Diabetic ketoacidosis, a potentially fatal complication of diabetes, occurs when blood glucose levels are high (often above 400 mg/dL) and insulin levels are very low.
Insulin is a pancreatic hormone that must be injected daily by type 1 (insulin-dependent) diabetics to control their blood glucose. Insulin helps glucose to pass from the bloodstream into body cells, where it is burned as fuel, and prevents excessive release of glucose by the liver. When insulin levels are too low, blood glucose levels rise, while body cells go hungry. Without access to glucose, body cells are forced to burn fat as an alternate energy source, a process that produces acidic chemicals called ketone bodies that are toxic at high concentrations. In diabetic ketoacidosis, ketone body (acetone, acetoacetate, hydroxybutyric acid) levels increase in the blood, seriously altering the normal chemistry of the blood and interfering with the brain’s function. Initially, impaired brain function causes only confusion and attention problems, but it may ultimately progress to coma (diabetic coma) and death.
Although diabetic ketoacidosis may occur because a diabetic has stopped taking normal insulin injections, it may also be triggered by an infection or severe physical stress, such as an injury or surgery. People with type 1 diabetes are at risk for diabetic ketoacidosis. It rarely occurs in type 2 diabetes. In about 25 percent of children, type 1 diabetes is initially diagnosed because they have an episode of diabetic ketoacidosis.
A patient with diabetic ketoacidosis must urinate frequently, because their kidneys are trying to flush away excess glucose from the blood into the urine. They are extremely thirsty, with a dry mouth and flushed, dry skin. Their appetite is poor, and they have nausea and vomiting with or without abdominal pain. As their blood ketone bodies rise, their breathing may become slow and deep, and their breath may have a fruity odor. Initially, they may seem to be tired or confused, or to have trouble paying attention. However, if their ketoacidosis is not treated, they can eventually lose consciousness, slip into a coma, and die.
When type 1 diabetics test their blood glucose, a glucometer reading above 300 mg/dL is a warning sign to test their urine for ketones. A urine test strip reading of “moderate” or “large” raises the possibility of ketoacidosis.
Patients with diabetic ketoacidosis are usually treated in a hospital. (Mild cases are sometimes managed under close observation in a physician’s office.) Your doctor will test your blood for levels of glucose, ketone bodies, and other constituents, such as sodium and potassium.
Symptoms of diabetic ketoacidosis can develop over a period of a few hours.
If you have type 1 diabetes, you can usually prevent diabetic ketoacidosis by following the insulin regimen and diet prescribed by your doctor and by testing your blood glucose regularly. If you develop a severe infection or have a bad accident, ketoacidosis can develop within hours.
To help ensure that you receive proper emergency treatment for diabetic ketoacidosis if you are away from home, wear a medical ID necklace or bracelet that identifies you as a diabetic. This will help emergency personnel to recognize your problem quickly if you are among strangers and you are too sick to speak for yourself.
When you are in the hospital, your diabetic ketoacidosis will be treated with insulin to lower your blood glucose level and to stop ketone body production. You will also receive intravenous fluids, have your blood glucose and acid levels monitored frequently, and be given potassium supplements to prevent irregular heartbeats. Your vital signs and urine output will be measured continually until the chemistry of your blood returns to near normal values. If an infection has triggered your episode of ketoacidosis, antibiotics or other medications will be used to treat the infection.
When To Call A Professional
If you are a type 1 diabetic and have several glucometer readings over 300 mg/dL, you should test your urine for ketones and call your doctor if moderate or high levels are present. Your doctor will give you more specific guidelines about when and how often to test your blood glucose and urine, and what readings to look for. Also call your doctor whenever you have prolonged nausea and vomiting, with or without abdominal pain.
With proper treatment, more than 95 percent of patients recover from diabetic ketoacidosis.
National Diabetes Information Clearinghouse1 Information WayBethesda, MD 20892-3560