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Is Ketoacidosis Life Threatening?

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Life-threatening Lactation Or “bovine” Ketoacidosis: A Case Report

Abstract Lactation or "bovine" ketoacidosis is a rare cause of raised anion gap metabolic acidosis whereby a perfect storm of negative calorie balance (starvation/glucose preferentially used for milk production) and insulin resistance (counter regulatory stress hormone release/infection) leads to a dysregulated ketogenic state. We present a case of life-threatening lactation-related ketoacidosis in a patient 9 weeks postpartum, who presented to the emergency department with an arterial pH of 6.88, HCO3 of 5.8 mmol/L and blood ketone level of 5.8 mmol/L. Treatment consists of aggressive glucose loading, triggering supraphysiologic endogenous insulin release, and subsequent inhibition of ketone body formation. Continue reading >>

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  1. jodysd6

    What is DKA?

    What is DKA?
    DKA stands for Diabetic Ketoacidosis, and it is a potentially life threatening complication of Diabetes. It is usually associated with uncontrolled high blood glucose levels and it occurs as a result of insufficient insulin.
    Who is at risk for DKA?
    Type 1 diabetics are most at risk of developing DKA as they have no residual insulin production, often even a little insulin production is enough to prevent DKA developing. Some Type 2 Diabetics who also have no residual insulin production are also at risk.
    Many Diabetics will never experience DKA, and many cases of DKA occur in people who have previously been undiagnosed with diabetes. In people who know they are Diabetic there are a few potential triggers for DKA:
    · Inadequate Insulin – insulin being missed, failed delivery from a pump or much more rarely ‘bad’ insulin
    · Infection – particularly bacterial infections, and especially if the patient is unwell and unable to test and adjust insulin as usual
    · Other Illness – anything which stresses the body, such as a heart attack
    Most Episodes of DKA in known diabetics can be prevented if you know the symptoms, know how to manage when you are unwell and are able to make contact with your healthcare team early. It is estimated that around 25% of admissions for DKA in known diabetics occur when people stop insulin because they are not eating or are vomiting. It is very important to keep taking insulin even when you are ill, at these times you may even need more than usual despite not eating.
    What happens in DKA?
    Without Insulin all the glucose in your blood is unable to get into the cells where it is needed for fuel. Your blood glucose level will rise, and your liver will produce even more glucose because it senses that your cells are ‘starving’. 2 Parallel processes then occur which together lead to dehydration and a lowering of the bloods pH level – your blood becomes acidic.
    As the blood glucose rises your kidneys attempt to get rid of all the excess glucose, as excess glucose is ‘spilled’ into the urine water follows it, this is what makes you go to the toilet more frequently. As you lose water you feel thirsty, and develop a dry mouth.
    Because the cells cannot use the glucose in your blood (because the cells require insulin to let the glucose in) they need to find another source of energy. The cells can get the energy from other sources such as fat but in doing so they produce ketones. Ketones are acidic and as they build up in your blood they lower the pH of your blood. This is dangerous because all the cells in your body rely on the pH of your blood staying within a certain range. As the pH of your blood drops you may notice you are breathing faster than usual, this is your bodies way of attempting to raise your bloods pH level.
    By this stage most people will be feeling very unwell and will seek help, however if this process continues it can be life threatening, as your brain cannot survive indefinitely without glucose and other cells in your body begin to die due to the acidity of the blood. This is why it is so important to seek help early.
    What are the symptoms of DKA?
    Early Symptoms
    · Frequent Urination
    · Thirst
    · Dry Mouth
    · Nausea
    Later Symptoms
    · Vomiting
    · Abdominal Pain
    · Rapid Breathing
    · Confusion
    · Drowsiness
    · Coma
    Some people are able to taste ketones on their breath, this has been described as tasting how you expect nail varnish remover to taste! Friends or family may also be able to smell ketones on your breath (often described as sweet smelling or smelling of ‘pear drops’)
    How can I prevent DKA?
