Introduction to Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) is a potentially life-threatening complication for people with insulin-dependent diabetes. It happens by a lack of insulin in the body. DKA occurs when there are excessive levels of ketone bodies accumulating in the bloodstream. WHO strongly warns about DKA because it may occur when people with diabetes don’t have access to care. Or it can be because they don’t follow medical advice on how to manage their diabetes properly. One reason why WHO warns about Diabetic Ketoacidosis (DKA) is that it often doesn’t give any warning signs or symptoms until the body is close to an acidic state, making it difficult to detect. This means that if left untreated, the blood acidity levels can extremely reach hazardous levels in a very short period of time. In this article, we’ll take a look at what DKA is and how you can manage it effectively.
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis (DKA) is a type of metabolic crisis that affects individuals who are insulin-dependent. Individuals with Type 1 diabetes or late onset Type 2 diabetes typically develop DKA. This happens when they don’t have enough insulin in their bodies to manage their blood sugar levels. When the body isn’t able to convert glucose into energy properly due to the lack of insulin it starts breaking down fat instead. So ketones build up in the blood and urine. This leads to acid buildup in the bloodstream resulting in diabetic ketoacidosis.
What are the Causes of DKA?
The most common cause of DKA is an absolute deficiency of insulin. This can be either due to poor diet and exercise habits or due to an underlying medical condition affecting the production or utilization of insulin by the body. Other possible causes include:
Diagnostic Test for DKA
- Fingerstick Blood Glucose Test: One of the initial tests for diagnosing DKA involves taking a fingerstick glucose test. This test measures the amount of glucose in your blood at any given time. If your blood glucose levels are higher than 200 mg/dl, as well as higher than normal ketone levels, you have DKA.
- Urine Tests for Ketones: The next step for diagnosing DKA involves performing a urine test. To determine if there are elevated levels of ketones present in your body. If present, this could indicate that your body isn’t producing enough insulin. And that ketones are being formed as a result. Additionally, certain chemicals on dipsticks can also help determine whether or not someone has high concentrations of ketones in their urine.
- Blood Tests: Doctors may also request additional blood tests such as Serum Sodium and Potassium Level Tests. pH Analysis Tests and Ammonia Toxicity Tests to assess if someone is experiencing symptoms of diabetic ketoacidosis or not. These blood tests will help provide more accurate results regarding the possible presence of high quantities of acid in the bloodstream. Which can be indicative of DKA.
- Electrocardiogram (ECG): Lastly, physicians may also order an Electrocardiogram (ECG) scan. Which will measure how electric signals from different parts of your body interact with each other. When it comes to diagnosing problems like DKA or other common conditions caused by diabetes. The results from ECG scans that indicate abnormal activity could potentially indicate further issues regarding one’s health status including challenges associated with diabetes such as changes related directly to DKA.
Signs and Symptoms of Diabetic Ketoacidosis
- Frequent Urination: People with diabetes may have increased urination because there’s too much sugar in their blood, which leads their bodies to secrete more fluids than normal as they try to flush out excess sugars. This results in more frequent urges to urinate.
- Increased Thirst: When your urine output increases due to frequent urination, your body loses more water than usual causing dehydration and an increased thirst as a consequence.
- Fatigue: If your body isn’t able to use glucose for energy due to DKA, it will turn to other sources such as fatty acids for fuel instead, leading you to become tired quickly and experience general fatigue.
- Nausea and Vomiting: When you suffer from DKA, nausea and vomiting can be one of the first signs as elevated ketone levels begin gaining control over your metabolism.
- Abdominal Pain: Since serotonin is released from high levels of ketones in the presence of DKA, abdominal pain may result from irritation in the lining of the stomach caused by high acidity levels in the intestines.
- Shortness of Breath: As ketones build up due to insufficient insulin secretion during DKA, they can cause extreme shortness of breath due to a limited amount of oxygen being transported into cells throughout your entire body.
- Fruity-Smelling Breath: When chemicals called acetones are released along with ketone buildups during times of diabetic ketoacidosis, they create a distinctive smell on an individual’s breath that has been described as smelling “fruity” or like nail polish remover.
