Management of Diabetic Ketoacidosis

What is diabetic ketoacidosis?

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a condition that occurs when the body cannot produce sufficient amount of insulin. This deficiency of insulin leads to a breakdown of fats to fuel and eventually produce high levels of acids in the bloodstream. 

You are more likely to suffer from diabetic ketoacidosis if you have type 1 diabetes.

Causes of diabetic ketoacidosis

Causes of diabetic ketoacidosis

Insulin helps to transfer glucose from the bloodstream to cells where sugar is used as energy. Due to insufficient insulin, our body is not able to convert sugar into energy, resulting in high blood sugar levels. This triggers the release of glucagon and other counter-regulatory hormones that promote the breakdown of fat into usable fuel (which doesn’t require insulin) and produces acid called ketones. 

Excessive ketones build up in the blood, making it acidic and finally leads to diabetic ketoacidosis. 

Diabetic ketoacidosis is triggered by:

  • Illness or infection like pneumonia or urinary tract infection.
  • Missing out an insulin injection or inadequate insulin therapy.
  • Clog in the insulin pump you use.
  • Physical or emotional stress.

Pathophysiology

Management of Diabetic Ketoacidosis - Pathophysiology

Diabetes ketoacidosis is associated with insulin deficiency and elevated blood glucose levels (greater than 300 mg/dL). It results in three major pathophysiological syndromes:

  1. Metabolic acidosis Metabolic acidosis is caused due to increased production of ketones in the blood and a decrease in peripheral cell use (due to the starvation state of the cells).
  2. Osmotic diuresis – When the blood sugar level reaches too high, glucose spills over into the urine where it creates an osmotic pressure. Due to this, a large amount of water is drawn by glucose and leads to dehydration in the patient.
  3. Electrolyte disturbance – Electrolyte imbalance is caused due to excessive urination. Excretion of electrolytes such as potassium, calcium, magnesium occurs due to the loss of large amounts of fluids through urine and results in electrolyte disturbance.

Symptoms of diabetic ketoacidosis

Symptoms

Signs of Diabetic ketoacidosis can be seen very quickly. The following symptoms indicate that you might be suffering from diabetic ketoacidosis:

Symptoms of diabetic ketoacidosis
  1. Frequent urination
  2. Excessive thirst
  3. High blood sugar levels (hyperglycemia)
  4. High ketone levels in the urine
  5. Nausea or vomiting
  6. Rapid and fruity-smelling breath
  7. Dry mouth
  8. Fatigue or extreme tiredness
  9. Abdominal pain
  10. Confusion

If left untreated, diabetic ketoacidosis can lead to coma or death. Therefore, seek medical help if you suspect you are experiencing DKA (Diabetic Ketoacidosis).

Diagnosis

Ketoacidosis diagnosis

If the doctor presumes that you are suffering from diabetic ketoacidosis, he will perform blood tests and urine tests. Urine tests are used to monitor the levels of urine ketones.  Blood tests will help to measure:

  • Blood sugar levels – As there is a lack of insulin in the body, the blood sugar levels will be high.
  • Ketone levels – Due to the breakdown of fats for energy, ketones will start building up in the blood.
  • Blood acidity – The excess ketone content will make your blood acidic.

To determine which factor triggered DKA and the possibility of DKA complications, the doctor may suggest some additional tests. It includes:

  1. Basic blood work (to monitor metabolic function)
  2. Chest X-ray (to check for infection like pneumonia)
  3. Arterial blood gas (to determine blood acidity)

Treatment

Diabetic ketoacidosis treatment requires a proper therapy plan to normalize both blood sugar and insulin levels. The treatment involves:

ketoacidosis treatment

Fluid replacement

The doctor will give you fluids, either orally or through a vein (intravenously) until you are re-hydrated. Fluid replacement helps to replace the fluids lost due to excessive urination and hence, treat dehydration. 

Insulin therapy

You will receive intravenous insulin therapy until your blood sugar levels fall below 200 mg/dL. This will help to reverse the procedure that caused diabetic ketoacidosis.

Electrolyte replacement

The deficiency of insulin lowers the level of electrolytes in the blood. Electrolytes are electrically charged minerals (like sodium, potassium, etc.) in our blood, which helps in the normal functioning of the heart, nerves, and muscles. 

Intravenous electrolyte replacement will help to boost the electrolyte content in the blood.

Along with the following treatments, the doctor might prescribe antibiotics if an infection is found to be the trigger that caused diabetic ketoacidosis.

Complications

Diabetic ketoacidosis can lead to the following complications:

  • Hypokalemia (low potassium) – The potassium level can drop significantly,  due to the excessive loss in fluids and insulin used in the treatment of diabetic ketoacidosis. Very low potassium levels can cause severe health problems like muscle weakness and heart rhythm problems.
  • Hypoglycemia (low blood sugar levels) – Insulin therapy helps to maintain blood sugar levels. Uncontrolled insulin therapy can lead to very low blood sugar or hypoglycemia. Therefore, the insulin dose should be timely adjusted, and the blood sugar levels should be monitored frequently.
  • Swelling inside the brain (cerebral edema) – The sudden adjustment of blood sugar levels during DKA treatment can produce swelling in the brain. Children are more likely to suffer from this complication. Its symptoms include headache, lethargy, and seizures. 
  • Kidney damage – The fluid loss due to frequent urination can damage the body organs like the kidney.
  • Pulmonary edema – Excessive fluid replacement in patients with chronic kidney disease or congestive heart failure can lead to pulmonary edema.

You must have noticed that most of the DKA complications are associated with its treatment itself. Therefore, the treatment of a diabetic ketoacidosis patient should be performed carefully.

Prevention and Cure

Diabetes ketoacidosis is a complication of diabetes. Therefore, the first thing you can do to prevent DKA is diabetes management.

diabetic ketoacidosis prevention
  • Diabetes management – Avoid a sedentary lifestyle and perform exercise regularly. Acquire healthy eating habits and stay hydrated with water. Take your medications on time.
  • Check your blood sugar levels – Monitor your blood sugar levels regularly to ensure that it is within the target range. 
  • Adjust your insulin dosage – Consult your doctor about managing and adjusting your insulin dosage based on your health condition.
  • Check your ketone levels – In case of illness, perform the urine test to check the ketone levels. If the ketone level is moderate or high, seek medical help immediately.

Early detection of diabetic ketoacidosis is necessary. Therefore, seek emergency care if your blood sugar level and ketones level are high.

Last but not least

Follow your diabetes treatment plan and take immediate action if you are experiencing DKA symptoms.

Diabetic ketoacidosis can be deadly. But your consciousness and quick response can save you from unhappy outcomes.

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