Diabetic Ketoacidosis – Part 3

As a patient, we need to be aware of the treatments we may encounter. Radiologic studies that may be helpful in patients with DKA include the following:

• Chest radiography: To rule out pulmonary infection such as pneumonia
• Head CT scanning: To detect early cerebral edema; use low threshold in children with DKA and altered mental status
• Head MRI: To detect early cerebral edema (order only if altered consciousness is present)

Doctors are told not to delay administration of hypertonic saline or mannitol in those pediatric cases where cerebral edema is suspected, as many changes may be seen late on head imaging.

Treatment of ketoacidosis should aim for the following:

• Fluid resuscitation
• Reversal of the acidosis and ketosis
• Reduction in the plasma glucose concentration to normal
• Replenishment of electrolyte and volume losses
• Identification the underlying cause

Regular and analog human insulins are used for correction of hyperglycemia, unless bovine or pork insulin is the only available insulin.

Medications used in the management of DKA include the following:

• Rapid-acting insulins (e.g., insulin aspart, insulin glulisine, insulin lispro)
• Short-acting insulins (e.g., regular insulin)
• Electrolyte supplements (e.g., potassium chloride)
• Alkalinizing agents (e.g., sodium bicarbonate)

The risk of diabetic ketoacidosis is highest if you:

• Have type 1 diabetes
• Are younger than age 19
• Frequently miss insulin doses

However, diabetic ketoacidosis can also occur if you have type 2 diabetes, although this is uncommon. In some cases, diabetic ketoacidosis may be the first sign that a person has diabetes.

Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.

Treatment complications include:

• Low blood sugar (hypoglycemia). Insulin allows sugar to enter your cells. This causes your blood sugar level to drop. If your blood sugar level drops too quickly, you may develop low blood sugar.
• Low potassium (hypokalemia). The fluids and insulin used to treat diabetic ketoacidosis may cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles, and nerves.
• Swelling in the brain (cerebral edema). Adjusting your blood sugar level too quickly can produce swelling in your brain. This complication appears to be more common in children, especially those with newly diagnosed diabetes.

Left untreated, the risks are much greater. Diabetic ketoacidosis can lead to loss of consciousness. Eventually, diabetic ketoacidosis can be fatal.

Blood tests used in the diagnosis of diabetic ketoacidosis will measure:

• Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise.
• Ketone level. When your body breaks down fat and protein for energy, toxic acids known as ketones enter your bloodstream.
• Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of various organs throughout your body.

Your doctor may order tests to identify underlying health problems that may have contributed to diabetic ketoacidosis and check for complications. Tests may include:

• Blood electrolyte tests
• Urinalysis
• Chest X-ray
• A recording of the electrical activity of the heart (electrocardiogram)

There's much you can do to prevent diabetic ketoacidosis and other diabetes complications.

• Make a commitment to managing your diabetes. Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
• Monitor your blood sugar level. You may need to check and record your blood sugar level at least three to four times a day — or more if you're ill or under stress. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
• Adjust your insulin dosage as needed. Talk to your doctor or diabetes educator about how to adjust your insulin dosage depending on your blood sugar level, what you eat, how active you are, whether you're ill, and other factors. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.
• Check your ketone level. When you're ill or under stress, test your urine for excess ketones with an over-the-counter urine ketones test kit. If your ketone level is moderate or high, contact your doctor right away or seek emergency care.
• Be prepared to act quickly. If you suspect that you have diabetic ketoacidosis — your blood sugar level is high and you have excess ketones in your urine — seek emergency care.

Diabetes complications are scary. But don't let fear keep you from taking good care of yourself. Follow your diabetes treatment plan carefully, and ask your diabetes treatment team for help when you need it.