Diabetic Ketoacidosis

Diabetic ketoacidosis or DKA is one of the acute complications of diabetes. It is an emergency medical condition and needs to be treated in the hospital. Ketoacidosis is different from ketosis. It is a kind of metabolic acidosis which results when ketones accumulate in blood as a result of hyperglycemia. In ketosis, the body breaks down fats into ketone bodies because there is not enough glucose to yield energy. Ketosis can happen in anyone during periods of starvation, but ketoacidosis only happens to diabetics, especially type 1 diabetics, during periods of hyperglycemia.

Other acute complications that can result either from diabetes mellitus or its treatment are:

Incidence of Diabetic Ketoacidosis

DKA usually occurs in patients with type 1 diabetes mellitus. In rare instances, it can occur in type 2 diabetes, when the diabetes has progressed so much that the pancreas no longer releases insulin, which can happen mostly in the elderly. This can be influenced by:

  • Type of diabetes - more in type 1 diabetes than type 2 diabetes
  • Age – may be more in younger diabetic people than the older. Sometimes, young people with diabetes do not know until they get into DKA.
  • Gender – may be more in diabetic women than diabetic men.

Causes of Diabetic ketoacidosis

DKA results because of hyperglycemia.

When the blood glucose is very high, usually over 240mg/dl, and there is no insulin, the body starts to break down fats in an effort to yield energy. This happens because the body does not sense blood glucose when blood sugar is too high. The release of ketones in the absence of insulin now raises the acidity of the blood and causes acidosis. The following could cause DKA:

  • Cardiovascular disease
  • Infection
  • Acute illness
  • Poor compliance with insulin and medication regimen
  • Lack of diabetes care training.

Prevention of Ketoacidosis

DKA is preventable with good diabetes management, keeping blood sugar as close to normal as possible. This can be done by:

  • Checking the finger-stick blood glucose as ordered and taking necessary steps to deal with hyperglycemia as soon as it appears.
  • Taking prescribed medication, especially insulin as ordered.
  • Knowing the causes of ketoacidosis and being proactive in prevention when those factors are present.
  • Pay attention to the your blood glucose patterns.
  • Exercise regularly.
  • If you are a type 1 diabetic, avoid exercise when you are hyperglycemic because exercise can cause DKA in diabetics who exercise in the presence of hyperglycemia.

Symptoms of Diabetic Ketoacidosis

Hyperglycemia – blood sugar is usually above 240mg/dl.

  • Ketone in urine.
  • Sugar in Urine.
  • Fruity odor in breath.
  • Some symptoms of hyperglycemia

If DKA is not treated promptly, it could result in diabetic coma.

Treatment of Diabetic Ketoacidosis

DKA is a medical emergency that is usually treated in the hospital. IV rapid-acting or short-acting insulin is usually used to reduce the blood glucose. IV fluid is also given to dilute the blood and flush out excess sugar in blood. The acidity of the blood is also treated if the doctor sees benefit. If hypokalemia or low blood potassium results from the use of IV insulin, then potassium may be given. If phosphate is decreased, that may also need to be treated too.

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