Being a diabetic, you might know that the cause of diabetes is related to insulin and if your blood sugar levels are on a higher side for a long time, it can impact your other organs especially kidneys, eyes and nervous system.

But everybody doesn’t know that lack of insulin can also cause Diabetic Ketoacidosis (DKA). It is a serious complication that occurs mostly in patients with Type 1 Diabetes.

It is caused by the production of an excess amount of “ketones” which causes the blood to become acidic. These ketones are produced because the body starts to break down fat for producing energy instead of glucose.

In this blog, we’re going to discuss everything that you need to know about Diabetic Ketoacidosis including its diagnosis, prevention and treatment.

What is Diabetic Ketoacidosis (DKA)?

Your body needs the energy to function. On the cellular level, the fuel for the energy is glucose which we get from the food that we eat. The glucose is transported from blood to body cells using a hormone called insulin.

In a diabetic body, insulin isn’t available or isn’t able to function. So, glucose absorption doesn’t happen. As a result, glucose starts floating in the blood causing ‘high levels of sugar in the blood (high sugar). Plus, the body cells do not get the required glucose for energy.

So a diabetic body starts looking for another source of energy in the form of fats. However, when fats break down for energy, it produces a waste product i.e. an acid known as ketones. When it exceeds certain limits, it causes Diabetic Ketoacidosis.

The 3 ketone bodies formed are:

• Acetone
• Beta-hydroxy butane
• Acetoacetate

Let’s move on and discuss the causes and symptoms of Diabetic Ketoacidosis so that preventive measures or treatment can be taken on time.

Diabetic Ketoacidosis causes

As mentioned earlier, DKA is more commonly observed in patients with Type 1 diabetes rather than type 2 diabetes and here are some common Diabetic Ketoacidosis causes:

1. Uncontrolled diabetes
2. Missing meals or long gap between meals
3. Missing insulin dose
4. Patient on an insulin pump and non-functional insulin pump
5. High levels of stress.
6. Infection in the body that keeps coming back

To know how stress and diabetes are related, read our blog “Stress, meditation and diabetes”.

Diabetic Ketoacidosis symptoms

The symptoms of DKA spring up quickly. Sometimes, it can happen within 24 hours. If you’re seeing some of the following signs in a diabetic patient, you must see a doctor quickly.

1. Vomiting and pain in the abdomen: Ketones are acidic in nature. High levels of ketones make the blood acidic and as a result, causes vomiting. In some patients, it may also cause abdominal pain.
2. Dehydration, dry mouth (thirst) and frequent urination: With high levels of sugar and ketones, the body works extra to throw out excess glucose through urine. It results in the removal of too much water from the body.

In this case, the body absorbs water from cells to maintain water balance in the blood which causes cells to dehydrate. This in turn, makes the patient feel thirsty and tend to drink more water.

1. Rapid breathing or breathlessness: Whenever the blood becomes acidic, the lungs start inhaling air faster to get more oxygen. Since carbon dioxide causes an acidic state, breathing more oxygen can make it less acidic.
2. Fruity breath or acetone like smell from the mouth: With high levels of ketones, the breath smells like acetone (can be similar to nail paint remover) or pear-like.

Other severe complications can be developed such as increased heart rate (due to increased breathing) and confusion (due to lack of glucose in the brain).

If the cause of DKA is an infection, the patient may experience fever, chills, cough, and cold along with other symptoms.

What are the complications if it is left untreated?

If not treated at an early stage, DKA can be life-threatening as it can lead to:

1. Swelling in the brain: This can further lead to a severe complication known as diabetic coma.
2. Kidney Failure: With too much glucose in the blood, our body throws it out of the body through urine which leads to loss of sodium and potassium in the body and dehydration. Due to dehydration, blood flow to the kidney is decreased and leads to renal failure.
3. Heart Failure: Loss of sodium and potassium, dehydration, swelling and fast heartbeats put extra pressure on the heart and may cause cardiac arrest or heart attack.

