimise the pro-inflammatory response and prevent problems.

HealthifyMe provides an extensive variety of supplements that are carefully designed by experts to cater to your nutritional requirements. The list of supplements includes Calcium, Vitamin D3, Omega 3, and Prebiotics and Probiotics to help you meet your dietary and health needs. Click here to visit the HealthifyMe Store now to explore the complete range of supplements available.

The Final Word

Diabetes poses significant health risks, with diabetic ketoacidosis (DKA) being a severe complication. It is vital to recognise its symptoms early and seek prompt medical attention. Treatment involves restoring fluid balance, administering insulin, and closely monitoring blood sugar levels. Lifestyle adjustments, such as maintaining a balanced diet and abstaining from alcohol, play critical roles in preventing DKA. With regular monitoring and expert guidance, individuals can effectively manage diabetes and reduce the risk of complications like DKA.

Disclaimer: The purpose of this article is just to disperse knowledge and raise awareness. It does not intend to replace medical advice from professionals. For further information, please contact our certified nutritionists Here.

Research Sources

1. Insulin pump therapy is associated with higher rates of mild diabetic ketoacidosis compared to injection therapy: A 2-year Swedish national survey of children and adolescents with type 1 diabetes

2. Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives

3. Comprehensive review of diabetic ketoacidosis: an update

4. Dietary intake and hospitalisation due to diabetic ketoacidosis and hypoglycaemia in individuals with type 1 diabetes

Frequently Asked Questions (FAQs)

Q: What is diabetic ketoacidosis?

A: Diabetic ketoacidosis (DKA) occurs when ketones, certain chemicals, accumulate in the blood due to insulin resistance. This condition mainly affects those with type 1 diabetes, where the body doesn’t produce sufficient insulin. In some rare instances, people with type 2 diabetes can also experience ketoacidosis.

Q: How long does it take to recover from diabetic ketoacidosis?

A: Patients with diabetic ketoacidosis typically make a full recovery within 24 hours with appropriate treatments. However, in some cases, recovery may take longer.

Q: What is the treatment for diabetic ketoacidosis?

A: DKA requires immediate medical treatment to replenish the significant loss of fluids and electrolytes. This treatment is done through an IV line inserted into the arm or hand. Additionally, you will receive insulin to enable your cells to use more glucose, which helps reduce both ketones and sugar levels in your blood.

Q: What to eat after diabetic ketoacidosis?

A: Stick to your regular diabetes meal plan and prioritise healthy food choices. Aim for lower amounts of saturated fat and salt. Stay hydrated by drinking water and other sugar-free fluids. Maintain a healthy diet by including low-GI fruits, vegetables, whole grains, and legumes.

Q: How does diabetes cause ketoacidosis?

A: When cells lack the glucose they need for energy, the body starts burning fat to produce energy, resulting in the formation of ketones. It occurs when there’s insufficient insulin to utilise glucose, the body’s usual energy source. High ketone levels can be harmful to the body, causing DKA to develop.

Q: Can diabetic ketoacidosis cause kidney failure?

A: Acute renal failure is a rare but potentially deadly complication of diabetic ketoacidosis (DKA). However, its severity can vary significantly depending on the degree of renal impairment. Early recognition and treatment of ARF during DKA is necessary for better results.

Q: What are the warning signs of diabetic ketoacidosis?

A: DKA usually starts slowly, but if vomiting occurs, it can worsen rapidly within hours. Early signs include thirst, frequent urination, high blood sugar, and ketones in the urine. Later symptoms may include constant tiredness, dry or flushed skin, and nausea or stomach pain. If vomiting lasts more than two hours, it could be a sign of something serious.

Q: How to manage diabetic ketoacidosis at home?

A: Incorporate healthy eating and regular physical activity into your daily routine. Follow your doctor’s instructions for taking diabetes medications or insulin. If your health declines, such as increasing blood sugars, rising ketone levels in urine, and worsening symptoms, seek immediate hospitalisation.

Q: Is diabetic ketoacidosis fatal?

A: If left untreated, diabetic ketoacidosis can progress to loss of consciousness and, ultimately, death. Therefore, it’s crucial to recognise its symptoms promptly and respond quickly. With timely treatment, the risk of death ranges from less than 1% to 5%.

Q: What is non diabetic ketoacidosis?

A: NDKA, or non-diabetic ketoacidosis, is ketoacidosis without the presence of diabetes. The prognosis for NDKA cases tends to be better compared to diabetic ketoacidosis cases. It’s a rare condition often triggered by starvation. When you do not consume the necessary carbs, it results in insufficient glucose levels. It pushes the body into ketogenesis, resulting in metabolic acidosis.

Q: How to detect diabetic ketoacidosis?

A: Blood tests can check for ketones and monitor glucose levels. Doctors may also test your urine for these substances. Additionally, blood tests measure plasma osmolarity, electrolyte levels like sodium and potassium, red and white blood cell counts, and kidney function. You might also need an electrocardiogram (EKG) to check your heart rhythm, as changes in blood electrolyte levels can affect your heart.

Q: What increases diabetic ketoacidosis?

A: High levels of ketones in your blood can trigger ketoacidosis. It might happen if you have diabetes but are unaware of it, causing your body to break down too much fat. Or if you have diabetes but are not properly managing it, such as not taking your medications as directed.

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