    Sometimes nothing you can do will stop it, and you will have to go to the ER in order to recieve appropriate treatment, however you may be ableto prevent DKA if you know the warning signs and respond quickly. If you have a high blood glucose you need to take an appropriate correction shot of fast acting insulin ( your doc can help you work out how much you need to take). Once you have taken the correction, you need to keep a close eye on your BG levels as they are falling, and be on the look out for hypoglycaemia. It is also importand to drink plenty of clear fluids, ideally water, as this will help combat any dehydration and help your body flush out the excess glucose and any ketones. If your blood glucose levels are falling steadily and you feel well, these steps may be all that is needed. You should continue to keep a close eye on you BG levels and on any ketones though, and be prepared to take further action if things stop improving or worsen.
    When Should I go to the ER?
    · If your BG is above 400mg/dl (or 20mmol/l) for more than a short period of time (some people may develop DKA at lower levels, so be prepared to seek help if you have any other symptoms, even if your BG is lower than this)
    · If your BG does not come down rapidly with short acting Insulin
    · If you have High Levels of Ketones (you can test for ketones using urine strips which are readily available, or some brands of glucose meter will allow you to test for blood ketones)
    · If you cannot tolerate oral fluids or begin vomitting
    · IF YOU ARE EVER IN DOUBT GO TO THE ER
    Remember it never hurts to call your healthcare team if you are at all concerned, they can advise you and would much rather you call them early than you end up more ill.
    What will happen in the ER?
    When you arrive at the ER you should tell them straight away that you suspect you may be in DKA. Sometimes if you have recently taken insulin your BG may appear normal and they may not realise what has been going on.
    Exactly what happens in the ER depends on how advanced the DKA is when you arrive, however there are certain things which are standard practice in the management of DKA. This includes:
    · Checking your pulse, blood pressure, temperature and respiratory rate – you can develop a low blood pressure due to the dehydration, and your respiratory rate may be raised by your body trying to correct the acidosis. If your temperature is raised it may be a sign that you have an infection.
    · Taking a blood sample from a vein – this allows the doctors to confirm your blood glucose, and to check the levels of other salts in your body. They will also check to see if you have any signs of infection, and they may take a sample to send to the lab to see if there is any bacteria in the blood. In some hospitals they will use this sample to check the pH of the blood too, but in some hospitals they may use a blood sample from the artery in your wrist. This test can be quite painful but it gives the doctors lots of useful information on the acidity of your blood, and allows them to confirm the diagnosis of DKA.
    · Start an IV – as you will probably be dehydrated the most important thing is to replace the lost fluid and this is usually done using an IV. An IV is usually also needed to give you insulin.
    · Most hospitals will also perform an ECG, an electrical tracing of your heart to check that you are not having any problems with your heart, this is a painless test and is routine for DKA.
    · They may also order a chest x-ray and take a sample of your urine, they do this because they are looking for any infection, and chest infections and urine infections are the most common.
    Most of the time you will be admitted to the hospital for a couple of days so they can ensure everything is back to normal, and they can restart your usual insulin. Once you are eating and drinking normally and your blood sugars are stable you should be able to go home. If they have found a reason for the DKA such as an infection you may have to stay longer, or take medication such as antibiotics when you go home.
    After an episode of DKA
    There is usually no lasting effects after an episode of DKA, though you may feel tired and not quite yourself for a while once you get home. You may need to rest a bit more at home in the first few days. You should keep a close eye on your blood sugars, and be prepared to contact your healthcare team if you are not happy with your results. You may have been given a follow up appointment with an endocrinologist or diabetes specialist nurse to discuss how things are going since you got home, you should take along any records of your blood sugars and feel free to ask about any concerns you have had. If you have had something like an infection your blood sugars may still be running higher than usual and you will have to discuss whether you need to increase your insulin.

