What Is Diabetic Ketoacidosis (DKA)?

When there is not enough insulin present in the body, it will begin to break down fat as fuel, which causes a buildup of acids called ketones. This process will eventually lead to diabetic ketoacidosis if it goes untreated, a serious condition that can result in coma, loss of consciousness, or even death.

DKA | Diabetic Ketoacidosis Defined

Diabetic ketoacidosis, or DKA, is a possible life-threatening complication for those living with diabetes. DKA is found in diabetic patients who have a combination of high blood sugar, low blood pH and ketoacids in the urine or blood.

DKA is what takes place when the body produces elevated levels of acids called ketones. DKA occurs when the body cannot produce enough insulin, which is responsible for helping glucose to enter cells.

Facts About DKA

Diabetic ketoacidosis can be triggered in several ways. Missed or inadequate insulin treatments can leave the body with insufficient insulin levels that will trigger diabetic ketoacidosis.

An illness or infection can cause the body to produce elevated levels of hormones that counter the effect of insulin. Common infections known to trigger ketoacidosis include pneumonia and urinary tract infections.

Other common triggers include:

• Some medications like corticosteroids and diuretics
• Drug or alcohol abuse
• Physical or emotional trauma
• Heart attack

There are some cases where the symptoms of ketoacidosis may be the first signs of diabetes. However, individuals living with type 1 diabetes and those who frequently miss doses of insulin are the highest risks of developing diabetic ketoacidosis. It is not a typical development in people diagnosed with type 2 diabetes.

Common Symptoms

The symptoms of diabetic ketoacidosis can come on quickly; sometimes within 24 hours. For some people, the symptoms can be initial signs of diabetes. These include:

• Shortness of breath
• Abdominal pain
• Frequent urination
• Extreme thirst
• Fatigue or weakness
• Confusion
• Fruity-scented breath
• High blood sugar levels
• High ketone levels in urine

There are some over-the-counter testing kits allowing individuals to test blood sugar and urine levels to check glucose and ketone levels.

If multiple symptoms are experienced at one time, or any of the following conditions apply, contact a doctor or seek emergency care if:

1. Unable to tolerate food, liquid and are vomiting.
2. Urine ketone level is moderate to high.
3. Blood sugar levels are higher than your target range.
4. Glucose levels that are consistently greater than 300 milligrams per deciliter or 16.7 millimoles per liter.

Common Treatments

Common treatments for diabetic ketoacidosis are a fluid replacement, electrolyte replacement, and insulin therapy. It is best for these treatments to be performed in a doctor’s care over the course of 24-48 hours after diagnosis.

Fluids are received orally or intravenously until the body is rehydrated. They help replace what was lost through frequent urination and dilute the overabundance of sugar in the blood.

The electrolyte replacement gives the body the minerals needed to keep the heart, muscles, and nerves functioning properly.

Insulin therapy delivers the insulin intravenously. This helps reverse the process that causes diabetic ketoacidosis in the first place. Once the glucose levels fall below 240 mg/dL, the blood is no longer acidic. At this point, intravenous insulin can be stopped, and the patient can return to regular insulin therapy.

Ironically, it is these treatments that are the cause of the most common complications of ketoacidosis.

These complications include:

• Low blood sugar, or hypoglycemia. Insulin helps the sugar to enter the cells, which will cause blood sugar to drop. Hypoglycemia happens when blood sugar drops too quickly.
• Low potassium, or hypokalemia. The fluids used in the treatment of ketoacidosis can potentially lower potassium levels too low. If potassium levels are too low, it can be harmful to the heart, nerves, and muscles.
• Swelling in the brain, or cerebral edema. This common complication in children, or those newly diagnosed with diabetes, happens when changes in blood sugar occur too quick, causing the brain to swell.

Best Treatment

The best way to manage diabetic ketoacidosis is to try and avoid it, as a basic medication may not have enough of an effect in a short amount of time. Frequently monitoring of the blood glucose levels significantly lowers the risk of developing DKA. A study of patients admitted to a pediatric intensive care unit for ketoacidosis found that most of these patients lacked proper glucose monitoring.

To try and prevent DKA, as well as other complications of diabetes, you can:

• Make a commitment to diabetic management. This includes maintaining a healthy diet and including physical activity in one’s daily routine.
• Make adjustments to insulin as needed. Speak to a doctor about how to adjust the amount of insulin dosage in relation to blood sugar levels, diet, and physical activity.
• Check ketone levels. During stressful periods in one’s life or during an illness, purchase an over-the-counter ketone test to check levels in urine. If the levels are too high, seek a doctor’s care as soon as possible. If the levels are too low, speak to a physician about increasing insulin levels.
• Monitor glucose levels. Checking blood sugar levels several times a day can help the individual keep within a targeted range. Adjustments can then be made to diet and exercise before levels are too high or too low.
• Be prepared for an emergency. If the individual is showing any symptoms of ketoacidosis or has a test kit show high levels, be ready to seek emergency care immediately. Being able to receive treatment as soon as possible is critical to the recovery process.

Short-Term Effects

If you suspect you’ve developed ketoacidosis, or have results from an at-home test that show high levels of ketones in the urine, it is recommended to seek emergency care immediately. Symptoms can include a fruity-smell to one’s breath, confusion, frequent urination, weight loss and abdominal pain.

Not receiving treatment for diabetic ketoacidosis can eventually lead to a loss of consciousness and even death.

Long-Term Effects

There are many long-term effects of diabetes, especially if it is not monitored closely. These complications can develop over the course of many years, and all relate to the effect that glucose has on blood vessels.

Some of the common long-term effects include microvascular complications that will affect the eyes, kidneys, and nerves. The tiny blood vessels in these areas are damaged because of inadequate glucose control. Eventually, they will stop delivering blood as they should, leading to developing cataracts, kidney disease, and severe nerve damage.

Also affected are the larger blood vessels that will cause macrovascular complications in the heart. Making heart-healthy choices in addition to maintaining proper glucose levels can help prevent the build of plague that could potentially cause a heart attack.

Diabetic Ketoacidosis, or DKA, can be detected through over-the-counter urine tests or by a showing of symptoms related to the condition. Emergency medical intervention is recommended to prevent further complications that, if left untreated, could result in losing consciousness or even death.