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Diabetes is a lifelong disease. It can’t be cured, though it is possible to delay or reverse it for some time. Most of us with diabetes live with the disorder, controlling it with a planned diet, medication, and regular testing. However, sometimes diabetes causes severe, life-threatening situations. Diabetic ketoacidosis (DKA) is one such condition.
Diabetes is a disorder of glucose handling in the body. The carbohydrates in our food are broken down or metabolized to glucose for use by the cells. Insulin, the pancreatic hormone, is needed for glucose to enter the cells. Destruction of the insulin-producing cells causes a deficiency of insulin (type 1 diabetes mellitus). Resistance of the cells to insulin effect causes type 2 diabetes mellitus (T2DM).
Diabetic ketoacidosis is a situation of hyperglycemia (high glucose blood levels), ketosis (ketone bodies in the blood), and acidosis (reduced blood pH). Ketosis by itself is not dangerous, but diabetic ketoacidosis is an emergency. It can cause death within hours if not treated; immediate admission to hospital is required to save life [1].
Diabetic ketoacidosis, like diabetes itself, can affect several organs and systems of the body. Among the most dangerous problems associated with it are cerebral edema ( swelling of the brain caused by fluid collection), kidney failure, and cardiac arrest ( heart stoppage) [2].
How Does DKA Happen?
This life-threatening complication usually happens with type 1 diabetes, though it can happen with T2DM, also. It is caused by insulin deficiency and worsened by hyperglycemia, dehydration (reduced water in our body), and acidosis. Sometimes, it can be triggered by an infection or a failure to take the treatment regularly [3].
Without insulin, our cells can’t use glucose. Our body shifts to using fat for energy and breaks them down into ketone bodies. When too much fat is broken down rapidly, our body can’t process the ketone bodies quickly enough, and the blood becomes acidic [2].
Diabetic ketoacidosis can sometimes happen with the onset of diabetes. More often, it happens when we don’t take our treatment correctly. Other illnesses like pneumonia and urinary tract infection (UTI) can provoke this dangerous disorder. Diabetic ketoacidosis is more likely with obesity and substance abuse (for example, cocaine) [3].
Starvation can also lead to diabetic ketoacidosis. Not eating because our appetite is poor during an illness can lead to this high-risk condition [4].
Signs of Ketoacidosis with Type 1 Diabetes
For such a dangerous condition, diabetic ketoacidosis often has few symptoms. We may feel quite well even when blood glucose and ketone levels are high. The common symptoms of diabetic ketoacidosis [2]:
- Dry mouth and skin
- Reduced alertness
- A fruity smell in the air breathed out
- Deep and fast breathing
- Headache
- Nausea and vomiting
- Severe thirst
- Frequent urination
- Stomach pain
- Muscle pain and stiffness
Blood glucose levels can be highly elevated, but this alone does not diagnose diabetic ketoacidosis. Urine examination will detect ketones, and the blood levels of ketones are high in this condition. Blood gas testing will show an acidic blood pH and reduced levels of bicarbonate [1].
How Long Does it Take to Die from DKA Without Insulin?
Diabetic ketoacidosis is a deadly complication of diabetes. It generally happens slowly, but vomiting can accelerate it [4]. If not treated swiftly, it can cause death in a day or two.
However, we must realize that we often don’t even have that much time. Once this complication has occurred, it often causes unconsciousness (coma) within a few hours. After that, we may be unable to reach a hospital on our own. It is crucial to be on our guard against diabetic ketoacidosis and get to the hospital at the earliest suspicion.
When we manage our diabetes at home, we are used to measuring our blood sugar ourselves. If our blood glucose is more than 240 milligrams/deciliter ( 13.3 millimoles/liter), we should test for ketones. We should also test for ketones when suffering from the flu or any other illness [4].
We can test for ketones in the urine using urinary test strips. These are simple to use, and we can conveniently use them at home. Dipping it in our urine will cause the test strip to change color, depending on the concentration of ketone bodies. Our doctor may also recommend a blood ketone testing kit. Putting a drop of blood on a strip and then inserting it into the machine tells us our blood levels of ketone.
How to Prevent Diabetic Ketoacidosis?
Some precautions for avoiding diabetic ketoacidosis [5]:
Taking our medicines regularly is vital. Irregular treatment is one of the most common causes of diabetic ketoacidosis.
When we have the flu, another illness, or an injury, we must be especially careful about measuring our blood glucose levels and checking for ketones. We need higher doses of insulin during such times, and it is sensible to take guidance from our doctor.
