What is diabetic ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a condition that occurs when blood sugars become elevated (over 249 mg/dl, or 13.9 mmol/l) over a period of time and the body begins to burn fat for energy, resulting in ketone bodies in the blood or urine (a phenomenon called ketosis). A variety of factors can cause hyperglycemia (high blood glucose), including failure to take medication or insulin, stress, dietary changes without medication adjustments, eating disorders and injury or illness. This last cause is important, because if illness brings on DKA, it may slip by unnoticed since its symptoms can mimic the flu (aches, vomiting, etc.). In fact, people with type 1 diabetes are often seeking help for the flu-like symptoms of DKA when they first receive their diagnosis.

The symptoms of diabetic ketoacidosis may include:
  • fruity (acetone) breath
  • nausea and/or vomiting
  • abdominal pain
  • dry, warm skin
  • confusion
  • fatigue
  • breathing problems
  • excessive thirst
  • frequent urination
  • in extreme cases, loss of consciousness
Diabetic ketoacidosis, also called DKA, occurs when you don’t have enough insulin. It is mostly a problem for people with type 1 diabetes. A person with diabetes may have such low levels of insulin that his or her liver may produce unchecked levels of glucose and ketones, especially during illness or stress. It can occur in people with type 1 diabetes who have not yet been diagnosed.

Diabetic ketoacidosis can start innocently enough; you miss a dose of insulin, the insulin you’ve been using has gone bad, or your insulin pump tubing gets blocked. The lack of insulin leads to an undetected high blood glucose level, which can progress to a coma, shock, pneumonia, difficulty breathing, and even death.

Diabetic ketoacidosis can occur during periods of stress or illness, when the body releases hormones that promote the release of stored glucose and block the effects of insulin. Sometimes when you are sick and can’t eat, you may think, “I shouldn’t take insulin today.” But your body still needs insulin to cover its 24-hour insulin needs, even if you aren’t eating. Plus, you are likely producing extra glucose. So, in addition to your usual dose of insulin, you may actually need extra insulin. Drinking plenty of fluids will also help. Talk with your health care providers ahead of time about a plan of action for dealing with ketoacidosis and how to prevent it when you are stressed or ill.
William Lee Dubois
Endocrinology Diabetes & Metabolism
Ketoacidosis, or DKA for short, is a form of coma that generally happens to Type1 Diabetics when the blood sugar is too high for too long, and there is little or no insulin in the body. It’s frequently the “presenting event” that leads to diagnosis of Type-1.

Untreated, DKA is fatal.

What’s happening is that your cells are starving in a sea of plenty. Even though you are chock full to the gills with sugar, in the absence of insulin, none of the sugar can get to the hungry cells. They start eating their shoe leather and… no wait… that’s castaways. The cells start eating fat instead of sugar, and like the smoke from a camp fire, the burning of fat creates a toxic waste called ketones. Ketones shift the pH of the blood, making it more acid.

Those of us who use insulin pumps are more at risk from DKA because we don’t use basal insulin, those specially formulated insulins that time-release over 24 hours. We get our basal needs covered by a constant drip of fast-acting insulin from the pump. If the pump fails or the cannula gets pulled out somehow the fast-acting insulin is totally gone from the body in four hours and ketones start to build up.

The bottom line is that if your blood sugar has been above 300 for a number of hours and you feel sick to your stomach, a trip to the ER is indicated.
The Born-Again Diabetic: The handbook to help you get your diabetes in control (again)

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The Born-Again Diabetic: The handbook to help you get your diabetes in control (again)

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.