What is Diabetic Ketoacidosis?
Have you ever wondered, what is diabetic ketoacidosis? Diabetic ketoacidosis, commonly referred to as DKA, is a life-threatening medical condition that requires emergency medical treatment. It affects people with type 1 and type 2 diabetes, though it is significantly more common in people with type 1 diabetes.
From 2009 to 2014, there was a significant rise in DKA hospital admissions – 19.5 to 30.2 hospitalizations per 1,000 people with diabetes. This is a rise of 54.9%. What’s more, each year between 2009 and 2014, the rate rose by about 6% annually across all age groups.
What is Diabetic Ketoacidosis (DKA)?
Glucose is the body’s main energy source. To be used for energy, insulin is required for the body to use glucose appropriately. Either our bodies produce the correct amount of insulin or endogenous insulin is administered, as is the case for someone with type 1 diabetes.
When DKA occurs, there is a lack of insulin in the body. Without insulin, the body is unable to use the glucose appropriately. Energy is required for our bodies to function, so fat is broken down for energy. Subsequently, ketones are produced. Ketones are a byproduct of fat breakdown. When ketones are produced and glucose levels are high, blood levels of various acids can become toxic, causing diabetic ketoacidosis.
DKA Symptoms
The most common symptoms of DKA are as follows:
- Stomach pain
- Nausea and vomiting
- Reduced alertness
- Deep, rapid breathing
- Dehydration
- Dry skin
- Frequent urination and increased thirst
- Fruity smell to the breath
- Headaches
When these symptoms develop – especially if there is difficulty breathing – it is important to seek emergency treatment and have a treatment plan in place with your healthcare provider.
Causes of DKA
Of course, as those with newly diagnosed type 1 diabetes know, it is extremely common to have DKA upon diagnosis. One study indicates that 27% of DKA cases are the result of newly diagnosed diabetes.
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However, we know that DKA is caused by a lack of insulin in the body. According to Beyond Type 1, “List prices for popular fast-acting insulins Humalog and Novolog have both risen 290% over the past decade. People with Type 1 diabetes without health insurance (or with high-deductible health insurance) face monthly costs upwards of $600 – sometimes much more – simply for the insulin needed to stay alive.”
Because people who are uninsured or underinsured may not be able to afford their insulin, they may withhold dosing or ration their insulin, ultimately causing DKA.
Insulin pump site failures can also cause DKA. When you use the same site repeatedly, lumps and bumps can occur, called liphypertrophy. When the pump site is inserted into an area with a lump, the cannula can kink, meaning that insulin is not infusing. This can cause DKA.
Treatment of DKA
Diabetic ketoacidosis is a medical emergency and should be treated as such. Once the above symptoms develop, it is important to seek treatment in an emergency department.
The goal of treatment is to reduce hyperglycemia with insulin, as well as to improve dehydration and correct electrolyte abnormalities. This can be a delicate balance, which is why it is not recommended to treat DKA at home.
To diagnosis DKA, the following laboratory tests are ordered:
- Ketones (urine or serum)
- Arterial blood gas (ABG)
- Basic metabolic panel (BMP), which measures electrolytes such as sodium and potassium, as well as kidney functions and chemical labs, such as anion gap
- Osmolality
- Blood glucose
When a diagnosis is achieved, treatment can commence.
Fluid Replacement
Fluid replacement will likely occur through an intravenous line. Electrolytes may be added to the IV fluids, depending on the values in your laboratory results.
Insulin
Insulin is often initially administered in an insulin drip. This means that insulin is given continuously at a slow but consistent rate, which helps to drive down the glucose levels. The combination of the fluids and insulin allows the glucose to reduce at a safe rate.
Electrolyte Replacement
Electrolyte replacement is ordered, depending on laboratory results. These may be ordered in oral form, through IV replacement, and added to IV fluids. Electrolyte replacement is a delicate balance because too little can be damaging to the heart and the nerves, but too much can have the same effect.
Prevention of DKA
If you are newly diagnosed with diabetes, a treatment plan for your new diabetes diagnosis can help prevent DKA from occurring. This will likely include a plan for blood glucose monitoring, insulin administration, and a meal plan.
Proper management of diabetes is the best way to prevent DKA from occurring.
If DKA is caused by omission or rationing of insulin, consult your healthcare providers to find a more affordable plan. There are also resources that a certified diabetes care and education specialist (CDCES) can help you with, so ask your provider for a referral.
Proper management of diabetes is key:
- Ensure that you are giving all insulin dosages as ordered and giving correct dosages
- Check blood glucose as recommended
- Follow your meal plan as recommended
- If using an insulin pump, ensure that you troubleshoot your pump site for failures
- Ask your provider for a sick day management plan
