Diabetic Ketoacidosis

Overview

For type 1 diabetics and some type 2 diabetics who are not producing enough insulin, periods of high blood sugars can be lethal when they lead to diabetic ketoacidosis (DKA). Type 1 diabetics are at a higher risk because their pancreas produces no insulin while type 2 diabetics are usually able to make some of their own. Those who are not diabetic are not at risk for DKA, though it can develop in people who are unaware they have type 1 diabetes.

High levels of glucose combined with an absence of insulin allows for blood to slowly become acidic. This acidity is dangerous for cells and causes the liver to secrete even more glucose in an effort to supply them with energy. When combined with dehydration, this process accelerates into a poisonous cocktail that undermines the heart, impairs the brain, and can lead to death in days.

Accuracy in measuring your level of ketosis is important to monitor early warning signs of DKA. We strongly recommend using a blood meter to monitor your ketones as urine strips and breathalyzers are often highly inaccurate and readings can be influenced by a number of factors. Without using a blood meter, it can be easy to miss early signs of DKA and the danger can escalate quickly.

Symptoms

DKA can develop slowly or quickly. If ketones are above 8.0 mmol/l (80 mg/dl) or your blood sugar levels are above 13.9 mmol/l (249 mg/dl) but you are symptom-free, call your doctor. If symptoms develop, check your blood ketones and call your doctor or go the the emergency room.  

The progression of symptoms first mimics those of high blood sugar:

  • Thirstiness;

  • Dry mouth;

  • And frequent urination.

If your body still doesn’t get the insulin it needs, your blood becomes more acidic:

  • Loss of energy;

  • Dry, warm skin;

  • Aches similar to those of a high fever.

When any of the following symptoms occur, your condition has likely progressed to DKA and is very serious:

  • Nausea, dizziness, vomiting, or abdominal pain;

  • A fruity or sweet odor on your breath;

  • Confusion or trouble concentrating;

  • Deep and labored breathing.

Causes

DKA occurs when, due to a lack of insulin, blood sugar levels become elevated (over 249 mg/dl or 13.9 mmol/l) over a period of time and the body begins to burn fat for energy, resulting in ketone bodies in the blood or urine. High levels of blood sugar, called hyperglycemia, can be caused by a variety of factors, including:

  • Failure to take medication or insulin;

  • Stress;

  • Dietary changes without medication adjustments;

  • Eating disorders;

  • Illness or injury.

If illness brings on DKA, it may slip by unnoticed as its symptoms can seem flu-like with aches and vomiting. In fact, people with type 1 diabetes are often seeking help for these symptoms when they first receive their diagnosis.

Please remember that DKA is a potentially life-threatening condition. If you think that you may have it, call your doctor immediately or go to the emergency room. Treatment for DKA involves administering insulin to lower blood glucose levels and restoring fluid balance or electrolytes to the bloodstream with an intravenous saline drip.