Everything You Need to Know About Diabetic Ketoacidosis (DKA)

Each year, in the United States alone, there are more than 200,000 cases of diabetic ketoacidosis, or DKA. If that number doesn’t seem all that high, take a look at the stories our audience has shared with us– so many of them involve an experience with DKA, and many were actually the impetus for their diabetes diagnoses.

But what is it? Well, for starters, diabetic ketoacidosis is an extremely serious condition that can lead to a diabetic coma, or even death. It occurs when the body experiences an insulin deficiency. When your cells can’t get the energy they need from glucose, they begin turning to body fat for energy, and burning that instead. The byproduct of this is a buildup of acids, called ketones, in the bloodstream. These excessive ketone levels can act as a poison, causing diabetic ketoacidosis.

If you have diabetes, or are prediabetic, it’s crucial that you know the symptoms of DKA because it can alert you to a potentially life-threatening emergency. It’s also one of the best ways you can avoid putting yourself through this frightening, and often painful, experience.

So, let’s take a look at the signs, as well as what you should do if you begin to notice them.

Nurse Starting an IV Line

What are the symptoms of DKA?

  • Confusion
  • Fruity-smelling breath
  • Difficulty breathing
  • Exhaustion, fatigue, general weakness
  • Frequent urination
  • Extreme thirst or dry mouth
  • Abdominal pain, vomiting, nausea
  • Dry skin (may also be hot or flushed)
  • Low blood pressure
  • Increased heart rate
  • High blood sugar
  • High concentration of ketones in urine
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    What causes DKA?

    As discussed, diabetic ketoacidosis is caused by insulin deficiency. If you don’t know you have diabetes, you’re likely unaware of what low blood sugar feels like, nor are you keeping track of your levels. For this reason, many people are often diagnosed with type 1 diabetes after experiencing DKA. People who are recently diagnosed might also run into this complication because they’re getting used to managing their condition. However, people who have had diabetes for years can, and do, encounter DKA.

    One common cause is illness. When you’re sick, you’re at increased risk of suffering from DKA. Because it’s harder to control your blood sugar, and you might not be drinking enough water or eating consistently, it’s not unusual for insulin levels to be thrown off. Further, the stress of illness raises both adrenaline and cortisol levels, which counteract the effects of insulin.

    If you’re ill, it’s important to check both your ketones and blood sugar levels every 4-6 hours. You can purchase an at-home urine ketone test kit at most drugstores or online without a prescription. It’s also a good idea to do a ketone test if your blood glucose level is higher than 240 mg/dl.

    Missed or insufficient insulin, heart attack, alcohol or drug abuse, trauma, severe dehydration, and some medications can also lead to DKA. If you think you’re displaying symptoms, it’s imperative that you contact your health care provider and/or visit an ER as soon as possible.

    Infusion bottle with IV solution in hospital

    How is DKA treated?

    If you’ve been diagnosed with DKA, you will either be treated in the ER, or admitted to the hospital. Their treatment plan will likely include:

    • Intravenous or oral fluid replacement
    • Intravenous Insulin therapy
    • Intravenous electrolyte replacement

    Regardless of the treatment plan, you will be required to have a follow-up evaluation with your doctor, and you will need to closely monitor both your blood sugar and ketone levels.

    Can DKA be prevented?

    Definitely. Just by learning to recognize the symptoms and preparing yourself for a DKA emergency, you’re protecting yourself. Other things you can do include:

    Take control of your management and be consistent: Make sure it includes a well-balanced diet and physical activity.
    Take medication consistently: Aim to take your medication at the appropriate times, without skipping doses
    Monitor your ketone level: Keep a close eye on your ketone level at times of increased risk of DKA (i.e. stress, trauma, illness).
    Monitor your blood sugar level: Keep a close eye on your blood sugar level, particularly at times of increased risk of DKA (i.e. stress, trauma, illness). It could help to keep a written record to track fluctuations.
    Talk to your doctor: Discuss a management plan with your health care team that includes how to properly adjust insulin to account for blood sugar changes.

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