Insulin Therapy And Metabolic Treatment Targets
A fixed rate intravenous insulin infusion calculated on 0.1 units/kg infusion is recommended. Patient demographics are changing and patients with DKA are now more likely to be obese or suffering with other insulin-resistant states, including pregnancy. This has led to the re-emergence of FRIVII in adults in the USA and international paediatric practice.1113 The FRIVII may need to be adjusted the recommended targets are:
- reduction of the blood ketone concentration by 0.5 mmol/l/hour
- if ketone meter not available, the venous bicarbonate should rise by 3 mmol/l/hour and capillary blood glucose fall by 3 mmol/l/hour
- potassium should be maintained between 4.0 and 5.0 mmol/l.
What Are The Side Effects Of Dka Treatment
One of the goals of diabetes-related ketoacidosis treatment is to lower blood sugar levels into an acceptable range. Your body needs insulin to decrease blood sugar levels. Sometimes, too much insulin can cause low blood sugar . If this happens and you’re treating your DKA from home, youll need to treat the low blood sugar by consuming sugar or carbohydrates per your healthcare providers instructions. If you are in the hospital for DKA treatment, your healthcare team will give you glucose to treat your low blood sugar.
What Are The Causes Of Diabetic Ketoacidosis
Diabetic ketoacidosis usually happens to people with type 1 diabetes. It is triggered by low insulin levels, most often caused by one of the following:
- Missed doses of insulin.
- Insulin not being given correctly. This may be because of problems with your insulin pen, insulin cartridge or insulin pump.
- An illness or hormonal change. Insulin in your body may not work well if you have an infection such as gastroenteritis , urinary tract infection, a chest infection or skin infection, or if you have stress or are pregnant. This is due to your body producing higher levels of other hormones, such as adrenaline or cortisol, which reduce the effect of insulin.
- An injury or surgery.
People with type 2 diabetes are at risk if they are taking empagliflozin.
Other causes include:
- alcohol or drug abuse, in particular, cocaine
- certain medicines, such as corticosteroids and some diuretics.
Sometimes there is no obvious cause.
Don’t Miss: 3 Hour Glucose Test Pregnant
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
What Are The Symptoms And Signs Of Dka
Its important to remember these signs of DKA, especially if you have diabetes or if you or your child are at risk for developing Type 1 diabetes.
Early symptoms of DKA can include:
- Peeing more often than usual .
- Extreme thirst.
- Feeling very tired or weak.
- Feeling disoriented or confused.
If you have any of these symptoms, call your healthcare provider immediately or go to the nearest emergency room.
Recommended Reading: Can Blurry Vision From Diabetes Be Reversed
What Do My Results Mean
A urine test will show that you have:
- 1.0 – 3.0 = moderately high
- Higher than 3.0 = very high
Write down your results on a chart or in a journal. Then you can track your levels over time.
Slightly high levels could mean that ketones have started to build up in your body. You might have missed an insulin shot. Take it as soon as you can and check again in a few hours.
Moderate to high levels mean you might have DKA. Call your doctor or go to the emergency room right away if they are very high.
Your Body Is Struggling With A Severe Illness Or Infection
While the common cold might cause a small number of ketones, it isnt likely going to put you into DKA. However, the flu or a serious infection can create so much stress within your body that moderate to large ketones develop.
Any time a person with diabetes becomes sick especially someone who takes insulin it is critical that you communicate with your healthcare team to adjust your insulin needs. Illness can require more overall insulin while your body fights whatever youre sick with. And infections left untreated can become life-threatening or threaten the wellbeing of an entire limb if ignored.
Recommended Reading: Dexcom G6 Transmitter For Continuous Glucose Each Stt-oe-002
Hyperglycemia And Ketoacidosis: Causes And Symptoms
Hyperglycemia and ketoacidosis may be caused by too little insulin or they may be caused by other factors such as illness, stress, or poor eating or drinking habits. Its important to know what to look for to keep your child healthy and safe:
Symptoms of hyperglycemia include:
- Ketones are shown to be present with testing
- Nausea and/or vomiting
- Fruity/medicine breath
- Deep rapid breathing
Can I Get Rid Of Diabetes
The exact cause of insulin resistance in prediabetes and Type 2 diabetes is uncertain but a major contributing factor is too much body fat, especially deep belly fat located beneath the layer of abdominal muscles. Therefore, step one is to engage in responsible weight management. Unfortunately, for the millions of afflicted Americans, when the choice is to either lose body fat or take a pill, the pill almost always wins. But taking a pill only addresses the symptoms of excess glucose in the blood and doesnt solve the problem.