  2. whisperwillow

    This is a great post. Thanks for posting it. It might save a life or two. I went to the ER with a BG of 986. I didn't know I had diabetes. I don't know how I wasn't in a coma. The docs couldn't either. But I am living testament that it is serious and it can kill you if left untreated. If you are experiencing any of this symptoms, don't walk but run to the ER. (Figuratively speaking). Your life might be on depend on it.

  3. hannahtan

    I'm a living testament as well that ketones in T2 happens...even with just a level of 20.9mmol/l (376 mg/dl)...and i was lucky to caught it early...
    Thanks Jody for the GREAT post on DKA...this will definitely be handy to save a life or two...

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Should Sodium Bicarbonate Be Administered In Diabetic Ketoacidosis?

To the Editor: In the November 2001 issue of AJRCCM, Boord and colleagues (1) published the article “Practical Management of Diabetes in Critically Ill Patients.” In the section titled “Management of Diabetic Ketoacidosis and Nonketotic Hyperosmolar Syndrome,” they quoted articles reporting a mortality rate of diabetic ketoacidosis between 2 and 20%. However, they did not mention that only the most severe stage of ketoacidosis, ketoacidotic coma, is life threatening (2). Its immediate cause is low blood-pH (3). Boord and colleagues have quoted the articles of Okuda and colleagues (4) and Viallon and colleagues (5) as evidence of the inefficiency of sodium bicarbonate treatment in diabetic ketoacidosis. However, the patients of Okuda and colleagues “gave consent to participate in the study”; thus, they were not comatose. The patients of Viallon and colleagues had Glasgow Coma Scale scores of 14, i.e., they also were not comatose (this being a score of 3–4 in a comatose patient). Therefore, these two articles are not suitable for evaluation of the efficiency of treatment of the life-threatening stage of diabetic ketaocidosis, ketoacidotic coma, and of the influence of t Continue reading >>

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Popular Questions

  1. jodysd6

    What is DKA?

