By dietcherry Latest Reply 2012-08-13 12:15:42 -0500
Started 2012-07-23 18:06:55 -0500

This serious complication, the result of acid buildup in the blood, can lead to coma or even death.

If you have type 1 diabetes, one of the serious complications you may face is a condition known as ketoacidosis. In diabetic ketoacidosis, acids called ketones build up in your blood and could eventually lead to diabetic coma or death.

But by vigilantly controlling your diabetes and watching for early signs of ketoacidosis, you can help prevent it from happening to you.

What Is Diabetic Ketoacidosis?
"When blood sugars get elevated and there is not enough insulin, your fat cells start to break down their storage sites of energy, which are called ketones," says Jay Cohen, MD, medical director of the Endocrine Clinic and clinical assistant professor in the department of family medicine at the University of Tennessee. Ketones are acidic, and that acid builds up in your blood.

Diabetic ketoacidosis is found more often in younger people than older people, and more often in women than in men. At least 20 percent of people learn they have diabetes after seeking medical care for complaints that turn out to be symptoms of ketoacidosis.

Common Causes of Diabetic Ketoacidosis
The three common causes of ketoacidosis are:
Not enough insulin. This can happen if you don’t inject enough insulin or if your insulin needs increase in response to an illness such as a cold or the flu. Blood glucose can’t be used for energy without enough insulin to help in the process, so the body breaks down fat for energy and high ketone levels result.
"Elevated blood sugars could be due to an infection or any other physical or emotional stress — good or bad," says Dr. Cohen. Unexpected increases in your blood glucose levels can increase your insulin needs. "You may have a certain amount of insulin that you usually use, but if you have an infection, you may need more insulin to help your body to improve blood sugars," Cohen explains.
Not enough food intake. If you don’t eat enough, your body has to break down fat for energy, producing high ketone levels. This is particularly common in people who are sick and don't feel like eating.
Low blood glucose levels. This situation can force your body to break down fat to use as energy, resulting in ketone production.

Diabetic Ketoacidosis Symptoms
Symptoms of ketoacidosis usually progress relatively slowly. But since diabetic ketoacidosis can be a life-threatening condition, it is important to seek medical help immediately if you experience any of its symptoms. These include:
Excessive thirst
Dry mouth
Frequent urination
Elevated blood glucose levels
Elevated ketones in the urine
Persistent fatigue
Skin that is dry or flushed
Nausea or vomiting
Pain in your abdomen
Shortness of breath
A fruity smell to your breath (the result of elevated ketone levels)
Inability to concentrate
Confused state

Preventing Diabetic Ketoacidosis
Ask your endocrinologist how you can reduce your risk of developing diabetic ketoacidosis. It is often a good idea to use a home dipstick test to check for ketones in your urine when your blood glucose levels are high (over 240 milligrams per deciliter) and when you have an infection.

Diabetes education also helps. One study found that hospital stays for ketoacidosis were reduced among a group of people who attended diabetes education classes.

Managing Diabetic Ketoacidosis
If think you may have ketoacidosis, it is essential to contact your doctor or get to the emergency room immediately.

"If we can catch it early, with medicine and IV fluids, we can stop the diabetic ketoacidosis from progressing to severe dehydration," says Cohen. "Diabetic ketoacidosis, if severe and not treated aggressively, has about a 5 percent death rate, so you really want to get a handle on it rapidly."

Remember that regularly monitoring your blood glucose levels, performing urine ketone tests as recommended, and recognizing symptoms that might indicate your ketone levels are high is the best approach to reducing your risk of diabetic ketoacidosis.

From Everyday Health

28 replies

Gem93 2012-08-13 11:55:19 -0500 Report

I recently had a friend that got DKA she only had ketones for a day and was bring violently sick she couldn't test for ketones as her strips were left at her uni campus and went home to visit her family for the weekend her mum was just about to leave to go get the strips when she said I don't feel well take me to hospital betime she got to hospital ( which is a 10 min drive from where she lives) her vains had short down and the only vain left was the one to her heart they had to cut her throat open to put in an insulin drip immediately and was put in intensive care her family was told she might not make it and that was from having ketone symptoms for just a few hours / day at the most .. This has woken me up to life alot Snd made me realise what can happen if you don't look after yourself

IronOre 2012-08-07 22:04:34 -0500 Report

What I have noticed is when blood sugars get above 320 is when ketones may get "spilled".
When that happens is takes me twice the amount of insulin to bring my level to acceptable levels than if it was just simply high.
In my situation I take one unit of insulin for every 40 (whatver the units are) above what I want the reading to be - But if ketones come into play I need two units for every 40 that I want it reduced by. Does that make sense?

Setzer 2012-07-25 12:13:51 -0500 Report

I've actually had to go to the hospital for this a few times. Hopefully the last time in 2005 was the last time. I had every symptom on that list and also uncontrollable shaking and a very intense lactic acid burn type feeling through my shoulders and an extremely elevated heart rate.

John 2012-07-24 11:23:38 -0500 Report

There is one cause of DKA: too little insulin. Insulin controls the storage and release of stored fat. If you have no insulin on board, your fat is free to burn off which it will, uncontrolled.

Eating too little, low blood glucose, or any other condition are not relevant. Non diabetics can last for days, weeks, even months with no food and show no signs of DKA. Ketogenic diets, where the primary fuel is fat, are growing in popularity, even here on DC. They've been used many years to treat epillepsy. Many diabetics test positive ketones daily on such diets, a target they strive for.

I eat a very low carb, high fat diet, and I routinely test positive for ketones. But I take a lot of insulin, and I do not burn my fat reserves uncontrolled. A1C 5.9.

The key here is control. With enough insulin present, you wil not burn fat uncontrolled. DKA is always accompanied by very high BGs.

Type1Lou 2012-07-24 08:56:03 -0500 Report

Thanks for this enlightening post Renee! It made me recall my one episode of DKA back in 1980. I had spent a vacation week skiing in Vermont and had caught a cold. I'd been diagnosed back in 1976 and had been trying to re-hydrate. I wound up driving to my Mom's, which was half-way to my home and my condition deteriorated causing a visit to the ER…they sent me home (don't recall if I mentioned I was diabetic)…well, I kept on getting worse, having trouble breathing and my Mom's neighbor drove me back to the ER where, I remember, they commented on the "fruity" smell of my breath. I was immediately admitted and spent several days in ICU…scared my Mom and me. Nothing I want to repeat.

dietcherry 2012-07-24 10:35:07 -0500 Report

It is an excellent article isnt it? I had DKA at 17 and I agree that you never want to experience it again!! You feel like youre dead without the benefits of actually BEING dead lol
I was a bit surprised that it only mentiions T1s getting this; I have to admit Im not sure, but cant T2s get it too? Or they can and its not as serious for them? Im non-plussed :(

jayabee52 2012-07-24 13:45:23 -0500 Report

All I can go by there is my admittedly limited experience. After I was divorced I wanted to find someone else and i was about 250 lbs. I heard that if I went into Ketosis I would lose weight without effort, so I deliberately decided to do (what I had learned later was called) "diabullemia". I tried to overwhelm my system with sweets and put myself into ketoacidosis. I was ignorant at the time of the dangers of DKA (that was years before I came on DiabeticConnect). However, the diabullemia didn't work as well as I had hoped and I only lost a few lbs. I suspect it was due to my pancreas was still producing insulin.

I do however believe my burning neuropathy and perhaps even my Kidney issues stem from that time of trying to cheat at losing weight.