Diabetes: Ketoacidosis

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a build up of acids in your blood. It is a life-threatening complication of a lack of insulin. It may happen if you have type 1 diabetes. (It rarely happens if you have type 2 diabetes.) It is an emergency that must be treated right away. If ketoacidosis is not treated right away, it can cause diabetic coma or death.

How does it occur?

Diabetic ketoacidosis happens when your body does not have enough insulin. Without insulin, sugars in the blood cannot move out of the blood and into your body’s cells, and so the cells burn fats instead of sugar for energy. The burning of fats makes byproducts called ketones. The ketones build up to dangerous levels in the blood. High blood sugar often happens at the same time as ketoacidosis because, without enough insulin, sugar builds up in the blood.

When ketoacidosis happens, it means that your diabetes is not in good control or you may be getting an infection. Ketoacidosis may occur even with proper treatment for diabetes when there is a change in your life such as:

• infection
• injury
• heart attack
• surgery
• pregnancy
• other types of physical or emotional stress.

Sometimes the diagnosis of diabetes is not made until ketoacidosis occurs. When you have type 1 diabetes, the pancreas stops making insulin. When this happens, ketones can build up to a high level very fast. It may happen so fast that ketoacidosis symptoms are the first symptoms you ever have of diabetes.

What are the symptoms?

If you have ketoacidosis, you may have these symptoms:

• shortness of breath
• fruity-smelling breath
• very dry mouth
• nausea and vomiting

Symptoms of high blood sugar include:

• blurry vision
• dry mouth
• feeling very thirsty and drinking a lot
• urinating a lot
• tiredness.

The ketoacidosis symptoms leading to a diabetic coma usually happen gradually. In most cases it takes several hours to a couple of days for ketoacidosis to cause a diabetic coma.

How is it diagnosed?

Your healthcare provider will ask about your medical history, review your symptoms, and examine you. Your provider will pay special attention to:

• possible infection
• the amount of fluids in your body
• how clearly you are thinking
• your breathing
• how well your heart and kidneys are working.

Your provider will do some tests to check the levels of sugar and other chemicals in your blood. Your provider will also order other lab tests, a chest X-ray, and an ECG.

How is it treated?

Ketoacidosis needs to be treated right away. You usually need to be treated at a hospital.

• You will be given insulin as soon as ketoacidosis is diagnosed.
• Your blood will be checked often for sugar levels and chemical balances.
• You will be given intravenous (IV) insulin and fluids.

How long will the effects last?

Ketoacidosis will continue until the insulin and fluids have restored a balance of chemicals in your body. If ketoacidosis is not treated, it can be fatal. With treatment, you will usually recover in hours to days.

How can I take care of myself and help prevent diabetic ketoacidosis?

To help take care of yourself and prevent ketoacidosis, follow these guidelines:

• Keep your blood sugar level under control, as recommended by your healthcare provider.
• Eat a healthy diet.
• Follow the physical activity or exercise plan your healthcare provider has recommended.
• Check your blood sugar level as often as you and your provider have discussed.
• Never take more insulin than your regular dose unless you have double checked your blood sugar reading and made sure that your sugar level is too high and you need more insulin.
• Know the early signs and symptoms of ketoacidosis.
• Your provider may recommend that you check for ketones if:
  • Your blood sugar level is higher than 240 mg/dL (about 13.9 mmol/L).
  • You are ill or under more stress than usual. When you are sick, ketones can be present even if your blood sugar is not high.

  Ask your healthcare provider when you should check for ketones. Be sure to follow his or her recommendations.

• Check your blood sugar more often if you think you are getting sick.
• Keep extra insulin with you.
• Carry an ID (such as a card or bracelet) that says you have diabetes, in case of an emergency.
• If you are pregnant and diabetic, be sure to follow your provider's recommendations for monitoring your blood sugar and ketones.

Call your healthcare provider right away if:

• You have type 1 diabetes and your urine test shows that you have ketones in your urine.
• You have fever or other symptoms of an infection, such as flu or a bladder infection.
• You have been vomiting and are unable to keep food and fluids down.
• Your blood sugar has been over 240 mg/dL (over 13 mmol/L) before meals for more than 1 day, especially if you also have vomiting or other symptoms of illness or ketoacidosis.