• Diabetes
• Type 1 Diabetes
• Type 2 Diabetes

Understanding Diabetic Ketoacidosis (DKA): Causes, Symptoms, and Treatment

Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes. It occurs when the body starts to break down fats too quickly due to a lack of insulin. When the body doesn’t have enough insulin to use glucose for energy, it turns to fat stores instead, producing acids called ketones as a byproduct. When ketone levels become dangerously high, blood acidity rises, which can disrupt multiple bodily functions and lead to severe health issues if untreated.

What Causes Diabetic Ketoacidosis?

Diabetic ketoacidosis typically occurs when insulin levels are too low to allow glucose to enter cells for energy, causing the body to rely on fat breakdown as an alternative energy source. This breakdown of fat produces ketones, which, in excess, increase blood acidity and lead to ketoacidosis. Common causes of DKA include missed insulin doses, infections, and severe physical or emotional stress, all of which can further reduce insulin availability or effectiveness. 

Who is Most at Risk for Diabetic Ketoacidosis?

DKA is more common in people with type 1 diabetes because they don’t produce any insulin naturally. Without insulin, the body can’t use glucose for energy. This prompts the liver to release stored glucose to compensate, even though blood sugar levels are already high. This results in an even greater accumulation of glucose in the blood, which the body cannot process, pushing it toward fat breakdown and excessive ketone production.

In type 2 diabetes, DKA is less common but can occur when insulin levels drop severely due to infection, illness, or intense stress. Under these conditions, the body may still enter ketosis, with ketones accumulating rapidly if left unchecked.

Other contributing factors include insulin pump malfunctions, certain medications, and consistently high blood sugar levels. Without enough insulin, glucose remains in the bloodstream, prompting ketone buildup and acidity changes that disrupt various bodily functions. Because of these risks, DKA is considered a medical emergency requiring immediate intervention to restore insulin levels, reduce blood acidity, and protect against potential complications.

What are the Symptoms of Diabetic Ketoacidosis?

Diabetic ketoacidosis symptoms can develop rapidly and vary in intensity. Early symptoms often include excessive thirst and frequent urination as the body tries to eliminate excess glucose through the urine. This is usually accompanied by fatigue, weakness, and high blood sugar levels. 

As DKA progresses, more severe symptoms may appear – such as abdominal pain, nausea, vomiting, and a distinct fruity-scented breath – caused by ketones. Individuals may also experience confusion, shortness of breath, and, in extreme cases, loss of consciousness. Recognizing these symptoms early is crucial, as untreated DKA can lead to serious complications and requires immediate medical intervention to prevent further health risks.

Diagnosis of Diabetic Ketoacidosis

Diagnosing diabetic ketoacidosis involves a series of blood and urine tests that assess blood sugar levels, ketone presence, and blood acidity. Standard diagnostic methods include blood tests to measure glucose levels, pH levels to determine blood acidity, and ketone levels, which indicate how much fat the body is breaking down. Urine tests for ketones are also commonly used to confirm the diagnosis and gauge the severity of ketone buildup. 

Key markers in these tests include elevated blood sugar, a high concentration of ketones, and a lower blood pH – all of which point to the onset of ketoacidosis. 

How Do You Treat Diabetic Ketoacidosis?

DKA treatment requires swift medical intervention to restore blood chemistry balance and insulin levels. The primary steps in treatment include rehydration, electrolyte replacement, and insulin therapy. Rehydration is achieved through intravenous (IV) fluids to restore fluid balance and support blood circulation. 

Because DKA depletes the body’s electrolytes – such as potassium, sodium, and chloride – replacement is necessary to prevent complications related to muscle and heart function. Insulin therapy is then administered to help lower blood sugar levels and halt further ketone production. 

For severe cases, doctors may administer a bolus of normal saline to rapidly rehydrate the body and restore blood volume. A bolus can help lower high blood sugar quickly while awaiting other treatments. In certain cases, medications such as metformin may also be adjusted to help maintain stable blood sugar levels post-treatment.

Can You Prevent Diabetic Ketoacidosis?

Prevention of DKA centers on maintaining stable blood glucose levels, proper insulin management, and regular ketone monitoring, especially during illness or periods of increased stress. Consistent communication with a healthcare provider about diabetes management can help identify and mitigate early warning signs.

For patients on medications such as metformin or SGLT2 inhibitors, careful monitoring may be necessary to monitor for signs of DKA or euglycemic DKA. For those using insulin pumps, ensuring the device is functioning properly is critical in avoiding missed doses that could lead to DKA.

Complications and Long-Term Risks

Untreated DKA can lead to severe complications such as kidney damage, brain swelling, and, in severe cases, death. Long-term risks are also a concern, as recurrent DKA episodes can weaken organs, increase the risk of cardiovascular issues, and affect quality of life. Proper management of diabetes and an understanding of DKA symptoms and risks are essential to preventing these complications.

While LifeMD offers care to patients with chronic conditions, DKA is a serious condition that requires ongoing specialty care and extensive work from an in-person healthcare provider. This being said, if you’re concerned about your DKA or other potential diabetes complications, LifeMD may be able to help.

LifeMD can offer guidance on ways to maintain healthy habits that may support the management of your condition and avoid further complications.

Additionally, a licensed medical provider may be able to treat other conditions contributing to DKA. Your healthcare provider may offer guidance on effective ways to manage your condition and/or prescribe the appropriate medication.

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