Definition
Diabetic ketoacidosis is a high level of ketones in the blood. Ketone is an acid that is made when fat is broken down for fuel. A certain level of ketones is normal but excessive levels can make you very sick.
Ketoacidosis is a serious condition that can lead to coma or death if not treated.
Causes
Glucose is the most common source of fuel for the body. A hormone called insulin helps the body use glucose. If insulin is low or missing, the body cannot use glucose for fuel. Fat is used as the main source of fuel in place of glucose. The increased use of fat creates a toxic level of ketones in the blood. Ketones that are high in the blood will also spill over into the urine.
This situation is most often cause by type 1 diabetes and sometimes type 2 diabetes.
Risk Factors
Factors that may increase your risk of ketoacidosis include have diabetes (type 1 or 2) and:
- New infection that may not be obvious such as pneumonia , urinary tract infection , sepsis
- Not taking insulin as prescribed or not taking enough insulin at all
- New heart disease such as heart attack
- Recent stroke
- Pregnancy
- Surgery
- Recreational drug use such as cocaine
- Blood clot to the lungs
Symptoms
Symptoms of ketoacidosis may include:
- High blood glucose levels (greater than 250 mg per dL)
- Dry mouth and skin
- Thirst
- Urinating often
Call for emergency medical help or have someone take you to the nearest emergency room if you have:
- Drowsiness
- Vomiting and nausea
- Severe stomach pain
- Trouble breathing
- Fruity breath odor
- Rapid pulse
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. A urine test will be done to look for the presence of ketones. Blood tests will also be done to:
- Look for ketones
- Measure blood glucose level
- Check pH levels of the blood
Treatment
Ketoacidosis is treated with insulin and fluids.
Insulin may be given by IV or injections. The insulin will immediately start reversing the cycle causing ketoacidosis. The insulin will let the body use glucose for fuel again. Fat will not be needed for fuel so new ketones will not be made. The body will then be able to get rid of the extra ketones.
Fluids and electrolytes will also be given through IV. Fluids will help flush the ketones from your body. Electrolytes will help your blood restore balance.
Prevention
You and your doctor will make a plan to manage your diabetes. These steps will also reduce the chance of ketoacidosis. Steps may include:
- Take your insulin as recommended. Always have insulin available. Plan ahead for refills.
- Monitor your blood glucose level as recommended, generally at least 3-4 times per day. Monitor more often when you are sick or you have high blood glucose levels.
- Check for ketones in your urine if you have a high blood glucose reading or are ill.
- Create a sick day plan that may include changes in insulin dose and what to do if you are having trouble eating.
- See your doctor if you have infection, cough, sore throat, or pain when you urinate.
If your blood glucose is high and you have moderate amounts of ketones in your urine:
- Contact your doctor.
- Increase your insulin as recommended.
- Eat foods that are low in carbohydrates.
- Drink plenty of fluids (sugar-free and caffeine-free).
- Do not exercise until your glucose is in balance again.