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Diabetes and Diabetic Ketoacidosis

What is DKA?

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Updated October 02, 2013

To first understand diabetic ketoacidosis (DKA), you must understand diabetes, which is a disease that causes excess glucose (a type of sugar) to build up in the blood. Diabetes means the body either can't make insulin anymore or can't effectively use the insulin that is produced. Insulin is a hormone that helps move glucose out of the blood and into the cells where it can be used for energy. There are three main types of diabetes.

Type 1 diabetes is most common in children and young adults. In Type 1, the insulin producing cells in the pancreas are destroyed. Scientists do not know what causes the destruction of the cells. People with Type 1 diabetes must take insulin to survive.

Type 2 diabetes typically affects older adults, although more teens and children are being diagnosed with it in recent years. Type 2 results when the body becomes resistant to the insulin that is made, and can't keep blood glucose levels in a normal range anymore. Oral medications are usually prescribed to help the insulin be more effective.

Gestational diabetes is a third kind of diabetes that can affect women in the second trimester of their pregnancy. Usually gestational diabetes disappears after the birth of the baby, although moms who have had gestational diabetes are at an increased risk of developing Type 2 diabetes later in life.

DKA: A Serious Complication of Diabetes

There are many complications that can occur with diabetes. One serious complication is diabetic ketoacidosis (DKA). It most commonly occurs with Type 1 diabetes and is often the first symptom of Type 1, because it can often strike without warning. DKA is caused when the body has little or no insulin to use. The blood glucose level keeps rising to dangerous levels. This is called hyperglycemia.

If the blood glucose continues to increase, the body goes into an "energy crisis" and starts to break down stored fat as an alternate energy source. This produces ketones in the blood as the fat is burned for energy. As the ketone levels rise, the blood becomes more and more acidic.

DKA progresses from hyperglycemia to ketosis, which is a build-up of ketones in the body. Ketosis can lead to acidosis, which is a condition in which the blood has too much acid. When this happens it is known as diabetic ketoacidosis. This is a medical emergency and must be treated immediately by medical professionals.

Causes of DKA

  • The sudden start of Type 1 diabetes is only one cause of DKA.
  • Common infections like pneumonia or urinary tract infections can be a cause of DKA. Infection raises the level of "stress" hormones, such as cortisol and epinephrine, which raise the glucose levels in the blood.
  • When someone is noncompliant (doesn't do the things necessary to control blood glucose) or can't afford their insulin or other medications they can also be at risk for DKA.
  • Insulin pump failure can lead to DKA. If a person is unaware that their pump has stopped administering insulin, blood glucose levels can rise quickly.
  • Kids who are going through adolescence can experience endocrine changes that can alter glucose levels and insulin effectiveness.

What are the signs and symptoms of DKA?

The symptoms to watch for are not always obvious. They can start slowly and can be mistaken for other illnesses. Often toddlers do not show the classic signs of DKA.

Early signs:

  • Feeling tired or fatigued
  • Excessive thirst and/or excessive urination
  • Signs of dehydration such as dry mouth

Later signs:

  • Nausea/vomiting
  • Abdominal pain
  • Confusion
  • Rapid, deep, labored breathing (Kussmaul's respirations)
  • Breath that smells fruity
  • Fever
  • Unconsciousness

Medical Treatment of DKA

Treating DKA means medical intervention. It's important to treat dehydration by replacing fluids that have been lost, so most likely IV therapy will be used. Electrolyte imbalances need to be corrected and insulin therapy started to control hyperglycemia. All of this must be done under careful medical supervision.

Prevention

When you are sick:

  • Have a plan in place for when you are sick.
  • Check blood sugar every three to four hours during illness. If blood sugar gets high (usually over 250 mg/dl) check more often and check for ketones in your urine.
  • During illness, make sure to drink plenty of sugar-free, caffeine-free liquids. Even if you are sick to your stomach, try to sip small amounts of liquid at frequent intervals. If your blood sugar is over 250 mg/dl, do not eat or drink high carbohydrate foods or fluids.
  • Don't stop taking your insulin when you are sick, even if you are not eating.
  • Have your doctor's emergency number on hand, in case you need to call.

Preventing DKA that is not associated with illness:

  • If you use an insulin pump, check it often to make sure that it is working properly and administering insulin.
  • Check blood sugar often throughout the day, usually four times a day.
  • Don't skip insulin doses or if you are Type 2 make sure to take your oral medications as prescribed.

Sources:

Cohen, Anita Stanziale MSN, RN, CS, CDE; and Edelstein, Elaine L. MS, RN, CDE. "Sick-day Management for the Home Care Client with Diabetes." Home Healthcare Nurse Vol 23, Number 11.Nov 2005 717-724. 27 Dec 2006

Carroll MD, Mary F; Schade MD, David S . "Ten Pivotal Quesions About Diabetic Ketoacidosis." Postgraduate Medicine Online Vol 110, Number 5, Nov 2001 Dec 2006

"When Blood Sugar Is Too High." Teens Health. July 2005. Nemours Foundation. 27 Dec 2006

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