Diabetic Ketoacidosis
What are ketones
When body can not use glucose as a fuel, fats are broken down and used as alternative fuel. Ketones are products of fat breakdown.
What is diabetic ketoacidosis (DKA)
When there is no insulin, blood sugars are high and body can not utilize glucose. Hence body produces ketones as alternative fuel. Combination of high sugar and excess ketones causes dehydration and built up of acid in the body. This can be dangerous as it can lead to coma and even can be life threatening. But with proper precautions this complication is preventable to a great extent.
Is it seen only in type 1 diabetics
Patients on insulin therapy (type 1 and some type 2) are at more risk of DKA, but it can also occur in diabetics on oral medications. It can be seen in type 2 diabetics even at the onset of the disease. So it is NOT exclusive only to type 1 diabetes.
Apart from diabetes, ketone production can occur in starvation, and sometimes in early morning urine of pregnant females.
What are the symptoms and signs of DKA?
Following symptoms can happen in DKA, if you notice any of these symptoms, check ketones and contact your doctor URGENTLY
- Vomiting, nausea
- Abdominal pain
- Breathing difficulty, air hunger, fast breathing
- Tiredness, fatigue
- Sweet/fruity odor of breath
- Excessive sleepiness, altered consciousness
- Excessive thirst, dry mouth
Risk factors
- Unrecognized diabetes
- Missing/stopping insulin
- Fever, infections
- Stressful periods (surgery, emotional stress, pregnancy, puberty)
- Very high blood glucose (>250-300 mg/dl) due to any other cause
How to check for ketones ?
Ketones can be checked in the urine or blood. Most commonly urine testing is done in India.
Checking urine ketones
- Strips are available for checking ketones in urine (URINE KETODIASTIX). They are different from the strips meant for checking urine sugar.
- Dip the strip into urine and take it out.
- After 15 seconds, match the color of the strip with ketones with the indicator given on the bottle.
- Read the result as nil or trace, small, moderate or large
- Contact your doctor urgently if ketones are positive (more dark purple is the color, more is the quantity of ketones)
- If your strips are very old, ketones may come falsely negative so if you have symptoms suggestive of DKA, contact doctor irrespective of the ketone test.
Blood ketones
Modern glucometers have function of testing blood ketones. Blood ketones become positive before urine ketones. So it can detect DKA at an earlier stage.
When to check for ketones?
- When you are ill. Ketones must be checked during illness even if your blood sugars are normal or low.
- When your sugars are high (>300 mg/dl)
- When you have nausea or vomiting or any other symptom suggestive of DKA
- When you are pregnant
- If you are on pump and you have suspended or discontinued the pump for more than 1- 1½ hour.
How to protect yourself from DKA
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Do not stop insulin.
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During the periods of infection or stress
- Drink plenty of non glucose containing fluid (water, butter milk, salted lemon water, tea without sugar
- Check your blood sugar frequently and take extra insulin as required
- Contact the doctor urgently if you have any symptoms suggestive of DKA or testing for ketones is positive.
What is the treatment ?
Urgent treatment is needed for this condition. Hospitalization is necessary in most of the cases for giving insulin intravenously and for giving intravenous saline.
