Diabetic Ketoacidosis: A life-threatening emergency

Jan 06, 2019 Dr Zulfikar Bux, Features / Columnists

By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Diabetic ketoacidosis (DKA) is a medical emergency in diabetics that has a very high death rate if left untreated. It occurs when their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly.
DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it’s important to be aware of the risk and know what to do if DKA occurs.
WHAT ARE THE
SYMPTOMS OF DKA?
DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually:
· excessive thirst
· dry mouth
· frequent urination.
The next stage of DKA symptoms include:
· vomiting
· abdominal pain
· diarrhea
· trouble breathing
· confusion or trouble concentrating
· loss of appetite
· weakness and fatigue
· a fruity odour on the breath.
WHAT CAUSES DKA?
The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration).
DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes.
HOW IS DKA
DIAGNOSED?
If you think you may have diabetic ketoacidosis, contact your doctor immediately. He or she will want to run some blood tests before giving you an official diagnosis. These tests include checking your blood sugar and ketone level. Your doctor may also order a urinalysis and chest X-ray.
CAN DKA BE PREVENTED OR AVOIDED?
When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels closely when they are more than 250 mg per dL. When you’re sick or stressed, you should check your blood sugar level more often than normal (sometimes every 3 to 4 hours). If your blood sugar reaches a critical level, check it every 1 to 2 hours. Ask your doctor if you should test your blood sugar level during the night. You should talk to your doctor to develop a plan if your blood sugar level gets too high. Make sure that you know how to reach your doctor in an emergency.
HOW IS DKA TREATED?
DKA causes excessive urination. This means you will urinate more than usual. You can become dehydrated and your body can lose electrolytes (minerals in your blood that help your body function). If you are diagnosed with DKA, your doctor will most likely treat you with fluids or saline. These fluids will contain electrolytes and insulin. Fluids can help rehydrate you and dilute some of the sugar in your blood. Electrolytes will help your body function normally. Insulin will help lower your blood sugar level.
ARE THERE STEPS I CAN TAKE TO DECREASE MY RISK?
Keeping the balance between blood sugar and insulin is the key to controlling diabetic ketoacidosis. In most cases, this means sticking to your insulin schedule
. But you may need to adjust the amount of insulin you are taking. You should also try to recognize when you feel stressed or sick. Small adjustments to your eating or drinking can make a big difference.
When you’re sick, drink lots of sugar-free, caffeine-free liquids. Sip small amounts every few minutes if you are feeling sick to your stomach. If your blood sugar level is more than 250 mg per dL, avoid foods that are high in carbohydrates. These little adjustments can mean the difference between life and death.

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