Diabetic Ketoacidosis

Did you know diabetes and its complications are one of the leading causes of morbidity and mortality, globally? As per one study conducted in India, up to 30% of diabetic ketoacidosis cases resulted in death while being hospitalized.

Diabetic ketoacidosis (DKA) is a serious metabolic complication of diabetes mellitus. This is usually an acute and life-threatening condition that could develop in hours and if untreated, could lead to diabetic coma or death. Diabetic ketoacidosis is characterized by excessive breakage of fats into ketones (metabolic product of fats). Ketones are acidic, and their excessive buildup causes the blood to become more acidic, leading to ketoacidosis.

Diabetic ketoacidosis is usually the result of poor signaling of insulin that leads to:

• Glucose not being absorbed into cells
• Liver producing excessive blood glucose
• A quick breakdown of fat

Diabetic ketoacidosis is more common and severe in people with type 1 diabetes mellitus. Sometimes, diabetic ketoacidosis can present as the first sign of type 1 diabetes mellitus. In people with type 2 diabetes mellitus, diabetic ketoacidosis is triggered by uncontrolled blood glucose levels for a prolonged duration. Diabetic ketoacidosis by occurrence is less common and less severe in type 2 diabetics.

Symptoms of Diabetic Ketoacidosis

Common symptoms of diabetic ketoacidosis include:

• Dry skin
• Frequent thirst
• Frequent urination
• Reduced alertness/confusion
• Muscle pain
• Abdominal pain
• Nausea and vomiting
• Fatigue
• Weakness
• Flushing face
• Dyspnea
• Headache
• Sweet-smelling breath

Treatment of Diabetic Ketoacidosis

You should immediately seek medical attention if you experience any of the above-mentioned symptoms or warning signs. You will need to go to the hospital to get treated for diabetic ketoacidosis. Any delay in immediate medical care can lead to diabetic coma or even death.

The majority of the people usually respond within 24 hours of the treatment therapy. Once the biochemical functions start returning to normal, your doctor might look for possible causes of diabetic ketoacidosis and initiate additional treatment strategies.

The treatment approach for diabetic ketoacidosis is symptomatic and based on the correction of the imbalances. Your doctor will give you emergency treatment such as:

• Intravenous (IV) fluids to keep your body hydrated, regulate your biochemical balance, and replenish the loss by excessive urination
• IV infusion of electrolytes to replace potassium, chlorine, and sodium in your body to upkeep functioning of heart, kidney, nerves, muscles, etc.
• IV Insulin to reduce the level of ketone bodies and blood glucose level. Once your blood glucose levels fall below 200 mg/dL and your blood is no more acidic, IV insulin can be switched to subcutaneous insulin
• Antibiotics to treat bacterial infections, if any
• Further, your doctor could evaluate your heart, nerve, and kidney functioning to ensure the safety of these organs

Road ahead

Prevention is better than cure; you should follow the advice given by your healthcare professional. You can prevent diabetic ketoacidosis in the future by the following lifestyle behaviors:

• Drink plenty of water and non-alcoholic sugar-free beverages
• Exercise regularly
• Religiously following a diet plan
• Continuous glucose monitoring
• Checking for ketone bodies by urine strip test, especially if blood glucose levels are above 240 mg/dL
• Take medications and insulin as prescribed
• Ensuring continuous supply of insulin and efficient working of insulin pumps/injections
• Have an emergency plan ready for diabetic ketoacidosis
• Consulting lifestyle experts and dieticians to learn about various options to keep your blood glucose levels under control and lead a complication-free life.

Keeping your blood glucose levels in control will help you avoid diabetic ketoacidosis. You should adopt lifestyle modifications such as eating right, exercising regularly, proper medication and becoming aware.

FAQs

1. What is the Treatment for Diabetic Ketoacidosis?

Treatment for diabetic Ketoacidosis involves three main lines:

• IV fluids: Keep you hydrated and replenish fluid loss
• IV electrolytes: Replenish levels of electrolytes (sodium, potassium, and chloride) and ensure proper function of heart, kidney, muscle, and nerves
• IV Insulin: Regulates blood glucose levels and clears excess ketone bodies from your blood

2. What is the initial treatment for Diabetic Ketoacidosis?

Initial treatment for diabetic ketoacidosis aims to correct electrolyte imbalance and provide insulin therapy for quicker resolution and prevention of complications. Fluid replacement is also an integral part of initial treatment.

3. Is Diabetic Ketoacidosis Curable?

Diabetic ketoacidosis is curable but with a clause. If diagnosed early, diabetic ketoacidosis is treatable using standard medical care along with a possible requirement for additional therapies. However, the clause is that you need to follow the doctor’s advice and also adhere to certain lifestyle behaviors to avoid the occurrence of diabetic ketoacidosis in the future. Becoming aware and understanding the risk associated with diabetic ketoacidosis is also crucial.

4. How is Early Ketoacidosis Treated?

Early ketoacidosis treatment is based on symptoms and could involve IV infusion of fluids, electrolytes, and insulin therapy to reduce ketone bodies from blood. Your doctor might also advise you to follow a strict diet plan and exercise regime to regulate blood sugar levels based on the severity of the ketoacidosis.