We must take the dose of insulin prescribed by our doctor. We can take their advice about adjusting the dose during sickness, unusual physical activity, surgery, etc.
Make sure the insulin pump is not clogged.
We must be cautious when taking medicines like diuretics (urine increasing) and corticosteroids, which provoke diabetic ketoacidosis. Alcohol and some drugs are also unsafe.
Frequently Asked Questions (FAQ)
How Long Does it Take to Recover From DKA?
Diabetic ketoacidosis must be treated in the hospital. If we suspect we have this complication, it is essential to reach the hospital urgently. This is a life-threatening situation, and it is dangerous to try treatment at home.
The treatment consists of correcting hyperglycemia, dehydration, and acidosis. Our doctor will also treat any infections or other diseases that are precipitating the situation. With appropriate treatment, the recovery from diabetic ketoacidosis takes 24 hours [2].
How to Get Rid of Ketones Quickly?
Our doctor will begin treatment to control diabetes. The kidneys remove ketones from the body, but excessive production overwhelms them. Once diabetes is controlled, ketone production ceases, and their levels in the blood drop. The typical treatment used is [5]:
Intravenous fluids. High blood glucose levels cause excessive urine production and lead to dehydration. Intravenous fluids are used to reverse it.
Insulin. This is the most important component of treatment. It allows the cells to use glucose for their energy needs. This reduces the blood levels of glucose and stops ketone body production.
Electrolytes. Sodium, potassium, and chlorides in the blood must be at controlled levels in the blood for the heart, nerves, muscles, and other tissues to work efficiently. Diabetic ketoacidosis disturbs these electrolyte levels; our doctor will take corrective steps.
Antibiotics. Diabetic ketoacidosis is sometimes provoked by infections like UTI or pneumonia. Appropriate antibiotics will cure the infection, helping bring diabetes under control.
Reversing acidosis. Insulin therapy and dehydration correction usually reverse the acidosis. If the acidosis is life-threatening (pH 6.9 or lower), our doctor may add bicarbonate to the treatment [1].
When Should We See a Doctor?
Some signs show that we are in danger and should go to the hospital [5]:
- Blood sugar of more than 300 milligrams/deciliter (16.7 millimoles/liter)
- Persistent vomiting
- Fruity-smelling breath
- Drowsiness
- Difficulty breathing
Diabetic ketoacidosis is a menacing situation, and we must be on our guard. At the earliest sign of this complication, we should see our doctor. Early treatment is crucial to safe and complete recovery.
If you have a blood ketone testing device at home, you can test your blood levels [6].
- Normal levels are less than 0.6 millimoles/liter.
- Levels of 0.6 to 1.5 millimoles/liter mean some risk. We should test again after two hours.
- Levels of 1.6 to 2.9 millimoles/liter mean increased risk. We should contact our doctor as soon as possible.
- Levels of 3 millimoles/liter and above show danger. We must go to the hospital immediately.
Final Thoughts
Diabetic ketoacidosis is a well-known danger associated with diabetes, especially type 1 diabetes. It can happen with T2DM, too, but is rare and usually less severe [2]. If we don’t recognize it in time and reach the hospital for treatment, this complication can escalate and become a threat to life.
Diabetic ketoacidosis is a serious complication of diabetes. Knowing the signs of this dangerous condition is essential for people living with diabetes and can be life-saving. Our doctor can treat it, but outcomes are best when we reach the hospital early.
Prevention is best. Measuring our blood sugar level regularly, taking insulin and other treatments precisely as advised, and contacting our doctor for dose adjustments during unusual situations will keep our blood glucose in the target range and prevent diabetic ketoacidosis.
References:
- Holt, T., Kumar, S. ABC of Diabetes, 7th edition. John Wiley & Sons, Chichester, UK. https://www.wiley.com/en-gb/ABC+of+Diabetes,+7th+Edition-p-9781118850534
- National Library of Medicine. Diabetic ketoacidosis. https://medlineplus.gov/ency/article/000320.htm
- Lizzo J.M., Goyal, A., Gupta, V. StatPearls: Adult Diabetic Ketoacidosis. StatPearls Publishing, 2022. https://www.ncbi.nlm.nih.gov/books/NBK560723/
- American Diabetes Association. Diabetes & DKA (Ketoacidosis. https://diabetes.org/diabetes/dka-ketoacidosis-ketones
- Centers for Disease Control and Prevention. Diabetic Ketoacidosis. https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html
- National Health Service. Diabetic ketoacidosis. https://www.nhs.uk/conditions/diabetic-ketoacidosis/
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