Diabetic Ketoacidosis: A Complete Guide For Individuals With Diabetes

Everything you need to know about the causes, progression, and treatment of this dangerous complication of hyperglycemia

From the second a person gets diagnosed with diabetes, doctors tell them to watch their symptoms and to ensure they are on track with therapy. This is because there is a chance things could look grim for their health if their disease progresses into serious complications. 

Diabetic ketoacidosis (DKA) is one such nightmare for people with diabetes and doctors alike. Often acute, it is a state of metabolic dysregulation that changes your blood biochemistry. If you have diabetes, you must know all the necessary information to protect your health from jeopardy. We have answered all the vital questions about DKA below to help you out.

What Exactly Happens In Diabetic Ketoacidosis?

Your cells typically absorb and utilize sugar as a source of energy. The blood carries this glucose sugar around the body, aided by a hormone called insulin. In diabetes, this glucose-insulin axis gets deranged.

Diabetic ketoacidosis is marked by three significant metabolic abnormalities in one's body fluids, especially blood and urine:

• High Glucose Levels: Because of insulin inadequacy, glucose doesn't get to your cells and accumulates in your blood, resulting in a state of hyperglycemia. It also gets secreted in your urine.

• High Ketone Levels: When glucose is unavailable for energy consumption, your body goes into starvation mode. It starts breaking down fats to make up for this sugar deficit. There is the conversion of lipids into chemicals called ketones, the levels of which rise in one's blood and urine, which is known as ketosis.

• High Acid Levels: Ketones are acidic in nature, and their accumulation results in a low pH, acidic environment in your blood. Not just this, it increases the load on your kidneys and further disturbs your body's delicate acid-base balance, resulting in metabolic acidosis.

Why Is Diabetic Ketoacidosis Life Threatening?

A lot of times, DKA goes unnoticed for days or weeks. In many cases, diabetic ketoacidosis is the first sign of disease that shows up. Many of these cases are children who have type 1 diabetes. A century ago, many of the deaths caused by type 1 diabetes occurred through this same cycle.

Since your entire body's equilibrium gets disturbed by metabolic malfunction, all systems show marked effects. Some of these complications are:

• Cerebral oedema, where fluid builds up in your brain

• Cardiac arrest (your heart's functioning comes to a halt)

• Your kidneys could stop functioning, and acute renal failure could set in  

• Fluid accumulation around the lungs 

• A number of electrolyte imbalances that can cause a variety of life-threatening effects across your body

Katie Lesley, who lost her brother to diabetic ketoacidosis before her wedding, bravely narrates her family's struggles with the possible complications of this horrible state. He was a person with diabetes who had caught an infection, the symptoms of DKA had quietly crept in, and by the time help arrived, it was simply too late.

What Does Diabetic Ketoacidosis Feel Like?

Many of these symptoms are general complaints that not people with diabetes can feel from time to time. It is, therefore, necessary to closely monitor your health issues and your home blood tests. The more serious signs and symptoms include:

• Severe abdominal pain

• Breathing issues

• Drowsiness

• Vomiting and nausea

• Fruity breath odour

• Fast pulse

• Headache

Perhaps the most characteristic symptoms are the presence of a ketonic, fruity breath and characteristically laboured breathing (Kussmaul breathing), which can help you differentiate between DKA and other signs of diabetes.

Who Is At Risk For Diabetic Ketoacidosis?

You could be at substantial risk for diabetic ketoacidosis if you have the following risk factors:

• The most significant risk factor for individuals diagnosed with diabetes (especially diabetes type 1) is noncompliance with insulin therapy and improper disease management.

• Undiagnosed type 1 diabetes (often in children) exhibits diabetic ketoacidosis

• Stomach problems (including infections) make a person vomit and can precede DKA

• Many cases of diabetic ketoacidosis occur after a person has contracted some infection, e.g. pneumonia

• Cardiovascular issues like heart disease, stroke or clots in different organs can make a person with diabetes more susceptible to developing a state of DKA

• Pregnant women are more at risk for diabetic ketoacidosis

• Certain medicines, such as steroids or antipsychotics, as well as recreational drugs like cocaine, may make a person more prone to DKA

• Even though it's mostly people with type 1 diabetes who are at risk for ketoacidosis, the hospitalization rates are also increasing in people with type 2 diabetes

How To Know If Someone Has Diabetic Ketoacidosis?