Now that you know the basics of Diabetic Ketoacidosis, let’s see how it is diagnosed and what can be done to prevent and treat it…

How is Diabetic Ketoacidosis diagnosed?

Here are some ways to diagnose diabetic ketoacidosis quickly:

1. Urine test: When ketones in our blood rise, they are thrown out of the body through urine. Hence, a urine test will be able to detect the presence of ketones. If the urine report is showing “nil” that means it is a normal result.
2. Blood test: In a blood test, the amount of ketones are measured. Two common types of ketones produced by breaking down fats are “beta-hydroxy butane” and “acetoacetate”. If levels of these rises, their amount can be measured in the blood.

Normal blood ketone level is 0.21–2.81 mg/dl. More than this is high and it indicates management of diabetes and ketone levels.

The more the amount of ketones in the blood, the more severe is diabetic ketoacidosis.

1. Arterial blood gas: Arterial blood gas measures two components — blood pH & bicarbonate levels. In diabetic ketoacidosis, low bicarbonate levels and low pH (less than 7.3) is observed.
2. Electrolytes test: With extra glucose, our body throws it out through urine which leads to loss of sodium and potassium. Low sodium and potassium levels are used to confirm diabetic ketoacidosis.
3. Kidney function test: Due to dehydration, blood flow to the kidney is decreased and leads to acute renal failure which causes disturbed kidney function tests.

Who is at risk?

Following conditions increase the risk to develop diabetic ketoacidosis:

1. Type 1 diabetes: Patients with Type 1 Diabetes are more prone to develop diabetic ketoacidosis than patients with Type 2 Diabetes due to no insulin production.
2. History of heart disease or a history of heart attack
3. Pancreatitis (inflammation in the pancreas) or disease of the pancreas as it further impacts insulin production
4. Stroke
5. Alcohol intake or drug abuse
6. Certain medications

Can one prevent Diabetic Ketoacidosis?

Despite all the risks and complications, diabetic ketoacidosis can be avoided with certain measures and by taking good care of yourself. It’s important that you follow your diabetes treatment plan and ask your diabetes treatment team for help when you need it.

Follow these guidelines in order to prevent DKA:

1. Take your diabetes medicines as prescribed by your doctor. Avoid skipping it.
2. Eat small meals every 2–3 hours to manage blood sugar levels. Avoid long meal gaps.
3. Avoid all fried, outside, processed and packaged food.
4. Drink 10–12 glasses of water throughout the day.
5. Adjust your insulin units as per your blood sugar levels and keep your doctor updated.
6. Measure your sugar levels at home with a glucometer at least 2–3 times a week.
7. Talk to your doctor once every three months for a medicinal review.
8. If you are suffering from an infection, measure your sugar levels and if they are consistently high, consult your doctor.
9. Get regular tests done to know the status of other diseases that may be caused by diabetes.
10. Follow a healthy lifestyle that includes modifications in your diet and physical activity.

Diabetic Ketoacidosis treatment

Here are ways in which your doctor can choose diabetic ketoacidosis treatment for you, depending on the severity.

1. Fluid therapy: Since DKA causes water loss, it is important to maintain a good amount of water intake and hence, saline water is given through IV.
2. Management of blood sugar levels: Since DKA is caused by high sugar, insulin should be administered (when potassium levels rise above 3.3).
3. Potassium therapy: DKA causes hypokalemia which means low potassium levels and hence, potassium levels have to be maintained.
4. Bicarbonate therapy: DKA is associated with acidic blood, bicarbonate is given to restore the pH of the blood.

Eat healthy food without delaying or skipping, being physically active, taking medicines on time and lastly, managing stress levels will help in managing your blood sugar levels.

This, in turn, will help in preventing Diabetic Ketoacidosis and other complications of diabetes.

If you have high blood sugar levels, it is important for you to have proper diabetes treatment to improve your health and live a happy life. And Zyla provides you with exactly that.

Zyla offers holistic management of diabetes and its complications through a team of 50+ medical experts. We work on lifestyle management through nutrition, exercises and medicines review.

You can download the Zyla app now to start your health journey!

For more information, you can visit here

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