Reducing body fat is a long-range approach because fat stores a highly concentrated amount of energy, with a whopping 3,500 calories per pound. This means, all things being equal, you have to walk briskly about 35 to 40 miles to lose one pound of fat. And ironically, if you did that, and walked all those miles to a fast-food restaurant, you could immediately replace nearly half of the calories you expended in one sitting .
You may likeIs red meat bad for you? Here are 4 things to know about how much red meat is healthy
Read Also: Dry Fruits For Diabetic Patients
How Many People In The Us Have Prediabetes
Currently, it is estimated that one in three adult Americans has prediabetes, and one in 10 has Type 2 diabetes. However, since prediabetes is likely to progress in severity over the years, morphing into Type 2 diabetes, the projection is for the incidence of Type 2 diabetes to double in the not-too-distant future.
Wow! Thats really bad news for our healthcare system.
Why is diabetes so devastating? When there is excess blood glucose for a prolonged period of time, it prevents blood vessels from being able to relax and expand . This can lead to high blood pressure, plus it reduces blood flow through vessels, denying oxygen to tissues, resulting in damage and possibly death. Amputation of the toes, feet and lower leg are examples of the progression of denying oxygen. Another example is the destruction of tissues in the eye, leading to blindness.
You may likeDoes showing gratitude make you healthier? Thankfully, research says yes. Here’s how.
Symptoms Of Diabetic Ketoacidosis
- needing to pee more than usual
- feeling very thirsty
- breath that smells fruity
- deep or fast breathing
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.
Also Check: How Do You Know If You Have Gestational Diabetes
How To Check For Ketones
Either a blood test or a urine test can check for ketones. The American Diabetes Association recommends that doctors use a blood test. Blood ketone testing equipment also is available for home use.
Why test blood rather than urine? First of all, because ketones enter the bloodstream first and then travel to the urine, ketones can be measured earlier in the blood. In addition, there are three types of ketones: acetoacetic acid, acetone, and beta-hydroxybutyric acid. Urine ketone strips measure only acetoacetic acid and acetone, while blood ketone tests measure b-OHB, the strongest and most prevalent acid in DKA, according to the 2004 ADA position paper Hyperglycemic Crises in Diabetes.
Among people who are accustomed to checking their blood glucose, measuring blood ketones is widely accepted, according to a study published in the March 2006 issue of the British journal, Diabetic Medicine. In the study, 123 people 3 to 22 years old and their families were educated on sick-day care. Some were then given a meter that can measure blood ketones, and others were given urine ketone strips. While more than 90% of the subjects reported checking for blood ketones during illnesses, stress, or when blood glucose was elevated, only slightly more than 61% measured ketones in their urine. Hospital visits among those who checked for blood ketones were nearly half that of those who checked for urine ketones.
Can You Get Ketones With A Normal Or Low Blood Sugar
Ketones can also be present when your blood sugar is normal or low. These are sometimes referred to as starvation ketones or nutritional ketones. During an illness or extreme diet change, if you have a significant decrease in carb intake, this can lead to the body using fat for energy because there are not enough carbs present to burn. Your blood sugar could remain normal or even be low in this case but your body could still be producing ketones.
Don’t Miss: New Injectable Medication For Type 2 Diabetes
Type 1 Vs Type 2 Diabetes: What Is The Difference
To avoid confusion, let’s consider Type 1 vs. Type 2 diabetes. In both cases, blood glucose levels are much too high, but for different reasons. Insulin resistance is the cause of elevated glucose levels in Type 2 diabetes, in approximately 90-95% of all cases. Ample insulin is produced and released, but it is not effective.
In contrast, only approximately 5-10% of diabetics are Type 1. In Type 1 diabetes, the pancreas gland is damaged and cannot produce and release insulin, so insulin resistance is not the problem. Lack of insulin in Type 1 means you must take insulin shots every day.
You may likeWhat is intermittent fasting and can it boost testosterone levels? Here’s what to know
Causes Of Diabetic Ketoacidosis
Diabetic ketoacidosis occurs when your body doesn’t produce enough insulin. Diabetic ketoacidosis most often affects people with type 1 diabetes, but can also occur with type 2 diabetes. Without insulin, sugar can’t be stored in your cells to be used as energy and builds up in your blood instead. Your body has to go to a backup energy system: fat. In the process of breaking down fat for energy, your body releases fatty acids and acids called ketones.
Ketones are an alternative form of energy for the body, and just having them in your blood isn’t necessarily harmful. Ketosis can happen when you go on a low-carb diet or even after fasting overnight.
“When I put people on a restricted diet, I can get an estimate of how vigorously they’re pursuing it by the presence of ketones in the urine,” said Gerald Bernstein, MD, an endocrinologist and coordinator of the Friedman Diabetes Program at Lenox Hill Hospital in New York City.
