Ketoacidosis - Diabetic Emergencies: Diabetes A Plan For Living

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Ketoacidosis

Chronically high blood glucose, or hyperglycemia, substantially increases the risk for long-term complications. However, it also presents more immediate dangers for people with type 1 diabetes. If their blood sugar runs too high, it can cause dehydration and diabetic ketoacidosis (DKA). Although relatively rare and preventable, DKA is an emergency that, if untreated, can lead to coma and possibly death.

DKA occurs when insulin falls to a critically low level. Ketones are natural by-products of fat digestion. When your insulin levels are very low, the rate of fat breakdown increases substantially and your cells can't take up and metabolize all the ketones. Therefore, they accumulate in your bloodstream, making your blood acidic. At the same time, your kidneys excrete large amounts of glucose-rich urine, causing dehydration. DKA produces nausea and vomiting, which cause further dehydration and make it impossible to replenish the lost fluid by mouth.

DKA can occur because you missed insulin doses or used too little insulin during a period of illness or unusual stress. Illness and stress increase your vulnerability because the hormones released in these situations oppose the action of insulin. Unless insulin doses are maintained or increased, insulin insufficiency develops. In some people, type 1 diabetes announces itself with an episode of DKA. Symptoms include increased thirst, frequent urination, rapid breathing, nausea, vomiting, fatigue, abdominal pain, and "fruity" breath (see "Fast fact").

As the condition progresses, blood pressure falls due to dehydration. Confusion and even coma can develop when blood sugar levels become extremely high. Treatment requires insulin and the intravenous replenishment of fluids. DKA can be life-threatening, and to treat it effectively, the individual may need to be admitted to an intensive care unit.

Because the warning signs often develop over several days, regular blood glucose tests can determine when levels are becoming high enough to increase the risk for DKA, usually above 300 mg/dL. You can also detect the development of DKA by monitoring ketones in your urine. This test is easily performed at home using a specially treated urine dipstick for ketones. Urine ketones should be checked whenever your blood sugar levels become unusually high or when you've developed a new illness, especially one with gastrointestinal symptoms such as abdominal pain, nausea, or vomiting. Call your doctor immediately if your urine test shows more than a trace of ketones.

If you detect urine ketones (ketoacidosis) early, before dehydration and full-blown acidosis develop, you can usually treat it at home by drinking extra fluids and taking more insulin. The keys to preventing DKA are to detect worsening glucose control early and never stop your insulin, even if you're too sick to eat. With your doctor's help you can adjust your doses, but stopping insulin altogether is a sure path to DKA.

Last updated:	January 23, 2007