Managing diabetes is hard enough but when experiencing illness or stress, extra pampering – and extra insulin – is necessary to avoid Diabetic ketoacidosis (DKA). The latest statistics show that DKA is responsible for one third of the total of health insurance costs for diabetes. Preventing DKA will not only prevent chronic health complications but it will save big dollars as well.
DKA, a life-threatening complication of both type 1 and 2 diabetes, happens when the metabolism is thrown out of balance by insulin deficiency. However, with the right precautions DKA can be avoided.
When the body doesn’t have enough insulin, muscles can’t take in the glucose that they need. They feel starved, so the body breaks down fat for energy.
Ketones are the by-products of this breakdown. If ketones form faster than the body can get rid of them in the urine, they build up in and poison the blood with acidic products.
At the same time, glucose spills into the urine, the kidneys produce more urine and dehydration sets in. If the body is dehydrated and there are ketones in the blood, DKA can be severe enough to lead to coma and even death.
Alan Marcus, MD, FACP, of South Orange County Endocrinology, reports that 10 percent of DKA cases are newly diagnosed diabetics, and the other 90 percent have a history of diabetes. In addition, 80 percent of the cases of DKA are caused by infections, like pneumonia or urinary tract infections. If DKA occurs in someone with type 2 diabetes, it may signal a change to insulin deficiency.
Illness is the most common cause of DKA. Both illness and stress increases the body’s need for insulin. When the body has to deal with a bacterial infection, or stress, hormones cause the liver to release stored glucose. These hormones also block the effect of insulin.
Other common DKA triggers to take note of include treatment errors, like skipping a dose of insulin. Drug and alcohol abuse play a role, because intoxicated patients can have trouble self-administering treatment. Pump malfunctions can contribute to DKA as well. Also, when receiving new prescriptions, ask if medications will interfere with insulin action.
When a patient is diagnosed with diabetes, or is getting it under control, the health care provider and patient should discuss a plan of action to follow if DKA occurs. With the onset of symptoms, make contact with the health care team immediately.
Symptoms include thirst, increased urination, loss of appetite, drowsiness, weakness, nausea and vomiting, abdominal pain, visual disturbances, rapid heartbeat, rapid breathing, warm dry skin, low blood pressure, blurry vision, fever, feeling weak, sleepiness, fruity odor on the breath and classic hyperglycemia: intense thirst, a dry mouth and frequent urination.
Luckily, DKA gives plenty of warning before it happens. The most important warning sign of DKA is high BGs, (over 250 mg/dl) which can be detected if BGs are tested several times a day. Although DKA usually occurs when BGs are in the 300 to 600 mg/dl range, it may occur with levels as low as the 200s.
Marcus advises home treatment with the onset of symptoms. Because ketones make the body insulin resistant, insulin dosage can be increased to five or 10 units administered every 30 minutes. Asking a physician for the appropriate personal dosage is strongly advised. Also, drinking a lot of water to become hydrated is necessary. After glucose levels drop, sugary drinks can be consumed. The break-down of sugar when insulin is present makes bicarbonate that normalizes the body’s acid level.
Just replacing fluids can have a positive effect on BGs because it both dilutes the glucose level in the blood and lets the kidneys eliminate it. Fluid helps the kidneys eliminate ketones as well.
However, if there is nausea and or vomiting, hospitalization is a must to stabilize the body. There fluids, insulin and electrolytes will be administered.
Testing for Ketones
Checking the urine for ketones is not part of every person with diabetes routine. However, queasiness or vomiting are signs to test urine for ketones, even if BGs aren’t high. Also, always test for ketones when BG readings are over 250 mg/dl, and/or when ill, (especially with a high fever) or when having diarrhea. Ketone tests are easy to read, the vials reading from 0 and trace to small, moderate and large. Ketone levels must be immediately lowered when they are combined with high BGs.
Notify your doctor if there are moderate or large amounts of ketones. However, trace or small amounts of ketones are fine.
Additional times to test include: during pregnancy, daily before breakfast (fasting), during very stressful times (physical or psychological), when chronically tired, when the breath smells fruity, when experiencing breathing difficulties, when having trouble concentrating or when your usual insulin dosage does not lower BGs.
Knowing the precautions, warning signs and preventative measures to take with DKA can keep a person with diabetes out of the hospital. Stay healthy by keeping close attention to diet, medication and paying heed to the body’s needs.