Diabetic ketoacidosis is an acute complication of diabetes that can endanger life and usually seen in patients with diabetes mellitus type 1 (insulin-dependent diabetes). It is characterized by the presence of unacceptably high blood glucose (hyperglycaemia), ketones in the urine and certain acids in the blood. Ketone bodies are elements of metabolism that the body uses when you need to make energy for escape routes. This sometimes occurs with diabetes, this disease because glucose does not reach where you have to reach the liver, primarily, so it can be transformed into energy, hence the accumulation of glucose in the blood.



Patients with diabetic ketoacidosis require, in most cases, hospital care for treatment with fluids and intravenous insulin. If we also detected the presence of infection, antibiotic treatment is also needed. Diabetic ketoacidosis can often be avoided through proper treatment of type 1 diabetes.

What is the cause of diabetic ketoacidosis?

Ketoacidosis is always due to a fault, absolute or relative, of the action of insulin. In people with known diabetes, the cause of decompensation of diabetes is often the omission of the dose of insulin . Infections of any kind can also lead to diabetic ketoacidosis.

The main function of insulin is to reduce concentrations of blood glucose , but also reduces the metabolism of body fat, that is, makes it "burn" less fat. If you lack insulin in the body, raising the concentration of glucose in the blood and, if the amount of insulin is reduced significantly, the body begins to burn fat in an uncontrolled way. Excess blood glucose is accompanied by an appearance of glucose in the urine. Also elevated in the blood and urine ketones, acidic substances that produce a reduction in blood pH (metabolic acidosis). The body tries to compensate for acidosis by more frequent and deeper breaths with which remove excess acid. At the same time, removing large amounts of glucose in urine is associated with a significant removal of water and mineral salts, so that the patient is at high risk of dehydration.

What are the symptoms of diabetic ketoacidosis?

Since diabetic ketoacidosis is usually associated with unacceptably high blood glucose, the symptoms are the same as those of diabetes:

Increased thirst

Increased urination

Fatigue

Confusion

Possible unconsciousness.

May also occur symptoms of ketoacidosis, such as:



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Rapid deep breathing

Acetone smelling breath

Nausea, vomiting and stomach pain.

Diabetic ketoacidosis is often triggered by another disorder, usually by an infectious disease. Can arise in a period of few hours, or they develop over several days.

Self-help methods

Above all, the most important thing is to avoid the occurrence of diabetic ketoacidosis. This can be achieved by strictly controlling blood glucose levels. If glycemic control is carried out regularly, you will notice any abnormal elevation.

It is particularly important to measure blood glucose levels when a person with diabetes is not well.

If glucose levels are too high, then they must also measure ketones in the urine. To do this, there are test strips according to the color mark the introduction into urine, give us an idea of the amount of ketones present. Remember that the test strips to measure urine ketones expire quickly, so they will not be reliable if they are expired. If you detect ketones in the urine and glucose levels in the blood are too high, you should consult with a physician indicating the most appropriate treatment for each patient.

Diabetic ketoacidosis is often triggered by an infection, usually the urinary tract or respiratory tract .

A frequent combination is that of a stomach infection (gastritis) and ketoacidosis. Usually causes nausea, vomiting and loss of appetite, suggesting that the patient needs less insulin. However, during a serious illness, especially in case of infections with fever, almost always need more insulin. In fact, the administration of a lower dose of insulin when you need more because of an infection can quickly trigger diabetic ketoacidosis.

It is therefore critical that people with diabetes to determine their blood glucose levels if they are sorry for any reason or have any other disease. If blood glucose is high, management should be an extra dose of insulin and continuing tight control of blood glucose values.



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How do you know if a status of diabetic ketoacidosis?

The diagnosis of diabetic ketoacidosis is made:

Measuring glucose in blood (glycaemia). Generally the figures are double the normal, but may be even higher.

Measuring glucose in the urine (glucosuria). Keep in mind, however, that the measurement of glucose in urine is less accurate than measuring glucose in the blood.

Extracting a blood sample from an artery to measure blood pH, ie, the "acidity" of the body.

At the same time the doctor will look for signs of infection.

How is diabetic ketoacidosis and what medications are used?

Generally for the treatment of diabetic ketoacidosis, the patient should be admitted to hospital. In some patients need admission to an intensive care unit. Treatment consists of:

Intravenous fluids. At first they used saline and dextrose later.

Insulin administered as an intravenous infusion.

Potassium supplements added to the infusion.

Antibiotics if an infection is found.



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Exercise

Some diabetic patients believe that exercise will prevent having high levels of blood glucose and ketones in the urine. But really, in a state of diabetic ketoacidosis exercise can worsen the situation. Diabetic ketoacidosis is due to reduced insulin levels and should be treated with insulin.

What is the prognosis?

If ketoacidosis is diagnosed early and treatment begins early, the patient usually recovers completely within a few days. If not treated promptly ketoacidosis may endanger life.


Dr. Jan Erik Henriksen, a specialist in endocrinology, Dr. Henning Beck-Nielsen, a specialist in endocrinology, Dr. Ole Nielsen Hother, a specialist in endocrinology, Dr. Ian W. Campbell, general practitioner.