Diabetes ketoacidosis is a very serious condition that can lead to diabetic coma or even death. It typically happens in type 1 diabetes, but on rare occasions happens in type 2. In type 1 diabetes, the body either doesn’t produce insulin or does not produce enough insulin for the body to function properly. Without the needed insulin, cells can’t get the glucose, or sugar, they need to create energy for the body. Therefore, the body begins to burn fat for energy. This produces a byproduct called ketones. When ketones, which are acids, build up in the bloodstream they poison the body and this causes diabetes ketoacidosis.

Luckily, over-the-counter test strips can be bought to see if ketone levels are high in your urine. Experts suggest that you check your urine anytime you blood glucose level is higher than 240 mg/dL or anytime you are sick. According to Diabetes.org, the warning signs of diabetes ketoacidosis include:

  • Thirst or very dry mouth
  • Frequent urination
  • Fatigue
  • Dry or flushed skin
  • Nausea, vomiting, or abdominal pain
  • Difficulty breathing
  • Confusion or difficulty paying attention

 

Diabetes Ketoacidosis Treatment

 

Treatment for diabetes with ketoacidosis typically begins in the emergency room as it is a severely dangerous state to be in. You may even be admitted into the hospital. Diabetes and ketoacidosis treatment usually has three elements. They are:

  1. Fluid replacement –Whether orally or intravenously (through the vein) you will receive fluids until you are rehydrated. This is because excess amount of sugar in the bloodstream tends to dehydrate a person. Many people with ketoacidosis diabetes symptoms are dehydrated from urinating more frequently than usual as well.
  2. Electrolyte replacement – When a person has ketoacidosis in diabetes, the absence of insulin causes your electrolytes to become too low. Electrolytes are minerals in the blood, such as sodium, potassium, and chloride, which carry an electric charge. They are important because they help your heart, muscles, and nerve cells to function normally.
  3. Insulin therapy – Most of the time in this treatment insulin will need to be given intravenously to reverse the diabetes ketoacidosis process. When your blood is no longer acidic and your blood sugar falls below 240 mg/dL the emergency treatment will come to an end and you will begin taking your insulin as you usuallywould again. Further treatment may be administered even after your blood sugar and ketone levels come back to normal. A doctor will decide if any additional treatment is needed.

 

Diabetes Ketoacidosis Pathophysiology

 

Anaesthetist.com describes the pathophysiology of diabetic ketoacidosis (DKA) as follows:

“Ketoacidosis is an extension of normal physiological mechanisms that compensate for starvation. Normally, in the fasting state the body changes from metabolism based on carbohydrate, to fat oxidation. Free fatty acids are produced in adipocytes, and transported to the liver bound to albumin. There they are broken down into acetate, and then turned into ketoacids (acetoacetate and beta-hydroxybutyrate). The ketoacids are then exported from the liver to the peripheral tissues (notably brain and muscle) where they can be oxidized….DKA represents the derangement of the above mechanism. Despite vast amounts of circulating glucose, this carbohydrate cannot be used owing to lack of insulin. Ketogenic pathways are maximally “turned on”, supply of ketones exceeds peripheral utilization, and ketosis results.”