Diabetic Ketoacidosis

Diabetic ketoacidosis is a serious medical condition that affects people with diabetes.

It occurs as a result of the accumulation of ketones (toxic acids) in the blood. It is caused by the absence of insulin, which transports glucose, the major source of energy, to the body's cells.

When there are insufficient amounts of insulin in the blood, the body breaks down fat stores to produce ketones as a source of energy. This leads to the accumulation of ketones and, later on, the development of diabetic ketoacidosis.

Since the body’s cells are unable to receive sugar for energy release, the body begins to search for other options. This entire breakdown process causes a severe chemical imbalance in the bloodstream, resulting in diabetic ketoacidosis.

The condition usually occurs in people with type 1 diabetes, although it can develop in those with type 2 diabetes as well. It can also be the first sign of diabetes in an individual.

The signs and symptoms of diabetic ketoacidosis usually develop within a period of twenty-four hours.

They include:

• Excessive thirst and frequent urination
• Nausea and vomiting
• Abdominal pain
• Weakness or fatigue
• Shortness of breath
• Fruity-scented breath
• Confusion

Specific signs of diabetic ketoacidosis include hyperglycemia and high ketone levels in the urine.

Diabetic ketoacidosis can be caused by an illness or improper insulin therapy. Ketoacidosis essentially results when the body does not receive adequate energy due to lack of insulin, either from an infection or a severe illness. The body could also be devoid of energy due to dehydration that again depletes insulin levels in the body. Diabetic ketoacidosis is very common in people with type 1 diabetes, however, people with type 2 diabetes are also at a high risk, particularly when blood sugar levels shoot up.

Other triggers include physical or emotional trauma, heart attack, alcohol or drug abuse, and certain medications, such as corticosteroids and diuretics.

A physical exam and blood tests can be used to diagnose diabetic ketoacidosis. Here are some of the tests commonly used to make a diagnosis:

• Blood sugar levels: When the body does not get an adequate supply of insulin, either by natural insulin production or through external insulin injections, it can cause the sugar to start entering the body’s cells instead of burning it to produce energy. This causes blood sugar levels to rise in the bloodstream, leading to hyperglycemia. As the body breaks down other available resources like protein and fats to release energy, the sugar levels continue to increase. Blood sugar levels are often tested to determine the exact levels in the body. It also analyzes the ketone levels and blood acidity levels, which help confirm the diagnosis for diabetic ketoacidosis.
• Ketone levels: When the body uses fats and proteins in the absence of available sugar for releasing energy, certain acidic compounds, known as ketones, begin to enter into the bloodstream. This can be assessed through a blood examination, which involves testing the ketone levels present in the body.
• Blood acidity: When the concentration of ketones increases in the bloodstream, it causes the blood to become acidic through a process known as acidosis. This results in the impairment of various organ functionings.

Additional tests that may help doctors identify the underlying cause of diabetic ketoacidosis include blood electrolyte tests, urinalysis, chest X-ray, and electrocardiogram (ECG), a recording of the electrical activity of the heart.

When diabetic ketoacidosis is severe, it needs immediate attention and must be treated at a hospital. In the course of treatment, insulin and fluids are administered to the patient through IV, and close administering of blood electrolyte levels is required. There are certain chemicals that need to be monitored closely to maintain a normal balance in the body. Nurses and doctors will ensure there is no swelling in the brain, as the fluids used for treatment must be administered in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through the vein and closely watching certain chemicals in the blood (electrolytes). The doctors and nurses will watch you closely to be sure your brain does not swell up while the fluids work on the dehydration.

The treatment could require some time, even lasting up to a few days as the blood sugars return to normal levels.

Treatments for diabetic ketoacidosis include:

• Replacing fluids either orally or intravenously: Additional fluids may be administered to the patient either orally or through an IV, until the body is rehydrated. The lost fluids will be replaced and the excessive sugars present in the blood will be diluted.
• Replacement of electrolytes, such as sodium, potassium, and chloride: Electrolytes are essential minerals found in the bloodstream that carry an electric charge. Some electrolytes include potassium, sodium, chloride, and so on. When sugar levels go down, an imbalance in these electrolytes is normal. Electrolytes are released in the body through the vein, which is important to keep up the functioning of vital organs, like the heart, muscles, and nerve cells.
• Insulin therapy to reverse the processes that cause diabetic ketoacidosis: Insulin administered in the course of treatment helps reverse the process initiated by diabetic ketoacidosis. Apart from the fluids and electrolytes, insulin is also given normally through the veins so the blood sugar levels can be restored in the body. When blood sugar levels drop below 240 mg/dL (13.3 mmol/L) and the acidic levels of the blood are restored, the IV insulin may be stopped and the patient can continue with the earlier insulin treatment.

During the course of treatment, close monitoring is necessary, as there could be complications associated with excess fluids being given to the patient. As the body nutrient levels return to normal, the doctor may recommend certain additional tests which could help determine what caused the diabetic ketoacidosis process. Based on the circumstances, additional treatment may be suggested by the attending doctor. Treatment plans are altered based on the triggers; for example, if a bacterial infection triggered the sudden sugar spike, antibiotics may be suggested to return the balance. An assessment of the heart may be required if the doctor suspects a heart attack.

Patients with diabetes can prevent diabetic ketoacidosis by:

• Committing to managing their diabetes
• Frequent monitoring of blood sugar levels
• Adjusting insulin dosages according to need
• Checking ketone levels in the blood
• Seeking immediate help when a patient suspects he or she has diabetic ketoacidosis

Risk factors for diabetic ketoacidosis include having type 1 diabetes and frequently missing insulin doses. The complications of diabetic ketoacidosis are related to the treatment. They include:

• Hypoglycemia: A condition characterized by low sugar levels in the body. Hypoglycemia changes the body chemistry so that insulin causes sugar to enter the cells of the body, which leads to a sudden drop in sugar levels. When the blood sugar levels drop rapidly, one can experience complications such as fainting, losing senses, and, in severe cases, coma.
• Low potassium (hypokalemia): Treatment of diabetic ketoacidosis involves certain fluids and insulin administered to the patient through an IV. In the course of treatment, it is highly possible the condition could cause potassium levels to drop to a very low level. This low potassium level in the body can lead to severe complications like impairment of the heart and muscular and nervous functioning.
• Swelling in the brain (cerebral edema): When the body adjusts blood sugar levels very abruptly or rapidly, it could lead to several complications, including inflammation in the brain. This complication is more commonly seen in children, as they are unable to tell when sugar levels are too high or too low. It can also occur in newly-diagnosed diabetic patients who are not as aware of their situation.

If left untreated, it can lead to loss of consciousness and death.