- Confusion: When Ketones start taking control over brain cells’ ability to take in glucose for energy production during bouts of DKA confusion and impaired judgment usually occur as a result.
Treatment Options for Diabetic Ketoacidosis
- Insulin Therapy: The primary treatment for DKA is insulin therapy. This can be done through injections or an insulin pump, depending on the availability of medical supplies in your area and your preference. Insulin allows sugar to move from the bloodstream into cells where it can be used as energy, thus lowering blood sugar levels and neutralizing acids in the body.
- Fluid Replacement: Dehydration resulting from diarrhea and vomiting due to ketoacidosis should be corrected with fluid replacement therapy. Dextrose solution containing potassium may be given intravenously to replace fluids lost during the ketoacidosis episode and restore electrolyte balance. Passing large amounts of urine also causes water loss which needs to be replaced. Thus, increasing fluid intake is important in order to manage dehydration caused by DKA.
- Invasive Monitoring: Some patients may require monitoring with invasive techniques such as arterial line access or central venous catheterization for management of rapid-onset metabolic derangement or severe acidosis with shock state requiring pressors medications.
- Lifestyle Changes: Besides medication and these treatments for DKA, there are various lifestyle changes you should make to improve your overall health. Especially if you have diabetes or are at risk for developing it. Quitting smoking (if applicable), and eating a healthy diet that includes carbohydrate counting. Also exercising regularly. All those things will help prevent future episodes of diabetic ketoacidosis.
Managing Diabetic Ketoacidosis
The first line of defense against Diabetic Ketoacidosis is closely monitoring your blood sugar levels and adjusting your diet accordingly. Make sure that you’re monitoring not only your food intake but also any medications. You may be taking as well as any changes in physical activity that could affect your blood sugar levels. Additionally, make sure that you’re drinking plenty of fluids throughout the day so that you can replace lost electrolytes. If you’re having trouble controlling your blood glucose levels with diet alone then you may need to speak with your healthcare provider. Talk about additional ways to manage your diabetes including medication therapy or adjusting your insulin regimen accordingly.
Lifestyle Changes To Prevent Recurrence & Progression of DKA
- Eat Regularly Scheduled Meals: To provide your body with consistent energy and glucose throughout the day, it’s important to eat meals at the same time every day. Additionally, make sure to include complex carbohydrates in your diet such as whole grains, fruits, vegetables, and legumes.
- Monitor Your Blood Glucose Levels: People with diabetes should strive to maintain near-normal glucose levels. Do this by consistently monitoring their blood glucose levels before and after meals and throughout the day. This will also allow you to recognize patterns. This could include signs that lead up to an episode of DKA such as increased urination or increased appetite. And can help you determine what could have caused your most recent episode so you know what triggers future symptoms.
- Exercise Regularly: Regular exercise has many benefits for those with diabetes including improved blood sugar control. However, it’s still important to exercise safely between episodes of DKA. Avoid activities that could spike your glucose levels quickly such as high-intensity intervals. If they are not necessary while managing very low blood sugar readings. Try lower-impact exercises such as walking or swimming. As well as stretching and light weights that focus on maintaining strength without raising your heart rate too quickly.
- Manage Stress During Episodes Of Illness Or Stressors: Stress is one factor of DKA. So it’s especially important for people with diabetes to manage stress during illness or periods of emotional turmoil. Such as a divorce or death in the family. To manage stress during these times talk to a healthcare professional about coping strategies. Like deep breathing exercises or relaxation techniques. Additionally, make sure you follow your doctor’s instructions regarding medication regimen changes.
- Take Medications At The Directed Time Interval & Dosage Instructions from Your Doctor: Follow doctor-prescribed guidelines when taking insulin injections or oral diabetic medications designed for sugar control. Take at the exact times instructed each day and make sure dosages do not vary without consulting your doctor first. Not doing so could increase the risk of future problems.
Diabetic Ketoacidosis (DKA) is a serious condition that can be fatal if not properly treated. However early detection and treatment through proper management can be successful in prevention. Your best defense against DKA is close monitoring of your food intake. Also lifestyle habits and medications as well as ongoing communication with your healthcare provider. So they can adjust your plan accordingly.