What is diabetic ketoacidosis?

What are the early warning signs of diabetic ketoacidosis?

• Extremely dry mouth with thirst
• Frequent urination
• Blood glucose levels above 240 mg/dL
• High levels of ketone bodies in the body (can be checked in either urine or blood)

• Pain in the abdomen
• Nausea and vomiting that continues for more than 2 hours
• Weakness and fatigue
• Dry, flushed skin
• Fruity breath that might resemble a nail-polish remover
• Heavy and laboured breathing (also called Kussmaul breathing)
• Mental confusion, irritability and inability to concentrate
• Slurring of speech
• Blurring of vision
• Swelling of the brain, which can make the person feel drunk and behave irrationally.

What causes diabetic ketoacidosis?

• Lack of insulin in the body, either due to missed insulin dose or due to the increased demand of insulin in the body, can trigger ketoacidosis.
• Adverse reaction to insulin can also increase the levels of ketone bodies in the blood.
• Skipping food frequently can increase the levels of ketone in the body.
• Acute infections such as pneumonia or urinary tract infection.
• Medical emergencies such as heart attack or stroke can trigger physiologic stresses in the body, resulting in low insulin production, thereby increasing ketone levels.
• Ketone levels can also spike during pregnancy.
• Use of certain drugs such as corticosteroids, thiazide diuretics, sympathomimetics and sodium-glucose co-transporter 2 (SGLT-2) inhibitors can also trigger ketoacidosis in diabetic people.

Can this dangerous condition be prevented?

• Regular monitoring of blood sugar levels, especially in times of stress or illness.
• Following a strict insulin regimen to make sure that the sugar levels are under control. Discuss with your doctor when and how to increase or reduce the dose of insulin.
• Following the diet and exercise pattern recommended by the endocrinologist and dietician rigorously.
• Checking for ketone bodies with either blood or urine ketone test kit. It is advised to check for ketone bodies every 4 to 6 hours when sugar level spikes to 240 mg/dl or when the person is suffering from an infection (such as cold or flu).

How can diabetic ketoacidosis be treated?

• D: Family/ previous history of diabetes or increased blood sugar levels
• K: Presence of ketone bodies in the urine or blood
• A: Higher levels of acid in the blood

• The patient is given a large volume of fluids intravenously (through the vein) to treat dehydration and to neutralise the acid levels.
• The patient is also given insulin intravenously, one to two hours after the fluids are administered, to lower the blood sugar levels.
• Potassium supplements are given to treat hypokalemia, which is one of the reasons for diabetic ketoacidosis.
• Blood sugar levels, fluid status, acid levels, cardiac status, urine output, blood pressure and electrolyte levels are monitored closely.
• The patient is given antibiotics or other medications in case of any infection that would have triggered ketoacidosis.

Conclusion