Patient education: Diabetic ketoacidosis (The Basics)

What is diabetic ketoacidosis? — Diabetic ketoacidosis ("DKA") is a serious problem that can happen to people with diabetes. It happens when chemicals called "ketones" build up in the blood.

DKA can affect people with either type 1 or type 2 diabetes, but it is more likely to affect people with type 1.

Normally, the body breaks down sugar as a source of energy. For this to happen, sugar gets into cells with the help of a hormone called "insulin." If there is not enough insulin, or if the body stops responding to insulin, sugar builds up in the blood. That is what happens when a person has diabetes.

If sugar cannot get into the cells, the body is unable to use it for energy. This is how DKA can happen:

●Blood sugar levels continue to increase.

●The body starts burning fat for energy instead.

●Burning fat can cause the body to make too many ketones.

●Ketones build up, making the level of acid in the blood too high.

DKA is an emergency and needs treatment right away.

What causes DKA? — People can get DKA for a few reasons:

●They do not know they have diabetes so they aren't taking insulin, and their body starts breaking down fat.

●They have a major illness or health problem, such as a heart attack or infection.

●They take certain medicines or illegal drugs.

●They don't take their insulin as directed.

●Their insulin pump does not work correctly.

What are the symptoms of DKA? — The symptoms can include:

●Feeling very thirsty and drinking a lot

●Urinating a lot, including at night

●Nausea or vomiting

●Belly pain

●Feeling tired or having trouble thinking clearly

●Having breath that smells sweet or fruity

●Weight loss

Should I see a doctor or nurse? — See your doctor or nurse right away if you have the symptoms listed above. Also, see your doctor or nurse if your blood sugar levels keep being higher than they should be. They might need to adjust your insulin dose.

Is there a test for DKA? — Yes. If the doctor or nurse thinks you have DKA, they will order several blood tests, including tests to check your blood sugar and ketone levels. They will also check your urine for ketones. These tests can show whether you have DKA.

Because DKA can cause problems with the heart, you might also need an electrocardiogram. This is a test that measures the electrical activity in the heart.

Your doctor or nurse will also talk to you about checking your urine for ketones at home. If you have type 1 diabetes, you might need to do this in certain situations, such as:

●If your blood sugar gets above a certain level

●If you are sick

●If you start having symptoms of DKA

You can buy urine test strips in a pharmacy or online. Some people use a meter to check for ketones in their blood instead of testing their urine.

Your doctor or nurse will tell you what to do if your ketone level is high.

How is DKA treated? — Treatment is usually done at the hospital. This can include:

●Fluids and electrolytes – During DKA, the body loses a lot of fluids. It also loses "electrolytes." These are chemicals in the body, such as sodium and potassium, that keep cells working normally. As part of treatment, doctors must replace lost fluids and electrolytes.

●Insulin – When the body has enough insulin, it can use sugar as fuel and it does not need to break down fat.

These treatments are usually given through a thin tube that goes into a vein, called an "IV."

During treatment, doctors will do regular tests to make sure you are improving. These include:

●Blood sugar – This will be checked every hour, at least until it improves.

●Other blood tests – These will be done about every 2 to 4 hours. They include tests to check your electrolyte levels and how your kidneys are working. One of the electrolyte tests lets the doctor monitor the level of acid in your blood.

Your doctor will also calculate something called the "anion gap." The electrolytes in your body have an electrical charge. The anion gap is the difference between the number of "positively charged" and "negatively charged" electrolytes. The anion gap is usually high when there are a lot of ketones in your blood. When it returns to normal, it is a good sign that you are getting better.

Can DKA be prevented? — You can lower your chances of getting DKA if you:

●Take your insulin exactly as instructed.

●Measure your blood sugar often to make sure that it is not too high or too low.

●Check your ketones at home, if your doctor told you to do this. Make sure that you know how and when to test, and what to do if your level is high.

●Ask your doctor about "sick-day rules." If you have an illness like a cold or the flu, your blood sugar might go up and down more than usual. This means that you need to check your blood sugar more often when you are sick. Your doctor or nurse can tell you how to adjust your insulin dose based on your blood sugar levels.

●If you are thirsty, drink fluids that do not have sugar. Sugary drinks, like juice, will increase your blood sugar more.

More on this topic

Patient education: Type 1 diabetes (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: Treatment for type 2 diabetes (The Basics)
Patient education: The ABCs of diabetes (The Basics)
Patient education: Hemoglobin A1C tests (The Basics)

Patient education: Type 1 diabetes: Overview (Beyond the Basics)
Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Overview (Beyond the Basics)
Patient education: Type 2 diabetes: Treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Glucose monitoring in diabetes (Beyond the Basics)
Patient education: Preventing complications from diabetes (Beyond the Basics)