What is diabetic ketoacidosis?

Diabetic ketoacidosis, a serious complication of high blood sugar, is a life-threatening condition. It must be treated immediately. If you have ketoacidosis you are at risk of falling into a diabetic coma.

How does it occur?

If you have diabetes and it is not treated properly, you may suffer from the very dangerous complication called ketoacidosis. At first your blood sugar (glucose) level may rise above normal. This condition is called hyperglycemia. Hyperglycemia occurs when you do not have enough insulin to keep your blood sugar down at the proper level. If your blood sugar is not brought under control you may develop ketoacidosis. In ketoacidosis the body breaks down fats into fatty acids and uses the fatty acids for energy instead of blood glucose. The fatty acids form ketones, some of which are passed out in the urine.

Reasons why your blood sugar may increase (even if you are taking insulin) include:

• not getting enough insulin

• not getting enough exercise

• eating the wrong amounts or types of food

• not testing your blood sugar levels properly or regularly.

Also, ketoacidosis may result from changes in your life such as illness, infection, trauma, heart attack, surgery, stress, or pregnancy.

If you have not yet been diagnosed with diabetes, ketoacidosis may be the first warning sign that you have type 1 diabetes (insulin-dependent diabetes).

What are the symptoms?

Symptoms of hyperglycemia include:

• increased thirst

• increased hunger

• dry mouth

• increased urination.

If you have ketoacidosis you may also experience these symptoms:

• excessive urination

• frequent thirstiness

• fruity-smelling breath

• nausea

• vomiting

• mental confusion

• tiredness.

The onset of a diabetic coma is usually gradual, producing the symptoms of ketoacidosis first.

How is it diagnosed?

To diagnose ketoacidosis, the doctor will ask about your medical history, review your symptoms, and give you a physical exam, paying special attention to:

• possible infection

• the amount of fluids in your body

• how clearly you are thinking

• breathing difficulty

• your heart and kidneys.

The doctor will probably do some blood tests to check the levels of sugar, ketones, and other chemicals.

If necessary, the doctor will also order a chest x-ray, ECG, and appropriate cultures.

How is it treated?

You will be given insulin as soon as ketoacidosis is diagnosed. Your blood sugar levels will be monitored frequently and electrolytes and blood gases checked as needed. You will probably be given intravenous (IV) fluids. Your treatment will include antibiotic medication if you have an infection.

How long will the effects last?

Ketoacidosis will continue until enough insulin is available to the body. If this condition is not treated, it can be fatal.

What can be done to help prevent diabetic ketoacidosis?

To help take care of yourself and prevent ketoacidosis, follow these guidelines:

• Wash your hands before and after checking your blood sugar.

• Check your blood sugar level daily when you first awaken, before you take any medication.

• For strict control, test your blood sugar level four times a day--before meals and at bedtime--or as your doctor recommends.

• Test for ketones in your urine, especially when your blood sugars are high or you are ill or under more stress than usual.

• Never take more insulin until you are sure that your blood sugar level is too high. The symptoms of low blood sugar can be similar to those of high blood sugar.

• Know the early signs and symptoms of ketoacidosis.

• Keep extra insulin with you.

• Teach a family member or friend how to give you an injection if necessary.

• Wear a medical ID bracelet for diabetes.

Call your doctor if:

• Your urine sugar is 1% or more for 2 days.

• Your blood sugar is 240 or more for 2 days.

• Your ketone test is positive two times in a row.

• You are vomiting constantly.

• You have symptoms that concern you.