Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes.  If you have diabetes, you are at risk of developing DKA.  If you or a family member has diabetes, you should know how to recognize this potentially life-threatening complication.  Let's talk more about this condition, including how to recognize the warning signs and when you should seek emergency care.

What is diabetic ketoacidosis (DKA)?

DKA develops when your body doesn't have enough insulin.  Insulin helps sugar to enter the cells of your body.  Your cells then use sugar as their main source of energy.  If you do not have enough insulin, your body cannot adequately use sugar for energy.  

This lack of energy production from sugar triggers release of hormones within the body that start breaking down fat to use as energy.  The chemical reaction that breaks down fats produces acids called ketones.  

When excess ketones are produced too quickly, they can build up in the blood, causing your blood and body fluids to become acidic.  As your blood becomes more and more acidic, some of the body's systems can stop functioning properly or even stop functioning altogether.  DKA is a condition that can make you very seriously ill and can kill you.  

Does DKA only happen in diabetics who take insulin?

No.  DKA is more common in people with type 1 diabetes (previously called insulin-dependent diabetes), but people with type 2 diabetes can also develop DKA.  For more information about the differences between type 1 and type 2 diabetes, use this link:  https://www.edocamerica.com/health-tips/difference-type-1-type-2-diabetes/ 

What causes DKA?

The two primary causes of DKA are:

• An illness - Infections, such as pneumonia or urinary tract infections, or other illnesses can cause your body to produce higher levels of certain hormones that can counter the effect of insulin.  Sometimes patients who take insulin may skip doses when they are sick because they are not eating as much, which can also be a trigger.
• Problems with insulin therapy - Missing insulin shots, a malfunctioning insulin pump, or taking the wrong insulin dose, all can leave you with too little insulin in your system.

Other possible triggers for DKA include:

• Heart attack or stroke
• Pancreatitis
• Alcohol or other drug abuse, particularly cocaine
• Physical or emotional trauma
• Pregnancy
• Certain medications, such as diuretics and some types of steroid medications.

What are the symptoms of DKA?

DKA signs and symptoms can develop quickly, often over less than 24 hours.  Sometimes DKA is the first sign that a person has diabetes, particularly type 1 diabetes.  Here are the symptoms to watch for:

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Feeling weak or excessively tired
• Shortness of breath
• Confusion
• Fruity scented breath - (Similar to the smell of Juicy Fruit gum)

Signs that you can see on home blood or urine tests include:

• High blood sugar levels
• High ketone levels in the urine

We will talk more about DKA next week, including prevention, diagnosis, and treatment.  

In the meantime, if you have diabetes and feel ill or stressed, or have had a recent illness or injury, you should check your blood sugar often.  If your blood sugar is above 240 mg/dl, you should use an over-the-counter urine ketone test kit every 4-6 hours.

You should call your doctor, go to the emergency room, or call 911 immediately if:

• Your ketones are moderate to high
• Your blood sugar stays at 300 mg/dl or higher despite home treatment
• Your breath smells fruity
• You are vomiting and can't keep food or drinks down
• You have significant signs and symptoms of DKA that I outlined above

If you have any questions about Diabetic Ketoacidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor