How Can I Prevent Diabetic Ketoacidosis
If you have diabetes, there are lots you can do to prevent diabetic ketoacidosis.
- Take control of your diabetes. Take your medicines, including insulin, as directed. Don’t skip insulin doses. If you think your insulin pen or pump may not be working properly, get it checked out.
- Be aware of how food and exercise affect your blood glucose levels.
- Be prepared work with your diabetes care provider to make a sick-day plan. Know how to manage your diabetes when you are unwell, such as what your target blood glucose level should be during an illness, how often to check your blood glucose and your ketone levels, how to adjust your insulin dose or timing and when to contact your doctor for help. Read more about having a diabetes sick day plan.
- Be careful when you start new medicines check with your doctor or pharmacist to find out if the medicines are safe for you to take.
What Are The Warning Signs Of Dka
DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following:
- Thirst or a very dry mouth
- Frequent urination
- High blood glucose levels
- High levels of ketones in the urine
Then, other symptoms appear:
- Constantly feeling tired
- Dry or flushed skin
- Nausea, vomiting, or abdominal pain. Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than two hours, contact your health care provider.
- Difficulty breathing
Diabetic Ketoacidosis: Not Always Due To Type 1 Diabetes
- Accepted 14 May 2013
This article discusses how to diagnose and manage patients with ketosis prone type 2 diabetes
Summary points
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Patients presenting with diabetic ketoacidosis may have type 1 or type 2 diabetes
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Diabetic ketoacidosis should be treated with insulin in accordance with nationally agreed guidance
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After treatment of diabetic ketoacidosis, patients found to have type 2 diabetes may not require lifelong insulin treatment
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Consider ketosis prone type 2 diabetes in older, overweight, non-white patients who present with diabetic ketoacidosis at their first presentation of diabetes this diagnosis is also a possibility in patients with any features that are atypical for type 1 diabetes
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Discharge all patients on insulin and arrange for specialist follow-up
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Under specialist supervision consider whether insulin can be down-titrated on the basis of clinical progress and, where possible, C peptide and antibody measurements
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What Can You Do To Prevent Or Slow Dka
First of all, be aware of the symptoms, if any. Our own DiabetesMine correspondent Wil Dubois, who landed in the hospital with DKA last year, writes:
The main symptoms of DKA that were told to watch for other than those associated with high blood sugar in the first place, like crazy thirst and peeing like a race horse are nausea or vomiting, abdominal pain, fruity-smelling breath, rapid breathing, and confusion.
Of course, you cant smell your own breath. If you are confused you probably dont know it. And most people arent aware of their respiration rate. So the main warning sign of impending DKA that all type 1s are taught to be alert for is the union of nausea and abdominal pain in the presence of high blood sugar. And I never had any. Nausea or pain, but clearly as my doctor noted, I was experiencing DKA.
If you know that you have missed a shot or are running low / rationing insulin, its a good idea to keep very close tabs on your blood sugar readings and keep ketone test strips handy.
For someone with established type 1 diabetes, if they really face a limitation of their insulin supply, dont let it run out completely! Stretch it out, encourages Inzucchi.
What’s The Difference Between Diabetic Ketoacidosis And Hyperglycemia
Hyperglycemia and diabetic ketoacidosis both happen when your body doesn’t have enough insulin or isn’t using the insulin it has properly.
The difference is that DKA is an acute complication, meaning it has a severe and sudden onset. While very high blood sugar is almost always a contributing factor to DKA, other conditions need to be present to have DKA, including ketones in your blood and/or urine. You can have high blood sugar without having ketones in your blood and/or urine.
Untreated high blood sugar can lead to DKA. This is why its important to treat high blood sugar with insulin as soon as possible.
Although its not as common, you can be in DKA even if your blood sugar is lower than 250 mg/dL. This is known as euglycemic diabetic ketoacidosis .
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Comparison Of Diabetic Ketoacidosis In Patients With Type
Background Diabetic ketoacidosis occurs most often in patients with type 1 diabetes, however patients with type 2 diabetes are also susceptible to DKA under stressful conditions. The aims of our study were to evaluate and compare the clinical and biochemical characteristics and outcomes of type 1 versus type 2 diabetes mellitus patients with DKA. Methods A retrospective cohort study of adult patients hospitalized with DKA between January 1, 2003, and January 1, 2010. The clinical and biochemical characteristics of DKA patients with type-1 DM were compared with those of patients with type-2 DM. The primary outcome was in-hospital all-cause mortality. Results The study cohort included 201 consecutive patients for whom the admission diagnosis was DKA: 166 patients with type-1 DM and 35 patients with type-2 DM. The patients with DKA and type-2 DM were significantly older than patients with type-1 DM . Significantly more patients with severe forms of DKA were seen in the group with type-2 DM . The total in-hospital mortality rate of patients with DKA was 4.5%. The primary outcome was significantly worse in the group of patients with type-2 DM. Conclusions DKA in patients with type-2 DM is a more severe disease with worse outcomes compared with type-1 DM. Advanced age, mechanical ventilation and bed-ridden state were independent predictors of 30-day mortality.Continue reading > >
What Can Patients Do To Prevent Dka
Keeping blood sugars in the normal range can help prevent DKA: 70-180 mg/dl is ideal. Risk of DKA increases substantially when blood glucose levels exceed 240 mg/dl. Sticking with healthy, regular eating patterns and taking medications at the right times are also critical for preventing DKA.
Its possible to check ketone levels with a simple, over-the-counter urine test strips or a ketone meter. Its a good idea to start checking ketone levels when blood glucose is over 240 mg/dl. Again, your healthcare provider can let you know when this is worth doing and what specific ketone levels would be a cause for concern.
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How To Recognize The Symptoms Of Dka In Type 2 Diabetes
It is important to understand that the symptoms of DKA in type 2 diabetes are somewhat different than the typical symptoms seen in type 1 diabetes. Type 2 diabetics are more dehydrated and less acidotic from DKA.
Here are the signs and symptoms of DKA in type 2 diabetes:
How Can I Prevent Dka
If you don’t have diabetes but are experiencing symptoms of diabetic ketoacidosis, call your healthcare provider immediately or go to the nearest emergency room. The only way to prevent more severe symptoms and side effects of DKA, in this case, is to seek medical attention and treatment.
If you already have diabetes, there are many things you can do to prevent diabetic ketoacidosis, including:
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How Do I Test For Ketones
Ketones are easy to test for. The best way is to use a blood ketone meter. If you have type 1 diabetes you can get a blood ketone meter and 2 boxes of ketone testing strips on prescription from your doctor. You can also test for ketones in your urine , but this is not as accurate because it reflects your ketone levels a few hours ago rather than right now. Monitoring blood ketones at home allows you to find out early if you are developing ketoacidosis, so that you can give yourself insulin and potentially prevent a trip to hospital.
What Causes Dka In Type 2 Diabetes
There are two main reasons why DKA sometimes occurs in type 2 diabetics:
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What Should I Do If My Ketones Are Raised
Whatever your ketone levels, it’s important to never stop taking your background insulin.
If your ketones are raised, adjust your insulin dose as outlined in your diabetes sick day plan. If you are unsure about how to adjust your insulin dose, contact your diabetes care provider or emergency service. Measure your blood glucose levels and ketone levels at frequent intervals, as outlined in your diabetes sick day plan. If they remain high, contact your GP, diabetes nurse, diabetes care provider or emergency health service. Diabetic ketoacidosis can quickly become life threatening, so it’s important to get medical help as soon as possible.
Who Gets Diabetic Ketoacidosis
Diabetic ketoacidosis is not just the hallmark of absolute insulin deficiency in type 1 diabetesit is increasingly being seen in people presenting with type 2 diabetes.12 This is at odds with traditional physiological teachingthat clinically significant ketosis does not occur in the presence of insulin concentrations associated with type 2 diabetes because there will always be sufficient insulin to suppress lipolysis .3 Current knowledge suggests that some people with type 2 diabetes may develop acute reductions in insulin production, which, coupled with insulin resistance, can cause DKA, usually without a precipitant.4 This is particularly so in African-Caribbean and other non-white ethnic groups.56 This potentially life threatening presentation of type 2 diabetes is referred to as ketosis prone type 2 diabetes . Clinicians should be aware of this variant of type 2 diabetes because observational studies in African-Caribbean people presenting with ketoacidosis indicate that 20-50% have type 2 diabetes.2
Fig 1 Physiological effects
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Faqs: Frequently Asked Questions
Can DKA recur?
Yes, DKA will happen whenever insulin levels are too low and not enough glucose is being produced to provide energy to your muscles and other tissues. If you miss a dose, underdose, or suffer from trauma or illness that depletes your insulin, DKA can recur.
Can DKA cause a heart attack or stroke?
Complications of DKA can include a heart attack or stroke because of the buildup of ketones in your body, so take it seriously and get emergency treatment as soon as you recognize the signs.
