As per the World Health Organization (WHO), more than 400 million people are suffering from diabetes across the globe. A survey conducted by the All India Institute of Medical Sciences (AIIMS), New Delhi from 2015 to 2019 stated that the prevalence of known diabetes cases was 8% and new diabetes cases were 3.8% in India.
If not managed properly, diabetes can severely affect various vital organs of the body including eyes, heart, kidneys and nerves. One such complication of uncontrolled diabetes is diabetic ketoacidosis, which affects a small population of diabetics but can lead to diabetic coma and even death.
What is diabetic ketoacidosis?
The cells of the human body require glucose (sugar) for energy. In the case of diabetics, when there is not enough insulin in the body to turn glucose into energy, the body starts burning the stored fat to produce energy. During this fat burning process, ketones are also released in the body. When these excess ketones are built up in the blood, they cause the blood to become acidic in nature. This is called diabetic ketoacidosis and is a potentially fatal condition, if not treated immediately.
What are the early warning signs of diabetic ketoacidosis?
Diabetes ketoacidosis usually develops slowly, however, there are certain signs that can be seen early enough, which include:
- 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)
Other symptoms that may follow include:
- 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?
The most common reasons for diabetic ketoacidosis are:
- 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?
Ketoacidosis is more prevalent in people with type 1 diabetes, and less frequently in type 2 diabetes cases. People at risk need to be extra careful about maintaining their blood sugar levels. Certain things that can help prevent diabetic ketoacidosis include:
- 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?
People with diabetes experiencing vomiting and abdominal pain along with high blood sugar levels must consult a doctor immediately as these could be signs of ketoacidosis. After reaching the hospital, the doctor would check for the three criteria of DKA:
- 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
Usually, the symptoms of diabetic ketoacidosis develop over a period of a few hours and instant treatment can help in rapid recovery. The treatment for diabetic ketoacidosis includes:
- 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.
Uncontrolled diabetes can wreak havoc in the body. By monitoring blood sugar levels frequently, administering adequate amounts of insulin, eating healthy and exercising regularly, people with diabetes can diminish their risk of developing diabetic ketoacidosis. If a person with diabetes experiences any of the symptoms of diabetic ketoacidosis mentioned above, they must consult an endocrinologist immediately.