If you suspect you have diabetic ketoacidosis:

• Check your blood glucose levels. 

• In case the value is 240 mg/dL or above, get an over-the-counter urine testing kit to check for the occurrence of ketones in your urine. 

• Similarly, several gadgets can also help you monitor the number of ketones in your blood.

These tests can be done by yourself as well as a doctor during the diagnosis of diabetic ketoacidosis.

In addition to blood tests, if you go to a patient-care setting (we highly recommend that you do), your doctor will analyze the following:

• The gases in your blood 

• Any samples that could indicate you've had a prior infection

• Your ECG results to see if your heart is working fine 

If you think someone else might be in diabetic ketoacidosis, you can look for the main signs by checking if they have fruity breath or deep laboured breathing. 

Is Diabetic Ketoacidosis Curable?

Luckily, despite its seriousness, diabetic ketoacidosis is treatable, and over 90% of people survive and live fulfilling lives after recovery. However, this is only achievable if the patient or someone near them notices their deteriorating health early on and medical intervention occurs as early as possible. The treatment and management of diabetic ketoacidosis usually consist of:

• Since it is mostly the more severe symptoms of diabetic ketoacidosis that make people reach out for help, hospital stays are generally required to manage them.

• Once admitted, the hospital staff closely monitors the patients and repeatedly checks their blood and urine to observe their condition. 

• If you have DKA, insulin administration is your best bet for recovery as early as possible. This way, your body can finally start using glucose as an energy source again, reversing the metabolic abnormalities of the biochemical imbalance.

• Since the patient is dehydrated and has lost vital body minerals, supportive care also helps relieve some of the symptoms.

How Can I Prevent Diabetic Ketoacidosis If I Have Diabetes?

Most patients who follow their doctor's advice entirely and make healthy modifications to their life will never develop diabetic ketoacidosis. Neither will you if you ensure the following preventive measures against DKA:

• Don't miss your insulin shots: Always stay on track with your insulin therapy. Since most diagnosed patients develop diabetic ketoacidosis after routinely missing their shots, it is best to always have additional refills with you.

• Check your blood sugar levels 3-4 times a day: Monitoring your blood glucose levels can help you be cautious of any hyperglycemic abnormalities as soon as they pop up.

• Stay hydrated: Drinking sufficient water is crucial for people with diabetes as this helps them eliminate excess sugar through their urine, thus lowering the amount of glucose in their blood.

• Don't skip meals: Ensure you are eating enough even when you don't feel like it so that a consistent nutritional intake works with your insulin shots to maintain stable blood sugar levels.

• Ketone levels: If you notice any remarkable rise in your blood sugar levels, start monitoring the ketone body levels in your body fluids.

• Get a wearable: All of these tasks can be hard to keep track of and manage daily. Wearable accessories make life much easier. In fact, we've got a much-loved collection of such gear for your comfort. Don't forget to browse! 

Conclusion: Don't Let DKA Land You In The ICU

Even with a hospital stay, people in developed countries mostly survive diabetic ketoacidosis and return to everyday life after a few weeks. However, the experience is definitely not something you want to experience, ever.

So, if you think you or somebody around you who has diabetes is entering a state of ketoacidosis, you must act promptly. Alerting your doctor or walking into an emergency room will help you control the disorder before it gets too late.

Frequently Asked Questions (FAQs)

How fast can someone recover from diabetic ketoacidosis?

Most patients who have diabetic ketoacidosis can recover from the symptoms within a day of proper medical care. It does take them some more time to return to routine, however.

What are the two main triggers for diabetic ketoacidosis?

Illness, which makes a person not eat much and thus causes a drop in their blood sugar levels, and missing insulin shots are usually the main triggers for diabetic ketoacidosis.

What organs are affected by diabetic ketoacidosis?

Diabetic ketoacidosis can affect multiple organs, including the heart, blood vessels, brain and kidneys. If left untreated, it can rapidly progress to multi-organ failure.