Diabetic ketoacidosis: causes, symptoms and treatment

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Definition

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a diabetes complication characterized by high levels of ketones in the body. Ketones are acids that are produced when the body starts burning fat for energy instead of carbohydrates (or glucose).

Diabetic ketoacidosis occurs when you don't produce enough insulin to make your cells absorb glucose (the main energy source).

If left untreated, diabetic ketoacidosis can lead to diabetic coma and death.

How common is this condition?

Diabetic ketoacidosis is more common in people with type 1 diabetes. Especially, if treatment with insulin is not done properly.

Even so, people with type 2 diabetes may also experience this one complication when they are sick and don't get enough carbohydrate intake.

This condition also sometimes occurs in people who do not realize that they have diabetes. U.S. page The National Libary of Medicine explains that ketoacidosis is often experienced by people with type 1 diabetes who don't know that they have diabetes.

Signs and symptoms

What are the signs and symptoms of diabetic ketoacidosis?

Signs and symptoms of ketoacidosis usually develop quickly, sometimes within 24 hours. These signs and symptoms could be an indication of the early symptoms of type 1 diabetes.You will feel the following:

• Urinating frequently
• Feeling very thirsty or drinking frequently
• Firey eyes
• Decreased consciousness (fainting)
• Feel nauseous and tired
• Stomach ache
• Hard to breathe
• Increase in blood sugar and / or ketone levels from the results of self-examination

There may be signs and symptoms not listed above. If you have concerns about a particular symptom, consult your doctor.

Check your blood sugar and ketone levels

If you have type 1 diabetes, it is recommended that you have a home ketone urine test. You can buy them at pharmacies or online.

Check your blood sugar level immediately if you feel the symptoms of this diabetes complication. According to the American Diabetes Association, you need to immediately have a urine test to check ketone levels when your blood sugar test results show a value of 240 mg / dL.

You can do this ketone test independently at home. A result above 2+ indicates you may have diabetic ketoacidosis.

Here's how to read the results of a ketone test via a blood test, as a precaution against the possibility of diabetic ketoacidosis:

• Normal: less than 0.6 mmol / L.
• Low risk: 0.6 mmol / L-1.5 mmol / L. You are advised to do a re-examination a few hours afterward.
• High risk: 1.6 mmol / L-2.9 mmol / L. Immediately contact a doctor in this condition.
• Very high risk: more than 3 mmol / L. You need a handler immediately.

When should I see a doctor?

You should contact your doctor if you experience any of the following symptoms:

• If you feel sick, stressed, or have had a recent illness or injury, you can check your blood sugar levels with an over-the-counter urine ketone test kit.
• Vomiting and unable to eat or drink.
• Blood sugar levels are higher than normal and medications are not working.
• Ketone levels in the urine are in the middle or high stage.

Immediately contact the Emergency Unit (UGD) if:

• Your blood sugar level is constantly above 300 mg / dL or 16.7 mmol / L.
• There are ketones in the urine and cannot reach the recommended level.
• You have more than 1 symptom of diabetic ketoacidosis, such as confusion (daze), thirst, frequent urination, nausea and vomiting, stomach pain, shortness of breath, and bad breath.

Cause

What causes diabetic ketoacidosis?

Diabetic ketoacidosis occurs because the body produces a lot of ketones as a result of burning fat for energy. Generally, the body will convert glucose into energy.

However, due to a lack of the hormone insulin, the absorption of glucose into the body's cells becomes disrupted so that the body lacks glucose and starts burning fat.

If this process continues, ketones can build up in your blood. The excess will change the balance of blood chemicals and disrupt the body's metabolism as a whole. Worse, excess blood acid can also poison the body.

In general, the causes of diabetic ketoacidosis are:

• Disease or infection can cause the body to produce more other hormones, such as adrenaline or cortisol, affect insulin action and cause diabetic ketoacidosis.
• The effect of insulin therapy can reduce insulin levels in the body, causing diabetic ketoacidosis
• Physical or mental disorders
• Heart attack
• Alcohol or drug abuse
• Certain medications such as corticosteroids and some diuretics.

What puts me at risk for this condition?