    What is DKA?
    DKA stands for Diabetic Ketoacidosis, and it is a potentially life threatening complication of Diabetes. It is usually associated with uncontrolled high blood glucose levels and it occurs as a result of insufficient insulin.
    Who is at risk for DKA?
    Type 1 diabetics are most at risk of developing DKA as they have no residual insulin production, often even a little insulin production is enough to prevent DKA developing. Some Type 2 Diabetics who also have no residual insulin production are also at risk.
    Many Diabetics will never experience DKA, and many cases of DKA occur in people who have previously been undiagnosed with diabetes. In people who know they are Diabetic there are a few potential triggers for DKA:
    · Inadequate Insulin – insulin being missed, failed delivery from a pump or much more rarely ‘bad’ insulin
    · Infection – particularly bacterial infections, and especially if the patient is unwell and unable to test and adjust insulin as usual
    · Other Illness – anything which stresses the body, such as a heart attack
    Most Episodes of DKA in known diabetics can be prevented if you know the symptoms, know how to manage when you are unwell and are able to make contact with your healthcare team early. It is estimated that around 25% of admissions for DKA in known diabetics occur when people stop insulin because they are not eating or are vomiting. It is very important to keep taking insulin even when you are ill, at these times you may even need more than usual despite not eating.
    What happens in DKA?
    Without Insulin all the glucose in your blood is unable to get into the cells where it is needed for fuel. Your blood glucose level will rise, and your liver will produce even more glucose because it senses that your cells are ‘starving’. 2 Parallel processes then occur which together lead to dehydration and a lowering of the bloods pH level – your blood becomes acidic.
    As the blood glucose rises your kidneys attempt to get rid of all the excess glucose, as excess glucose is ‘spilled’ into the urine water follows it, this is what makes you go to the toilet more frequently. As you lose water you feel thirsty, and develop a dry mouth.
    Because the cells cannot use the glucose in your blood (because the cells require insulin to let the glucose in) they need to find another source of energy. The cells can get the energy from other sources such as fat but in doing so they produce ketones. Ketones are acidic and as they build up in your blood they lower the pH of your blood. This is dangerous because all the cells in your body rely on the pH of your blood staying within a certain range. As the pH of your blood drops you may notice you are breathing faster than usual, this is your bodies way of attempting to raise your bloods pH level.
    By this stage most people will be feeling very unwell and will seek help, however if this process continues it can be life threatening, as your brain cannot survive indefinitely without glucose and other cells in your body begin to die due to the acidity of the blood. This is why it is so important to seek help early.
    What are the symptoms of DKA?
    Early Symptoms
    · Frequent Urination
    · Thirst
    · Dry Mouth
    · Nausea
    Later Symptoms
    · Vomiting
    · Abdominal Pain
    · Rapid Breathing
    · Confusion
    · Drowsiness
    · Coma
    Some people are able to taste ketones on their breath, this has been described as tasting how you expect nail varnish remover to taste! Friends or family may also be able to smell ketones on your breath (often described as sweet smelling or smelling of ‘pear drops’)
    How can I prevent DKA?
    Sometimes nothing you can do will stop it, and you will have to go to the ER in order to recieve appropriate treatment, however you may be ableto prevent DKA if you know the warning signs and respond quickly. If you have a high blood glucose you need to take an appropriate correction shot of fast acting insulin ( your doc can help you work out how much you need to take). Once you have taken the correction, you need to keep a close eye on your BG levels as they are falling, and be on the look out for hypoglycaemia. It is also importand to drink plenty of clear fluids, ideally water, as this will help combat any dehydration and help your body flush out the excess glucose and any ketones. If your blood glucose levels are falling steadily and you feel well, these steps may be all that is needed. You should continue to keep a close eye on you BG levels and on any ketones though, and be prepared to take further action if things stop improving or worsen.
    When Should I go to the ER?
    · If your BG is above 400mg/dl (or 20mmol/l) for more than a short period of time (some people may develop DKA at lower levels, so be prepared to seek help if you have any other symptoms, even if your BG is lower than this)
    · If your BG does not come down rapidly with short acting Insulin
    · If you have High Levels of Ketones (you can test for ketones using urine strips which are readily available, or some brands of glucose meter will allow you to test for blood ketones)
    · If you cannot tolerate oral fluids or begin vomitting
    · IF YOU ARE EVER IN DOUBT GO TO THE ER
    Remember it never hurts to call your healthcare team if you are at all concerned, they can advise you and would much rather you call them early than you end up more ill.
    What will happen in the ER?
    When you arrive at the ER you should tell them straight away that you suspect you may be in DKA. Sometimes if you have recently taken insulin your BG may appear normal and they may not realise what has been going on.
    Exactly what happens in the ER depends on how advanced the DKA is when you arrive, however there are certain things which are standard practice in the management of DKA. This includes:
    · Checking your pulse, blood pressure, temperature and respiratory rate – you can develop a low blood pressure due to the dehydration, and your respiratory rate may be raised by your body trying to correct the acidosis. If your temperature is raised it may be a sign that you have an infection.
    · Taking a blood sample from a vein – this allows the doctors to confirm your blood glucose, and to check the levels of other salts in your body. They will also check to see if you have any signs of infection, and they may take a sample to send to the lab to see if there is any bacteria in the blood. In some hospitals they will use this sample to check the pH of the blood too, but in some hospitals they may use a blood sample from the artery in your wrist. This test can be quite painful but it gives the doctors lots of useful information on the acidity of your blood, and allows them to confirm the diagnosis of DKA.
    · Start an IV – as you will probably be dehydrated the most important thing is to replace the lost fluid and this is usually done using an IV. An IV is usually also needed to give you insulin.
    · Most hospitals will also perform an ECG, an electrical tracing of your heart to check that you are not having any problems with your heart, this is a painless test and is routine for DKA.
    · They may also order a chest x-ray and take a sample of your urine, they do this because they are looking for any infection, and chest infections and urine infections are the most common.
    Most of the time you will be admitted to the hospital for a couple of days so they can ensure everything is back to normal, and they can restart your usual insulin. Once you are eating and drinking normally and your blood sugars are stable you should be able to go home. If they have found a reason for the DKA such as an infection you may have to stay longer, or take medication such as antibiotics when you go home.
    After an episode of DKA
    There is usually no lasting effects after an episode of DKA, though you may feel tired and not quite yourself for a while once you get home. You may need to rest a bit more at home in the first few days. You should keep a close eye on your blood sugars, and be prepared to contact your healthcare team if you are not happy with your results. You may have been given a follow up appointment with an endocrinologist or diabetes specialist nurse to discuss how things are going since you got home, you should take along any records of your blood sugars and feel free to ask about any concerns you have had. If you have had something like an infection your blood sugars may still be running higher than usual and you will have to discuss whether you need to increase your insulin.

  2. whisperwillow

    This is a great post. Thanks for posting it. It might save a life or two. I went to the ER with a BG of 986. I didn't know I had diabetes. I don't know how I wasn't in a coma. The docs couldn't either. But I am living testament that it is serious and it can kill you if left untreated. If you are experiencing any of this symptoms, don't walk but run to the ER. (Figuratively speaking). Your life might be on depend on it.

  3. hannahtan

    I'm a living testament as well that ketones in T2 happens...even with just a level of 20.9mmol/l (376 mg/dl)...and i was lucky to caught it early...
    Thanks Jody for the GREAT post on DKA...this will definitely be handy to save a life or two...

