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OVERVIEW

What is diabetic ketoacidosis?

Diabetic ketoacidosis, or DKA, happens when your blood sugar is higher than normal and your insulin level is lower than normal. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. It mainly affects people who have type 1 diabetes. However, it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (diabetes during pregnancy).

SYMPTOMS

What are the warning signs of DKA?

DKA is a very serious condition. If you have diabetes and think you have DKA, contact your healthcare provider or go to a hospital right away. The first symptoms to appear are usually:

• Excessive thirst
• Dry mouth
• Frequent urination

The next stage of DKA symptoms include:

• Vomiting (usually more than once)
• Abdominal pain
• Diarrhea
• Trouble breathing
• Confusion or trouble concentrating
• Loss of appetite
• Weakness and fatigue
• A fruity odor on the breath

If your sugar is very high or symptoms are severe (especially confusion), you should go to the nearest emergency room.

CAUSES & RISK FACTORS

What causes DKA?

The main cause of DKA is not producing enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This lack of insulin causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones poison the body.

High blood glucose levels can also cause you to urinate often This leads to dehydration.

DKA can be caused by missing an insulin dose, eating poorly or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection, such as a fever, cough, or sore throat, contact your healthcare provider.  It’s important to get the right treatment. For some people, DKA may be the first sign that they have diabetes.

DIAGNOSIS

How is diabetic ketoacidosis diagnosed?

If you think you may have diabetic ketoacidosis, contact your healthcare provider right away. They may want to run some blood tests before giving you an official diagnosis. These tests include checking your blood sugar and ketone level. Your healthcare provider also may order a urinalysis (requiring a urine sample) and chest X-ray.

PREVENTION

Can diabetic ketoacidosis be prevented or avoided?

If you have diabetes, there are some things you can do to watch for diabetic ketoacidosis. When you are sick, watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your healthcare provider what your critical blood sugar level is. Most patients should watch their glucose levels closely when they are more than 13.9 mmol/L (250 mg per dL).

When you’re sick or stressed, you should check your blood sugar level more often than normal (sometimes every 3 to 4 hours). If your blood sugar reaches a critical level, check it every 1 to 2 hours. Ask your healthcare provider if you should test your blood sugar level during the night.

You should also test your urine for ketones every few hours if you’re sick, stressed or if your blood sugar level is more than 13.9 mmol/L (250 mg per dL).

You should contact your healthcare provider to develop a plan if your blood sugar level gets too high. Make sure that you know how to reach your healthcare provider in an emergency.

TREATMENT

Diabetic ketoacidosis treatment

DKA causes excessive urination. This means you will urinate more than usual. You can become dehydrated, and your body can lose electrolytes (minerals in your blood that help your body function). If you are diagnosed with DKA, your healthcare provider will most likely treat you with fluids (usually through an IV). These fluids will contain electrolytes and insulin. Electrolytes will help your body function normally. Insulin will help lower your blood sugar level. Overall, fluids can help rehydrate you and dilute some of the sugar in your blood.

Living with diabetic ketoacidosis

Keeping the balance between blood sugar and insulin is the key to controlling diabetic ketoacidosis. In most cases, this means sticking to your insulin schedule. But you may need to adjust the amount of insulin you’re taking.

You should also try to recognize when you feel stressed or sick. Small adjustments to your eating or drinking can make a big difference.

Should I keep taking insulin when I’m sick?

You should keep taking your insulin, even if you are too sick to eat. Your body needs insulin even if you are not eating. Ask your healthcare provider whether it is necessary to adjust your dose or take extra insulin.

If you use an insulin pump, make sure that you keep a variety of supplies on hand.  Make sure that you have short-acting insulin, long-acting insulin and needles in case your pump is not working right. You also should have an emergency phone number to call for help with your pump.

What else should I do?

When you’re sick, drink lots of sugar-free, caffeine-free liquids. Sip small amounts every few minutes if you are feeling sick to your stomach. If your blood sugar level is more than 13.9 mmol/L (250 mg per dL), avoids foods that are high in carbohydrates.

FOR MORE INFORMATION

Diabetes Canada
http://www.diabetes.ca

PEI Government Website
https://www.princeedwardisland.ca/en/topic/diabetes

Health Canada website at:
https://www.canada.ca/en/health-canada/services/health-concerns/diseases-conditions/diabetes.html