What causes a coma in DKA?
When blood-sugar levels become too low, triggering hypoglycemia, severe dehydration can then cause a diabetic coma.
How long does it take to recover from diabetic ketoacidosis?
Finally, some good news! Once youre safely admitted to the hospital for DKA, recovery is usually complete in one to three days.
What Are The Symptoms Of Dka
Beware the fruity breath. This tell-tale sign of diabetic ketoacidosis is caused by the body breaking down ketones, which become acetone which we then excrete through breathing. If you see someone whos breathing rapidly and their breath smells like fruit or a nail salon, they probably have DKA, says Dr. Klonoff.
Heavy breathing, known as Kussmaul breathing, is a reflex to try to bring up the pH that has gotten to be too low, according to Dr. Klonoff. Its named after Adolph Kussmaul, a German physician who first observed it in his patients with severe diabetes in 1874. You could be breathing really hard, and not even realize necessarily that youre doing it, Klonoff says.
Diabetic ketoacidosis affects the brain, making it work through what feels like mental sludge, according to Dr. Christofides. Confusion and irritability are major signs to watch out for.
As a result of your brain swelling, DKA can make you feel as if youre drunk and act just as irrationally. Ive seen situations where people have gotten into fights, or have become a risk to themselves physically, or had an intervention by law enforcement while driving because they appear to be acting drunk or are incoherent when stopped, says Dr. Christofides.
The main warning signs of DKA are:
- Heavy breathing
- Blurred vision
- High blood-sugar levels
The three Ps of DKA:
- Polydipsiathirst
- Polyuriaurination
- Polyphagiaappetite
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What Can You Do To Avoid Dka
You can help avoid DKA by monitoring your blood sugar levels regularly and altering your insulin dose in response to your blood sugar levels and what you eat.
Your blood sugar levels could be higher than normal when you are unwell. So, its a good idea to work with your healthcare team to come up with some sick day rules for when you are ill. You may need to drink more fluids, take more insulin and check your blood sugars more than you would usually. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you .
It is still a good idea to contact your GP or diabetes team if:
- You feel fine but are getting higher than usual readings for blood glucose and ketones.
- You feel unwell but your blood glucose and ketones are only slightly higher than normal.
“The experience has taught me that its so important to listen to your body. No matter how many HCPs you visit, whether theyre a GP or a diabetes specialist or a family friend who works in the field, you know your body and you know what feels right and what doesnt feel right. When it comes to diabetes, its so important to trust your instincts.” Amber, 21, had DKA
Symptoms Of Diabetic Ketoacidosis
- needing to pee more than usual
- feeling very thirsty
- breath that smells fruity
- deep or fast breathing
- confusion
- passing out
You can get DKA if you have high blood sugar and a high level of ketones in your blood or urine. You can check your ketone levels using a home-testing kit.
Symptoms usually start over a 24-hour period, but they can happen faster.
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Dka Signs And Symptoms
DKA usually develops slowly. Early symptoms include:
- Being very thirsty.
- Urinating a lot more than usual.
If untreated, more severe symptoms can appear quickly, such as:
- Fast, deep breathing.
- Nausea and vomiting.
- Stomach pain.
Sometimes DKA is the first sign of diabetes in people who havent yet been diagnosed.
What Happens When You Run Out Of Insulin
First, lets talk about the physical process that sets in when a person with diabetes does not get enough insulin into their body.
Very quickly, severe hyperglycemia sets in. That is high blood sugar that leads to a state called DKA, short for diabetic ketoacidosis, which untreated leads to death.
Basically whats doing on is this: insulin helps sugar enter the cells, which use it for fuel. Without insulin, the body cannot access enough sugar to function properly, so your liver begins to turns some of the body fat into acids called ketones. These build up in the bloodstream and spill over into the urine. When these excess ketones get into the blood, the blood becomes acidic, causing DKA: a combination of very high blood sugar, dehydration and shock, and exhaustion.
Symptoms are vomiting and hyperventilation, and eventually passing out and going into a coma. Without treatment, this leads to death.
Generally, the first signs of DKA show up once the blood glucose level has been north of 300 mg/dL for about four hours, but how quickly things get out of hand at that point is highly variable. Some people with diabetes feel ill immediately, while others can wander around in a daze for days.
If you have any residual insulin at all in your system, it can help hold off DKA even when your blood sugar level is high, according to Dr. Silvio Inzucchi, clinical director of the Yale Diabetes Center.
Hospitalizations for DKA are unfortunately on the rise in the United States.
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