Diabetic Ketoacidosis: The Symptoms, Causes and Risk

Diabetic ketoacidosis occurs when your body produces high levels of blood acids called ketones. It can be life-threatening if it is not treated right away.

Type 1 diabetes develops when your body stops producing insulin. Insulin is a hormone that your pancreas normally creates to help sugar (glucose) get into your cells to give them the energy they need. Without enough insulin, your body breaks down fat for energy, but this process creates chemicals called ketones, which build up in your blood over time. These excess ketones can cause life-threatening complications if not treated.

If you have diabetes, or if you are at risk of getting diabetes, it is important to learn the warning signs of diabetic ketoacidosis, a serious medical emergency that can happen when you do not treat your diabetes.

Symptoms of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening condition that can occur in people with diabetes. It is caused by dehydration and high blood sugar, which triggers the kidneys to release too much of a hormone called insulin, which drives down blood sugar levels. This can make it difficult for your body to use glucose for energy or store it as fat.

Dehydration is a serious and often overlooked condition that can cause many different symptoms. Symptoms of dehydration may include excessive:

• Thirst
• Frequent urination
• Nausea
• Vomiting
• Stomach pain
• Weakness or fatigue
• Shortness of breath, and fruity-scented breath.

Ketoacidosis is a complication of diabetes that occurs when there is an extreme level of blood sugar and ketones in the body. This can be detected through home blood and urine testing kits, which are available online and at many pharmacies.

When to see a doctor

If you are feeling ill or stressed, check your blood sugar level and ketone levels. Try using a urine ketone test kit to see if they are elevated. Then call your doctor or go to the emergency room, because it is likely that you have diabetes.

• Contact your doctor immediately if

If you are vomiting and unable to tolerate food or liquid, contact your doctor immediately. Your blood sugar level is higher than your target range and does not respond to home treatment, or your urine ketone level is moderate or high: these could be signs of diabetic ketoacidosis.

• Seek emergency care if

If your blood sugar level is consistently higher than 300 mg/dL, or 16.7 mmol/L, or you have any signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion — you should seek emergency care immediately.

Causes

Normally, insulin helps sugar enter your cells. But when you have diabetes and your body does not produce enough of this hormone, sugar builds up in the blood.

When you do not have enough insulin, your body cannot use sugar normally for energy. Without enough insulin, your body thinks it cannot store fat properly either, so it begins breaking down the fat instead of using it for energy. Ketones are acidic byproducts of this process. They build up in your blood until they spill over into your urine.

Diabetic ketoacidosis is usually triggered by:

• Diabetic ketoacidosis is a serious complication that occurs in people with diabetes when the body does not have enough insulin or is not able to effectively use the insulin it does have. This can result in too much glucose building up in the blood, which leads to dangerously high levels of acid in the body (ketones).

• The most common problem with insulin therapy is missed insulin treatments or inadequate insulin therapy. If you are not getting enough insulin when you are supposed to, or if your body cannot use the insulin effectively because of high blood sugar levels, ketoacidosis can occur.

The list of other triggers of diabetic ketoacidosis is extensive. It includes physical trauma, childbirth, major surgery, certain drugs such as cocaine, alcohol, and cortisone, cold exposure or fever, severe infections including malaria and pneumonia, high levels of stress, heavy alcohol use, severe hangovers, and unsafe sex practices, and starvation.

Risk factors

If you have type 1 or type 2diabetes and miss doses of insulin or drink too much alcohol, it may increase your risk of developing diabetic ketoacidosis. This is a dangerous condition that can be fatal if not treated.

Complications

Diabetic ketoacidosis can be life-threatening. It is treated with fluids, and electrolytes such as sodium, potassium, chloride, and insulin. But this lifesaving treatment brings with it some surprising complications, especially if the kidneys fail.

Complications of the treatments

Treatment complications include:

• Your blood sugar may drop too quickly. In some cases, your healthcare professional may need to adjust your insulin dose or change the timing of your meals and/or snacks. This can help prevent low blood sugar during treatment.
• A low potassium level can impair the activities of your heart, muscles, and nerves. To avoid this, electrolytes, including potassium are usually given along with fluid replacement as part of the treatment of diabetic ketoacidosis.
• Swelling of the brain (cerebral edema) is a complication of diabetes. It happens when too much fluid leaks into your brain, causing it to swell. This can block the flow of blood to your brain and cause permanent neurological damage. Swelling often appears right after an episode of high blood sugar. But it can also occur hours or even days later.

Therefore, it is important to know the symptoms of diabetic ketoacidosis, such as nausea and vomiting, rapid breathing and pulse rate, extreme thirst or hunger with dry mouth, and fruity breath odour (which can be detected with a simple test). If you think you may have the signs of diabetic ketoacidosis visit your doctor immediately.

Prevention

To prevent diabetic ketoacidosis and other diabetes complications, it is important to take proper care of yourself. This includes proper diet, exercise, and medication use.

• Your lifestyle choices have a major impact on your health. Commit to managing your diabetes with healthy eating and physical activity, including taking oral medications or insulin as directed by your doctor.
• When you have diabetes, it is important to know what your blood sugar level is always. Before they develop complications such as heart disease or kidney disease, many people with type 2 diabetes and prediabetes have no apparent symptoms at all. The only way to identify these cases early, before any symptoms present themselves, is by monitoring your blood sugar regularly.
• Your insulin dosage may need to be adjusted because of your changing health and the situations you are going through. You can talk to your doctor or diabetes educator about how to adjust your insulin dosage in relation to factors such as your blood sugar level, what you eat, how active you are, and if you are ill.
• To check your ketone level, you need a ketone urine test kit that you can buy from the pharmacy. When your body starts to use fat for fuel, it produces ketones. If you have excess ketones in your blood or urine, contact your doctor right away or seek emergency care. If you have low levels of ketones, you may need to take more insulin if you are testing with a blood glucose meter.
• High blood sugar (hyperglycemia) and ketones in the urine are warning signs that your diabetes is not being controlled. If you see these signs, be sure to treat them early. By acting quickly, you may avoid long-term health problems that make it harder for you to control your diabetes.

It is normal to be worried about the possible health complications of diabetes. But with proper treatment and care, you can live a long and healthy life. In this section, you will find tips for taking good care of yourself from keeping your blood sugar levels under control to staying physically active.