Diabetic Ketoacidosis: All You Need to Know

What is Diabetic Ketoacidosis?

Diabetic Ketoacidosis or DKA is a condition that occurs in diabetics, when your body produces very little insulin. Due to the lack of sufficient levels of insulin, your cells are unable to use the glucose in your blood to generate energy. Because of this, your body starts breaking down the fat in your body to use it as fuel. Your liver processes these fats and turns them into ketones (acidic, water-soluble molecules used to produce energy). The presence of too many ketones in your blood can turn it acidic, which can cause severe complications.

DKA is more common in Type 1 Diabetics than Type 2 Diabetics. It is a medical emergency that can result in hospitalization and may prove to be fatal if not treated immediately.

What Are the Causes of Diabetic Ketoacidosis?

Diabetic ketoacidosis is caused by high blood ketone levels, which is a result of too little or no insulin production in your body. Several factors can lead to reduced insulin production in Type 2 Diabetics. They are:

• Missing doses of insulin shots

DKA occurs due to insufficient levels of insulin in your body. If you are a Type 2 Diabetic taking insulin injections to manage your condition, taking lesser than the prescribed dose of insulin, missing or skipping scheduled insulin doses, or using expired or improperly stored insulin could lead to ketoacidosis.

• Skipping meals

When you skip a meal or do not eat enough, your body uses stored fat to produce energy. This results in the release of ketones, which could potentially cause diabetic ketoacidosis.

• Prolonged stress

Experiencing stress for long periods of time can elevate the levels of stress hormones (cortisol, catecholamines, growth hormones, etc.) in your body. Stress hormones lower insulin production in your body and increase energy production by breaking down fat and protein (muscle). This can increase ketone levels in your body.

• Excessive alcohol consumption

Excessive alcohol consumption, alcohol abuse, or binge drinking can often cause nausea, vomiting, and loss of appetite. When you do not consume any food before or after drinking, your body utilizes the glucose stored in your liver to produce energy. When that fuel source is exhausted (after about 12 hours of eating), your body starts breaking down fat to produce energy. This results in elevated ketone levels and a condition called Alcoholic Ketoacidosis. Having diabetes and being malnourished can increase your chances of developing ketoacidosis after an episode of heavy drinking.

• Being ill or having an infection

When you are sick or have an infection, your body produces more cortisol and other stress hormones, which lower insulin levels. You may also experience a loss of appetite when you are ill. Both of these factors can lead to ketoacidosis.

• Keto diet

A ketogenic diet that is high in fats and low in carbohydrates is considered a good option for weight loss. However, when you have Type 2 Diabetes, a keto diet can increase the production of ketones in your body, which drastically increases your chances of developing diabetic ketoacidosis.

What are the Symptoms of Diabetic Ketoacidosis?

The symptoms of diabetic ketoacidosis can develop quickly (within 24 hours). Diabetic ketoacidosis symptoms are mostly caused by high blood sugar and ketone levels.

The following are the warning signs of diabetic ketoacidosis:

• Extreme thirst and dry mouth
• Frequent urination
• Heavy breathing or shortness of breath
• Blurred vision
• Dry, hot, or flushed skin
• Nausea and vomiting
• Confusion or the appearance of being “drunk”
• Fruity-smelling breath

Seek immediate medical attention if you are experiencing any of these symptoms.

How is Diabetic Ketoacidosis Diagnosed?

Your doctor or healthcare provider will perform the following tests to confirm the diagnosis of DKA.

1. Random Blood Sugar (RBS) test to check for high blood glucose levels.
2. Serum Ketone test to detect and evaluate the levels of ketones present in your blood.
3. Arterial Blood Gas (ABG) Analysis which measures the pH levels of your blood (to check for acidosis), blood oxygen levels, and bicarbonate (HCO3) levels.

Your doctor may perform some additional tests and check-ups to monitor your vitals.

How is Diabetic Ketoacidosis Treated?

Diabetic ketoacidosis can only be treated in clinical or hospital settings.

DKA treatment goals include: 

• Lowering blood glucose levels by administering insulin.
• Rehydration by administering oral or intravenous (IV) fluids.
• Eliminating ketones from your body through urine (achieved with insulin therapy and fluid replacement).
• Improving blood circulation by restoring blood volume.
• Restoring electrolyte balance by administering sodium and potassium.
• Normalizing blood pH value by administering bicarbonate infusion.

What are Diabetic Ketoacidosis Complications?

• Elevated blood potassium levels (hyperkalemia)
• Hypovolemic shock (organ failure caused by poor circulation and low blood volume)
• Blood clots which could lead to stroke or heart attack
• Difficulty breathing or respiratory distress
• Accumulation of fluid in lungs (pulmonary edema)
• Kidney damage

• Low blood sugar levels, caused by high dose or rapid insulin administration. 
• Decreased blood potassium levels, caused by potassium entering your cells after insulin administration.
• Edema or swelling in the brain, caused by a rapid drop in blood sugar levels.

How can Diabetic Ketoacidosis be Prevented?

The core principle of diabetic ketoacidosis prevention is effective diabetes management. The following tips may help in the successful prevention of DKA:

• Eating well-balanced, diabetic-friendly meals.
• Regular home monitoring of your blood glucose levels using a glucometer.
• Taking the appropriate and prescribed doses of insulin and other hypoglycemic medication consistently.
• Eating on time and not skipping meals.
• Frequent monitoring of blood glucose and urine ketone levels when you are ill or have an infection. 

When to See a Doctor?

• You are vomiting and cannot eat or drink anything.
• Your blood glucose levels are over the target range, and are not responding to treatment at home.
• The level of ketones in your urine is moderate or high.