  4. -> Continue reading
read more
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What is KETOACIDOSIS? What does KETOACIDOSIS mean? KETOACIDOSIS meaning - KETOACIDOSIS definition - KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also smell, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accompanied by insulin deficiency, hyperglycemia, and dehydration. Particularly in type 1 diabetics the lack of insulin in the bloodstream prevents glucose absorption, thereby inhibiting the production of oxaloacetate (a crucial molecule for processing Acetyl-CoA, the product of beta-oxidation of fatty acids, in the Krebs cycle) through reduced levels of pyruvate (a byproduct of glycolysis), and can cause unchecked ketone body production (through fatty acid metabolism) potentially leading to dangerous glucose and ketone levels in the blood. Hyperglycemia results in glucose overloading the kidneys and spilling into the urine (transport maximum for glucose is exceeded). Dehydration results following the osmotic movement of water into urine (Osmotic diuresis), exacerbating the acidosis. In alcoholic ketoacidosis, alcohol causes dehydration and blocks the first step of gluconeogenesis by depleting oxaloacetate. The body is unable to synthesize enough glucose to meet its needs, thus creating an energy crisis resulting in fatty acid metabolism, and ketone body formation.

Diabetic Ketoacidosis

Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in ge Continue reading >>

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Popular Questions

  1. jodysd6

    What is DKA?

