March 21, 2015

Diabetic Ketoacidosis – Part 1

Diabetic ketoacidosis (DKA) is generally a complication for people with type 1 diabetes, but some people with type 2 diabetes do develop DKA. If you have type 2, especially when you are older, you are more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). I will cover this in some future blogs.

DKA starts with high ketone levels when you body doesn't have enough insulin. This means your cells can't use the glucose in your blood for energy, and your body starts using fat for fuel instead. The ketones start building in your blood and if not corrected soon, the excess can change the chemical balance of your blood and change how your body works.

People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when -
  1. You miss a meal,
  2. You're sick or stressed,
  3. You have an insulin reaction.
When your blood glucose level is over 240 mg/dl (13.3 mmol/L) or you have symptoms of high blood glucose, such as:
  • Dry mouth
  • Feeling really thirsty
  • Peeing a lot
When you have the above symptoms, it is important to test your ketones. For this you can use your blood glucose meter that measure ketones or use a urine test strip. Try to bring your blood glucose level down and check you ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work. This is more important if your ketones aren't normal and if you have one or more of the following symptoms:
  • You have been vomiting for more than 2 hours
  • You feel queasy or your belly hurts
  • Your breath smells fruity
  • You are tired, confused, or woozy headed
  • You are having a difficult time breathing
You may have to go to the hospital. You'll probably need insulin through an IV to bring your ketones down and fluids to get you hydrated and balance your blood chemistry again. If you don't treat ketoacidosis, you could pass out, go into a coma, and possibly die. Your doctor may change your insulin dose or the kind you use to prevent it from happening again.

Good glucose management should help you avoid ketoacidosis. Take your medicines as directed, follow your meal plan closely, maintain your exercise regimen, and test your blood glucose regularly. When you have an episode of ketoacidosis, always run down a checklist:
  1. Make sure your insulin has not expired.
  2. Do not use it if it has clumps (insulin should be either clear or evenly cloudy with small flecks.
  3. If you are using an insulin pump, look closely for insulin leaks, and check your tube connections for air bubbles.
  4. Lastly, talk to your doctor if your blood sugar levels are often out of your target range


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