But too many ketones are a problem. “In individuals with diabetes who have no or low insulin production, there is an overproduction of ketones, and the kidneys can’t get rid of them fast enough,” said Dr. Zonszein. “Diabetic ketoacidosis occurs when so many ketones build up in the blood that it becomes acidic.”
In people with type 1 diabetes, diabetic ketoacidosis can be caused by skipping insulin either on purpose or accidentally . Diabetic ketoacidosis can also be caused by illnesses, namely pneumonia, and urinary tract infections.
Read Also: Do You Give Insulin If Blood Sugar Is Low
How Can I Prevent Dka
If you don’t have diabetes but are experiencing symptoms of diabetes-related 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 diabetes-related ketoacidosis, including:
When Should I Test For Ketones And How Will This Affect The Management Of My Diabetes
The following information is of relevance to people who need to take insulin.
- Blood glucose levels rise above 17 mmol/L
- Blood glucose levels are consistenly above 13 mmol/L
- If blood glucose levels rise in response to illness
- If you notice symptoms of ketoacidosis such as vomiting or suffering from diarrhoea
If you record high levels of ketones, contact your health team immediately for advice on how best to manage your diabetes.
Recommended Reading: What’s Insulin Used For
Is Ketosis The Same As Ketoacidosis
Nutritional ketosis occurs when there is not enough carbohydrate in the diet to meet the bodys energy requirements. In this situation, the body switches over from burning sugar to burning fat as its main fuel.
Fat, whether from the diet or the bodys stores, is broken down into ketones in the liver. These ketones are an efficient energy source for many organs, particularly the brain.
Everyone has ketones in their blood at very low levels, under normal conditions. When the body enters ketosis, and so switches to burning mostly fat, levels of ketones in the blood increase.
When To Get Medical Help
Go to your nearest A& E immediately if you think you have DKA, especially if you have a high level of ketones in your blood or urine.
DKA is an emergency and needs to be treated in hospital immediately.
- your blood sugar or ketone levels are high or getting higher over time, but you do not feel unwell
- you feel unwell but your blood sugar or ketone levels are normal or are only a little bit higher than usual
If you cannot contact your care team or GP, call your local out-of-hours service or NHS 111 for advice.
You May Like: How Much Sugar Can A Diabetic Have In A Day
Common Causes Of Sudden Mild Or Severe Dka
- A failure in your insulin pump site or pod
- A drastic mismatch of insulin versus food
- Forgetting to take your insulin
- Using insulin accidentally damaged by cold or hot temperatures
- Purposefully consuming a large quantity of food without taking insulin
- Severe illness like a stomach virus or flu
- Certain medications with a risk of inducing DKA, like Invokana
Who Needs A Ketone Test
You might need one if you have type 1 diabetes. In this type, your immune system attacks and destroys cells in your pancreas that make insulin. Without it, your blood sugar rises.
People with type 2 diabetes can also get high ketones, but it isn’t as common as it is with type 1.
Tests can show you when your level gets high so you can treat it before you get sick.
Read Also: Free Diabetes Tester And Strips
Treatments For Diabetic Ketoacidosis
DKA is usually treated in hospital.
Treatments for DKA include:
- insulin, usually given into a vein
- fluids given into a vein to rehydrate your body
- nutrients given into a vein to replace any you’ve lost
You’ll also be closely monitored for any life-threatening problems that can happen, such as problems with your brain, kidneys or lungs.
You can leave hospital when you’re well enough to eat and drink and tests show a safe level of ketones in your body. It’s common to stay in hospital for around 2 days.
Before leaving hospital, ask to speak to a diabetes nurse about why you got DKA and what you can do to stop it happening again.
Page last reviewed: 01 May 2020 Next review due: 01 May 2023
What Can I Do To Lessen My Chances Of Suffering From Dka
The number one is to maintain your proper insulin intake.
If youre dealing with illness or trauma that could cause levels of insulin to drop, make sure you drink lots of water or other fluids.
If you cant afford your prescribed level of insulin, talk to your healthcare provider to see about assistance programs or samples they can give you to keep your dose at the right level.
If youre worried about being unable to afford your treatment plan long-term, let your doctor know so they can offer you an alternative cheaper insulin plan .
Read Also: Herbal Medicine For Diabetes In The Philippines
Check For Ketones If You Have The Following:
- An unexplained elevation in your blood sugar
- Persistently elevated blood sugars
- Symptoms of nausea or vomiting
There is a higher risk for developing ketones on pump therapy. This is because long-acting insulins are not used, and rapid-acting insulin is delivered in extremely small amounts. If this basal insulin delivery is interrupted for more than an hour, check your blood sugar and ketones. If you continue to not get insulin, blood glucose and ketone levels may increase into a dangerous range. See also Acute: Diabetic ketoacidosis .