    What is DKA?
    DKA stands for Diabetic Ketoacidosis, and it is a potentially life threatening complication of Diabetes. It is usually associated with uncontrolled high blood glucose levels and it occurs as a result of insufficient insulin.
    Who is at risk for DKA?
    Type 1 diabetics are most at risk of developing DKA as they have no residual insulin production, often even a little insulin production is enough to prevent DKA developing. Some Type 2 Diabetics who also have no residual insulin production are also at risk.
    Many Diabetics will never experience DKA, and many cases of DKA occur in people who have previously been undiagnosed with diabetes. In people who know they are Diabetic there are a few potential triggers for DKA:
    · Inadequate Insulin – insulin being missed, failed delivery from a pump or much more rarely ‘bad’ insulin
    · Infection – particularly bacterial infections, and especially if the patient is unwell and unable to test and adjust insulin as usual
    · Other Illness – anything which stresses the body, such as a heart attack
    Most Episodes of DKA in known diabetics can be prevented if you know the symptoms, know how to manage when you are unwell and are able to make contact with your healthcare team early. It is estimated that around 25% of admissions for DKA in known diabetics occur when people stop insulin because they are not eating or are vomiting. It is very important to keep taking insulin even when you are ill, at these times you may even need more than usual despite not eating.
    What happens in DKA?
    Without Insulin all the glucose in your blood is unable to get into the cells where it is needed for fuel. Your blood glucose level will rise, and your liver will produce even more glucose because it senses that your cells are ‘starving’. 2 Parallel processes then occur which together lead to dehydration and a lowering of the bloods pH level – your blood becomes acidic.
    As the blood glucose rises your kidneys attempt to get rid of all the excess glucose, as excess glucose is ‘spilled’ into the urine water follows it, this is what makes you go to the toilet more frequently. As you lose water you feel thirsty, and develop a dry mouth.
    Because the cells cannot use the glucose in your blood (because the cells require insulin to let the glucose in) they need to find another source of energy. The cells can get the energy from other sources such as fat but in doing so they produce ketones. Ketones are acidic and as they build up in your blood they lower the pH of your blood. This is dangerous because all the cells in your body rely on the pH of your blood staying within a certain range. As the pH of your blood drops you may notice you are breathing faster than usual, this is your bodies way of attempting to raise your bloods pH level.
    By this stage most people will be feeling very unwell and will seek help, however if this process continues it can be life threatening, as your brain cannot survive indefinitely without glucose and other cells in your body begin to die due to the acidity of the blood. This is why it is so important to seek help early.
    What are the symptoms of DKA?
    Early Symptoms
    · Frequent Urination
    · Thirst
    · Dry Mouth
    · Nausea
    Later Symptoms
    · Vomiting
    · Abdominal Pain
    · Rapid Breathing
    · Confusion
    · Drowsiness
    · Coma
    Some people are able to taste ketones on their breath, this has been described as tasting how you expect nail varnish remover to taste! Friends or family may also be able to smell ketones on your breath (often described as sweet smelling or smelling of ‘pear drops’)
    How can I prevent DKA?
    Sometimes nothing you can do will stop it, and you will have to go to the ER in order to recieve appropriate treatment, however you may be ableto prevent DKA if you know the warning signs and respond quickly. If you have a high blood glucose you need to take an appropriate correction shot of fast acting insulin ( your doc can help you work out how much you need to take). Once you have taken the correction, you need to keep a close eye on your BG levels as they are falling, and be on the look out for hypoglycaemia. It is also importand to drink plenty of clear fluids, ideally water, as this will help combat any dehydration and help your body flush out the excess glucose and any ketones. If your blood glucose levels are falling steadily and you feel well, these steps may be all that is needed. You should continue to keep a close eye on you BG levels and on any ketones though, and be prepared to take further action if things stop improving or worsen.
    When Should I go to the ER?
    · If your BG is above 400mg/dl (or 20mmol/l) for more than a short period of time (some people may develop DKA at lower levels, so be prepared to seek help if you have any other symptoms, even if your BG is lower than this)
    · If your BG does not come down rapidly with short acting Insulin
    · If you have High Levels of Ketones (you can test for ketones using urine strips which are readily available, or some brands of glucose meter will allow you to test for blood ketones)
    · If you cannot tolerate oral fluids or begin vomitting
    · IF YOU ARE EVER IN DOUBT GO TO THE ER
    Remember it never hurts to call your healthcare team if you are at all concerned, they can advise you and would much rather you call them early than you end up more ill.
    What will happen in the ER?
    When you arrive at the ER you should tell them straight away that you suspect you may be in DKA. Sometimes if you have recently taken insulin your BG may appear normal and they may not realise what has been going on.
    Exactly what happens in the ER depends on how advanced the DKA is when you arrive, however there are certain things which are standard practice in the management of DKA. This includes:
    · Checking your pulse, blood pressure, temperature and respiratory rate – you can develop a low blood pressure due to the dehydration, and your respiratory rate may be raised by your body trying to correct the acidosis. If your temperature is raised it may be a sign that you have an infection.
    · Taking a blood sample from a vein – this allows the doctors to confirm your blood glucose, and to check the levels of other salts in your body. They will also check to see if you have any signs of infection, and they may take a sample to send to the lab to see if there is any bacteria in the blood. In some hospitals they will use this sample to check the pH of the blood too, but in some hospitals they may use a blood sample from the artery in your wrist. This test can be quite painful but it gives the doctors lots of useful information on the acidity of your blood, and allows them to confirm the diagnosis of DKA.
    · Start an IV – as you will probably be dehydrated the most important thing is to replace the lost fluid and this is usually done using an IV. An IV is usually also needed to give you insulin.
    · Most hospitals will also perform an ECG, an electrical tracing of your heart to check that you are not having any problems with your heart, this is a painless test and is routine for DKA.
    · They may also order a chest x-ray and take a sample of your urine, they do this because they are looking for any infection, and chest infections and urine infections are the most common.
    Most of the time you will be admitted to the hospital for a couple of days so they can ensure everything is back to normal, and they can restart your usual insulin. Once you are eating and drinking normally and your blood sugars are stable you should be able to go home. If they have found a reason for the DKA such as an infection you may have to stay longer, or take medication such as antibiotics when you go home.
    After an episode of DKA
    There is usually no lasting effects after an episode of DKA, though you may feel tired and not quite yourself for a while once you get home. You may need to rest a bit more at home in the first few days. You should keep a close eye on your blood sugars, and be prepared to contact your healthcare team if you are not happy with your results. You may have been given a follow up appointment with an endocrinologist or diabetes specialist nurse to discuss how things are going since you got home, you should take along any records of your blood sugars and feel free to ask about any concerns you have had. If you have had something like an infection your blood sugars may still be running higher than usual and you will have to discuss whether you need to increase your insulin.

  2. whisperwillow

    This is a great post. Thanks for posting it. It might save a life or two. I went to the ER with a BG of 986. I didn't know I had diabetes. I don't know how I wasn't in a coma. The docs couldn't either. But I am living testament that it is serious and it can kill you if left untreated. If you are experiencing any of this symptoms, don't walk but run to the ER. (Figuratively speaking). Your life might be on depend on it.

  3. hannahtan

    I'm a living testament as well that ketones in T2 happens...even with just a level of 20.9mmol/l (376 mg/dl)...and i was lucky to caught it early...
    Thanks Jody for the GREAT post on DKA...this will definitely be handy to save a life or two...

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