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Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars.
Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes.
DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA.
Symptoms of DKA can appear quickly and may include:
It is important to make sure you consult with your doctor if you experience any of these symptoms.
If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help.
If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA.
If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for ketones. You should also test if you are sick or planning on exercising and your blood sugar is 250 mg/dL or higher. Call your doctor if moderate or high levels of ketones are present. Always seek medical help if you suspect you are progressing to DKA.
The most common triggers for the breakdown of fat that causes DKA are:
You cannot avoid illness or infection, but there are steps you can take to help you remember to take your insulin:
Your risk of developing DKA might be higher if you:
Although DKA is rare in people who have type 2 diabetes, it does occur.
Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. If home urine testing confirms ketosis, contact your doctor, who may order more testing. Tests of blood acidity and sugar levels are commonly done. Other tests your doctor may order are:
The treatment for DKA usually involves a combination of several approaches to normalize abnormal blood sugar and insulin levels. If you’re diagnosed with DKA but have not yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring. If your DKA is a result of an infection or illness, your doctor will treat that as well, likely with antibiotics.
At the hospital, your physician will likely give you fluids to replace fluid that’s lost as a result of DKA. If possible, they can give them orally, but you may have to receive fluids through an IV, or intravenously. Fluid replacement helps treat dehydration, which can cause even higher blood sugar levels.
Insulin will likely be administered to you intravenously until your blood sugar level falls below 240 mg/dL. When your blood sugar levels are within an acceptable range, you will need to work with your doctor to help you avoid the risk of DKA in the future.
Lower than normal levels of insulin can cause the levels of electrolytes in your body to also become abnormally low. Electrolytes are electrically charged minerals that help your body, including the heart and nerves, function properly. Electrolyte replacement is also commonly done through IV.
DKA is a serious potential complication of diabetes, but it can be prevented. Follow the treatment plan your doctor has recommended, and take a proactive approach to your health. Let your doctor know if you think your treatment is no longer working or if you’re having trouble sticking to it. They can adjust your treatment plan or help you come up with solutions for managing your condition.
There are many ways to prevent DKA. One of the most important is proper management of diabetes:
You can also try the following prevention methods:
Written by: Carmella Wint and Marijane Leonard
Medically reviewed on: Oct 20, 2016: Peggy Pletcher, MS, RD, LD, CDE
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