Diabetic Ketoacidosis: Causes, Symptoms, and Management – By Harold Gunatillake
An Overview for Patients and Carers
All individuals with diabetes must remain cognizant of this complication.
Diabetic ketoacidosis is a medical condition characterised by the rapid breakdown of fat in the body, resulting in the production of ketones as a by-product. This condition generally occurs due to a deficiency of insulin, which is most observed in individuals with type 1 diabetes and, less frequently, in those with type 2 diabetes. The accumulation of ketones in the blood and urine can lead to a potentially hazardous situation if not addressed promptly.
Causes
The primary cause of diabetic ketoacidosis is insulin deficiency, which prevents glucose from entering cells for energy production. Consequently, the body relies on fat stores as an alternative fuel source, leading to the formation of ketones. Typical precipitating factors encompass missed insulin injections, illness or infection, stress, or undiagnosed diabetes.
If your blood glucose is above 240 mg/dL, it is advisable to check your ketones with a urine test or a blood ketone monitor every 4-6 hours. Usually, ketoacidosis begins around 250 mg/dl. Be sure to consult your doctor if your blood sugar levels go outside your target range.
Symptoms of Ketoacidosis
- Increased thirst and frequent urination
- Dry mouth and skin
- Fatigue or weakness
- Rapid breathing or shortness of breath
- Fruity-smelling breath (due to acetone)
- Nausea, vomiting, or abdominal pain
- Confusion or difficulty concentrating Diagnosis
Diabetic ketoacidosis is diagnosed through blood and urine tests that measure glucose and ketone levels. High blood glucose levels alongside elevated ketones indicate the presence of ketosis, and further assessment is required to rule out diabetic ketoacidosis (DKA), a more severe complication.
Diabetic drugs linked to DKA.
The primary diabetic medications associated with ketoacidosis (DKA), including the less prevalent euglycemic DKA (characterised by normal blood glucose levels), are Sodium- Glucose Co-transporter 2 (SGLT2) inhibitors, such as canagliflozin
(Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro). These agents induce urinary glucose excretion, which can stimulate lipolysis for energy production, thereby leading to ketone formation and acidosis, particularly in illness or insulin deficiency.
Lactic acidosis is a frequently observed finding in diabetic ketoacidosis (DKA). Multiple pathophysiological mechanisms are accountable for the exceptionally elevated lactate levels occasionally observed in patients with ketoacidosis.
Side effects of taking Metformin.
The primary adverse effects of metformin encompass gastrointestinal disturbances such as diarrhoea, nausea, and abdominal pain, which frequently ameliorate with continued use. An infrequent but severe adverse reaction is lactic acidosis, and prolonged administration may result in vitamin B12 deficiency.
Management and Treatment
Go to the emergency room if your blood sugar is 300 mg/dL or more and won’t go down or if you have any symptoms of DKA, including frequent throwing up, tiredness, or difficulty breathing.
If there is suspicion of diabetic ketosis, it is imperative to seek medical consultation without delay. The standard treatment typically includes restoring insulin levels, rehydrating, and correcting underlying triggers, such as infections. Individuals with diabetes should consistently monitor their blood glucose and ketone levels, particularly during periods of illness. It is crucial not to omit insulin doses, and you should consult your healthcare provider if there is any uncertainty regarding insulin adjustments during stressful or sick periods.
Prevention
- Take insulin as prescribed and never skip
- Monitor blood glucose and ketone levels, particularly during illness or Seek medical help promptly if you notice symptoms of ketosis or if your ketone levels are elevated
- Stay hydrated and maintain a balanced
- Have a sick-day management plan and discuss it with your healthcare team.
Early identification and management of diabetic ketosis are critical in preventing the evolution into diabetic ketoacidosis, a condition that constitutes a medical emergency. Through a comprehensive understanding of its aetiology, diligent recognition of its symptoms, and adherence to an appropriate management plan, individuals living with diabetes can markedly mitigate their risk of associated complications.
Difference between Ketones and Ketoacidosis
Ketones are chemical byproducts of fat metabolism, while ketosis refers to the metabolic state in which the body utilises these ketones for energy rather than carbohydrates, typically achieved through a low-carbohydrate diet or fasting. Consider ketones as the fuel (analogous to oil), and ketosis as the process or condition of the body operating on this fat-derived fuel. Ketosis is generally a normal and intentional state; however, if ketone levels become dangerously elevated- particularly in the context of diabetes- it may lead to ketoacidosis, a medical emergency.
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