There are several risk factors that have the potential to cause diabetic ketoacidosis, namely:

• You have type 1 diabetes
  People with type one diabetes are at risk of developing diabetic ketoacidosis because their bodies don't produce insulin. Ketone levels can also increase when you skip meals, get sick or stressed, or when you experience the side effects of insulin therapy.

• Age

Ketoacidosis can also occur in people with type 2 diabetes, although it is a rarer case. Some of the factors that put people with type 2 diabetes at greater risk of developing this complication are:

• Are less than 19 years old
• Experiencing various forms of trauma, both emotional and physical
• Stress
• Have a high fever
• Have had a heart attack or stroke
• Smoke
• Alcohol or drug dependence

Diagnosis

How do doctors diagnose diabetic ketoacidosis?

If you suspect you have diabetic ketoacidosis, your doctor will perform a physical exam and some blood tests. In certain cases, additional tests will also be performed to determine the trigger for the condition.

1. Blood test

Blood tests done to diagnose diabetic ketoacidosis will usually show:

• Blood sugar levels
• Ketone levels
• Blood acidity

2. Additional tests

Your doctor will perform additional tests to see if there are other health problems affecting the diabetic ketoacidosis and to check for complications. These examinations may include:

• Blood electrolyte test
• Urinalysis
• Chest X-ray
• Records of electrical activity in the heart (electrocardiogram)

Complications

What are the complications of diabetic ketoacidosis?

Complications that may affect diabetic ketoacidosis patients are:

• Lack of blood sugar (hypoglycemia)
  Insulin allows sugar to enter your cells causing your sugar levels to drop. If your blood sugar levels drop too quickly, you could become deficient in blood sugar.

• Potassium deficiency (hypokalemia)
  Fluid and insulin intake are usually used to treat diabetic ketoacidosis. However, this can also lead to a decrease in potassium. If your potassium levels drop, your heart, muscles, and nerves will be affected.

• Swelling in the brain
  Regulating your blood sugar levels too quickly can cause swelling in your brain. Complications usually arise in children, especially those newly diagnosed with diabetes. If not treated quickly, ketoacidosis can lead to diabetic coma or even death.

Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

What medications can I take to treat diabetic ketoacidosis?

Treatment for diabetic ketoacidosis usually involves a combination approach to normalizing blood sugar levels as well as insulin therapy.

If you have ketoacidosis, but have never been diagnosed with diabetes, your doctor will create a treatment plan to keep this condition from recurring.

Infection can also increase the risk of diabetic ketoacidosis. If the test results show that your condition is due to a bacterial infection, the doctor will also give you antibiotics.

In general, some diabetic ketoacidosis treatments include:

1. Fluid replacement

You will get fluids, both from the mouth and through a vein (IV), until your dehydration is gone. These fluids will replace fluids lost through excessive urination and help remove ketones from your blood.

2. Electrolyte replacement

Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the levels of some electrolytes in the blood.

Electrolyte replacement can be done through a vein to allow your heart, muscles, and nerves to function normally.

3. Insulin therapy

In addition to fluids and electrolytes, you will receive insulin therapy, usually through a vein. When the blood sugar level is already at 200 mg / dL (11.1 mmol / L) and the blood is no longer acidic, you may be able to stop intravenous insulin therapy. After that, you can continue with regular insulin injection therapy.

Prevention

What can I do to prevent diabetic ketoacidosis?

There are many things you can do to prevent diabetic ketoacidosis and other complications of diabetes, namely:

• Follow a balanced diet for diabetes by eating foods that are low in sugar and have a low glycemic index.
• Monitor blood sugar levels by checking blood sugar at least three to four times a day. Do it more often when you are sick or stressed.
• Follow a diabetes treatment plan, either insulin therapy or consumption of diabetes drugs to lower blood sugar according to doctor's recommendations.
• If you are sick or stressed, check your urine for excess ketones. If your ketone levels are moderate to high, call your doctor for emergency care.
• When experiencing complaints that are suspected of being ketone symptoms, do not hesitate to immediately consult a doctor or go to the Emergency Unit (UGD) when the symptoms are severe enough.

This diabetes complication is indeed a serious and dangerous condition, but it can be prevented. Tell your doctor if your diabetes treatments are not working well or you find a problem. Your doctor will adjust your medication so you can control your blood sugar without increasing your risk of complications.