Cochin Cardiac Club

Health Blog by Dr.Uday Nair


What is diabetes?

Diabetes is a disease that occurs when a person’s body doesn’t make enough of the hormone insulin or can’t use insulin properly. There are 2 types of diabetes. Type 1 diabetes occurs when your body’s pancreas doesn’t produce any insulin. Type 2 diabetes occurs when the pancreas either doesn’t produce enough insulin or your body’s cells ignore the insulin. Between 90-95% of people who are diagnosed with diabetes have type 2 diabetes.

When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, because your body doesn’t make enough insulin or can’t use it properly, the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems, including heart disease and damage to the nerves and kidneys.

What is Diabetic Ketoacidosis(DKA)?

Diabetic Ketoacidosis is a condition in which the body cells are unable to get glucose for energy due to low or no insulin. Thus body start breakdown fat for energy, produces toxic acid called ketones.
Diabetic ketoacidosis develops when there is too little or no insulin in the body. Without enough insulin, glucose can't be burnt by cells for energy. Thus blood sugar level rises, and also body cell dangerously need energy and thus body begins to break down fat for energy called ketosis by producing ketones, a toxic acids. When left untreated, diabetic ketoacidosis may cause to lose consciousness and it is fatal.Most commonly diabetes type 1 frequently come across diabetic ketoacidosis and also frequently type 1 diabetes are diagnosed after diabetes ketoacidosis episode. Rarely type 2 diabetes may too develop diabetic ketoacidosis.

What are the causes of Diabetic Ketoacidosis(DKA)?


Ketoacidosis is due to low or no insulin. Low insulin may be caused by emotional feeling, physical illness, alcohol abuse and improper insulin therapy.

Glucose is the main source of energy for the cells that make up your muscles and other tissues. Normally, glucose enters the cells with the help of insulin. If don't have enough insulin in the body, body won't be able to use glucose for energy. This lead to the release of hormones that break down fat as an alternate fuel, this produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually come out through urine.

Triggering Causes

  • Illness - An infection or illness (commonly Pneumonia and urinary tract infections) can produce hormones adrenaline. Unfortunately, these hormones work against insulin and sometimes triggering diabetic ketoacidosis.
  • Improper insulin therapy - Missed insulin treatments or inadequate insulin therapy can leave with too little or no insulin and triggers diabetic ketoacidosis.

Other triggering causes

  • Stress or tension
  • Physical or emotional trauma
  • Very high fever
  • After surgery
  • Heart attack or Stroke
  • Drug or alcohol abuse

What are the Symptoms of diabetic ketoacidosis(DKA).

Diabetic ketoacidosis is due to no or low insulin secretion, ends up with breakdown of fat for energy and releases ketones.  This produces ketoacidosis symptoms mostly within 24 hours.

  • Too much thirst
  • Urinate frequently
  • Nausea and vomiting
  • Pain in the abdominal
  • Appetite loss
  • Weakness or fatigue
  • Drowsiness
  • Shortness of breath
  • low pulse and low blood pressure
  • Fruity-scented breath
  • Confusion

Immediate treatment is a must if you have symptoms of

  • vomiting and unable to uptake any food or liquid
  • blood glucose level is higher than normal and not responding to home treatment
  • urine ketone level is moderate or high

Emergency care is needed if:

  • blood glucose level is consistently higher than 300 (mg/dL) or 16.5 (mmol/L) excess ketones in urine
  • have multiple symptoms of diabetic ketoacidosis - excessive thirst or urination, nausea and vomiting, pain in abdomen, appetite loss, shortness of breath, fruity-scented breath and confusion.
Please Note, untreated diabetic ketoacidosis can be fatal.

What are the Risk factors of DKA?

The risk of diabetic ketoacidosis is highest if you:
  • Have type 1 diabetes
  • Are younger than age 19
However, diabetic ketoacidosis can occur in other situations — whether you have type 1 diabetes, type 2 diabetes or gestational diabetes. In a few cases, diabetic ketoacidosis is the first sign that a person has diabetes

What are the Signs and tests for DKA:

Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is done using a urine sample. Ketone testing is usually done at the following times:
  • When the blood sugar is higher than 240 mg/dL
  • During an illness such as pneumonia, heart attack, or stroke
  • When nausea or vomiting occur
  • During pregnancy
Other tests that may be done to diagnose ketoacidosis include:
  • Arterial blood gas
  • Blood glucose test
  • Blood pressure measurement
  • Amylase blood test
  • Potassium blood test
This disease may also affect the results of the following tests:
  • CO2
  • CSF collection
  • Potassium urine test
  • Magnesium blood test
  • Phosphorus blood test
  • Sodium blood test
  • Sodium urine test
  • Urine pH

What is the Treatment for DKA?

The goal of treatment is to correct the high blood glucose level by giving more insulin. Another goal is to replace fluids lost through excessive urination and vomiting. You may be able to recognize the early warning signs and make appropriate corrections at home before the condition gets worse.
Most of the time, you will need to go to the hospital. The following will be done at the hospital:
  • Insulin replacement will be given.
  • Fluids and electrolytes will be replaced.
  • The cause of the condition (such as infection) will be found and treated.

What are the Complications of DKA?

  • Fluid buildup in the brain (cerebral edema)
  • Heart attack and death of bowel tissue due to low blood pressure
  • Renal failure

    How can we Prevent DKA?

    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 several 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 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.Insulin pump users need to check often to see that insulin is still flowing through the tubing, and that there are no blockages, kinks, or disconnections
    • 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 diabetologist for help when you need it.

    What  are the Expectations (prognosis)

Acidosis can lead to severe illness or death. Improved therapy for young people with diabetes has decreased the death rate from this condition. However, it remains a significant risk in the elderly, and in people who fall into a coma when treatment has been delayed.

Please Note

This condition can become a medical emergency. Call your doctor if you notice early symptoms of diabetic ketoacidosis.
Go to the emergency room  if you experience:
  • Decreased consciousness
  • Difficulty breathing
  • Fruity breath
  • Mental stupor
  • Nausea
  • Vomiting

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