Diabetic ketoacidosis (DKA) is a dangerous and potentially life-threatening condition with thousands of preventable cases each year.
DKA most commonly happens in people with Type 1 diabetes, although it occasionally occurs in people with Type 2 diabetes. DKA happens when there is persistently high glucose in the blood and a lack of insulin.
There are two main stages of DKA.
Some types of illness can affect your diabetes control by raising your blood glucose levels. When you are ill, your body reacts by releasing more glucose into the bloodstream and increases insulin resistance, stopping it from working properly. This happens even if you are eating less food than usual or vomiting.
In someone without diabetes who is ill, the body simply releases more insulin to deal with the higher levels of glucose in the blood, bringing them back within the normal limits. However, in people with diabetes, this is not done, increasing the risk of developing DKA.
As the amount of glucose in the blood rises, the body tries to remove the excess by passing it out in the urine. This leads to dehydration, as the body moves water from cells to the bloodstream to dilute the glucose. As this happens, levels of sodium and potassium (called electrolytes) are affected too. When these are unbalanced, you become even more poorly.
Even though there is a lot of glucose in the blood, the lack of insulin means it can’t get to the cells where it is needed for energy. The cells send out emergency signals, and the body breaks down fat stores as replacement energy. As fat is broken down, poisonous acidic chemicals, called ketones, are released into the bloodstream.
Potential symptoms of stage one
· Blood glucose levels higher than 13.9mmol/L
· Going to the toilet a lot to pass urine
· Small amounts of ketones in the blood (0.6-1.5mmol/L) or urine
If DKA is detected at stage one, with only small amounts of ketones in the body, it may be possible to bring things back to normal by taking extra short-acting insulin – your healthcare team will tell you how.
If you have Type 1 diabetes and you are pregnant, it is even more important that DKA does not progress, so seek medical advice straight away. You will probably be admitted to hospital to ensure the safety of both yourself and your baby.
As DKA progresses into its second stage, the amount of ketones in your blood rises. Ketones are poisonous, and the body tries to remove them in the urine and on the breath. Higher levels of ketones in the blood can make you feel sick and can lead to vomiting. If untreated, high levels of ketones, dehydration and an imbalance of other chemicals in the blood can lead to unconsciousness and can eventually be fatal.
Potential symptoms of stage two
· Moderate to large amounts of ketones in the blood (over 1.5mmol/L) or urine
· Nausea and vomiting
· Deep rapid breathing
· Breath smelling of pear drops
If any of this happens, you will need immediate medical attention – usually being given fluids intravenously, and extra insulin to bring your blood glucose levels back under control. DKA can take up to 24 hours to develop in adults but develops faster in children.
It is important to get medical advice as soon as you think you may be developing DKA. Remember, at this stage, DKA is a medical emergency, and you should not try to treat it yourself.
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