Diabetic Ketoacidosis: Causes, Treatments and Prevention

Every year, the month of November is observed as the Diabetes Awareness Month - celebrated globally to raise awareness about both Type 1 and Type 2 diabetes. And, 14 November is observed as World Diabetes Day which is the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922.

The theme of World Diabetes Day and Diabetes Awareness Month 2019 is 'Family and Diabetes'. The day was initiated in 1991 by the IDF and the World Health Organization as a response to growing concerns about the escalating health threat posed by diabetes.

In the current article, we will take a look at diabetic ketoacidosis - an elevated form of diabetes.

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is the elevated form of diabetes mellitus, commonly referred to as diabetes. When compared to that of diabetes, the build-up of acids in your blood can be ^[1] life-threatening. The complication develops when your blood sugar levels are higher than the normal levels of 100 to 125 mg/dL. However, DKA does not occur overnight but worsens over time when the sugar blood levels are high; resulting in the production of blood acids called ^[2] ketones.

DKA amplifies with your body's disability to produce the required amount of insulin, causing the build up of ketones. As the lack of insulin restricts the^[3] utilisation of glucose for energy, the body breaks down fat as the alternative form of energy. It is the intensified form of type 1 diabetes and is rarely found in type 2 diabetes.

In children, DKA is termed as paediatric diabetic ketoacidosis and are found in children suffering from type 1 diabetes. It can cause abdominal pain, shortness of breath, confusion and in some cases coma. It is important to get ^[4] immediate medical attention for DKA because leaving it untreated can result in coma or death.

Diabetic ketoacidosis signs ^[5] often develop quickly. In some cases, the symptoms may be an indication of having diabetes.

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Causes Of Diabetic Ketoacidosis

The lack of insulin in your body results in the development of DKA. As aforementioned, this incites the release of hormones that utilises fat for energy. An individual ^[6] suffering from diabetes or who is at the risk of diabetes are the ones who can get affected by DKA. The condition is usually caused by:

1. Issues with insulin therapy

An inadequate amount of the hormone or missing out on insulin treatment can trigger the development of the condition. With insulin ^[7] being the prime element in the issue, a balanced level is critical for the human body function.

2. An infection or illness

As your body undergoes any attack from bacteria or viruses, it produces cerebral hormones such as cortisol or adrenaline to treat the disease. However, this extra production of ^[8] hormones can hinder the effect of insulin on your body - triggering the advancement of DKA. Some of the most common triggering diseases are urinary tract infections and pneumonia.

The other causes are:

• heart attack,
• emotional or ^[9] physical trauma,
• alcohol or drug abuse, especially cocaine,
• certain medications, such as steroid medication,
• menstruation, and
• pregnancy.

Risks For Developing Diabetic Ketoacidosis

DKA is not a common condition that occurs to any ^[10] individual. Your chances of developing DNA are high of you:

• have an alcohol or drug addiction,
• have a history of stroke or heart attack,
• have ^[11] type 1 diabetes,
• have experienced any sort of physical or emotional trauma,
• have a high fever,
• have a smoking habit,
• are under the age of 19, and
• are stressed.

Diagnosis Of Diabetic Ketoacidosis

If you find yourself constantly being affected by the aforementioned symptoms of DKA, it is important to pay a visit to the doctor.

The diagnosis will include:

• a blood test to check the ^[12] blood sugar level, ketone level, and blood acidity,
• blood electrolyte tests,
• urinalysis,
• chest x-ray,
• osmolality blood test,
• electrocardiogram,
• arterial blood gas test,
• blood pressure measurement, and
• a blood test to check the anion gap.

A ketone test is used for an individual diagnosed with type 1 diabetes, using a blood and urine sample. If the urine test shows a ketone positive result, the beta-hydroxybutyrate (common type of ketone) level in your blood will be tested.

Treatment Of Diabetic Ketoacidosis

If you are diagnosed with DKA after the diagnosis, you will be asked to get admitted in the hospital or be taken into the emergency room; depending on the seriousness of the diagnosis. The most common treatments for DKA involves:

1. Insulin therapy

Under this treatment, the individual suffering from DKA will be supplied with insulin to reverse the adverse effects caused by the ^[13] lack of insulin. Insulin therapy will be done through your veins, so as to regain the insulin level balance in your body. The therapy will help remove the acidity in your blood and the extensive therapy can be stopped ^[14] once the blood sugar level becomes 200 mg/dL. Once the blood sugar level falls to 200 mg/dL, it is advised to adapt to subcutaneous insulin therapy.

2. Electrolyte replacement

The mineral content in your blood, such as potassium, sodium and chloride carries an electric charge that is necessary for the ^[15] functioning of your body. These minerals are defined as electrolytes, which will be lowered in the absence of insulin. Therefore, through the electrolyte replacement treatment, your body will receive the necessary electrolytes through the ^[16] veins. This will aid in the proper functioning of the muscles, heart and the nerve cells.

3. Fluid replacement

Under this treatment, the individual will receive fluids intravenously, that is, through vein or mouth till the dehydration vanishes. It rehydrates ^[17] your body, that is, the treatment will replace the fluid lost through excessive urination and diminish the excess sugar levels in the blood.

Complications Of Diabetic Ketoacidosis

The treatment methods for DKA include fluid and electrolyte replacement among others. These methods may have some complications, such as:

1. Hypoglycemia or low blood sugar

The orchestrated supply of insulin into your bloodstream allows sugar to enter the cells in your body. This can cause a drop in the ^[18] sugar blood levels, resulting in the development of low blood sugar.

2. Hypokalemia or low potassium

The insulin and fluids used in the treatment of DKA have an adverse effect on the potassium levels in your blood. It can cause the potassium levels to drop ^[19] to an inadequate level, which can have a detrimental effect on the proper functioning of your nerves, muscles and heart.

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3. Cerebral oedema or swelling in the brain

The DKA treatments adjust your blood sugar levels. The sudden and quick adjustments can develop swelling in your brain. Cerebral oedema ^[20] is commonly reported in children, especially the ones who have been recently diagnosed with diabetes.

Prevention Of Diabetic Ketoacidosis

Unlike the other diabetic conditions and complications, there are ways that you can always adapt to avert the onset of the condition.

1. Monitoring blood sugar levels

One of the primary methods in preventing the onset of the condition is by keeping an eye on the level of sugar in your blood. Check and ^[21] record the blood sugar level at least three times per day, if you are under stress or have any illness, check more often.

2. Adjusting the insulin dosage levels

In accordance with your blood sugar levels, it is necessary to change your insulin intake. Talk to your doctor and understand the procedure of insulin intake, the relation it has with your blood sugar level, your food habits, activities and health condition.

3. Managing diabetes

Follow the diet and exercises your doctor has prescribed for your diabetic condition. Exercise on a daily basis, and commit to your diabetic medication.

4. Checking the ketone level

In the event of any illness or if you are under any stress, test your urine to assess the level of ketone. This can be done with the help of a urine ketones ^[21] test kit, which is available in drug stores. If the ketone level is high, get immediate medical attention. If the levels are low, you may be in need of insulin - but always consult your doctor.

5. Be prepared

If you find yourself having the symptoms of DKA, that is high blood sugar level and excess ketone in urine, go to a hospital immediately.

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