Diabetic Ketoacidosis

This was originally posted to my blog, Diabetes Odyssey.

Diabetic Ketoacidosis (DKA) is a frightening term for any diabetic. This condition can rapidly kill a diabetic if treatment is not administered immediately.

Ketoacidosis can occur in any person for a number of reasons such as alcoholism or starvation, but diabetic ketoacidosis is only found in diabetics, primarily uncontrolled type 1 diabetics. Often times a diabetic is first diagnosed with diabetes when rushed to the ER in severe ketoacidosis.

In general ketoacidosis is when the body produces too much ketones, it breaks down fatty acids and these build up in the blood and quite literally the blood becomes toxic and poisonous making the body deathly ill. The build up of acetone in the blood is marked by a sweet almost fruity smell on the breath and sometimes in the sweat.

Exactly what causes ketoacidosis in diabetics? When a diabetic is uncontrolled and their blood sugar runs too high over an extended length of time the body recognizes that it is being starved for insulin, so it begins to breakdown fat for energy. This breakdown of fat causes acid to build up in the blood and this leads to ketoacidosis.

Oftentimes diabetic ketoacidosis is triggered by illness and/or dehydration. If you are diabetic and have, say, a cold or the flu and your blood sugar has been running higher for a while, you are at high risk of developing ketoacidosis. Always drink plenty of water to avoid becoming dehydrated and ending up sick. Hydration is good for everyone, especially diabetics.

What are the symptoms of ketoacidosis? Frequent urination, unquenchable thirst/dry mouth, nausea, vomiting, muscle aches/cramps, dehydration, fruity smell on the breath, high blood sugar, shortness of breath (an uncontrollable fast, shallow breathing).

Before the early 1900’s diabetic ketoacidosis was the end-stage of diabetes. A person would develop diabetes and not long after (because insulin was not discovered yet) they would develop diabetic ketoacidosis and that very quickly led to death.

But now days diabetics are much more likely to never experience diabetic ketoacidosis, and if they do it is probably once and that would be at diagnosis of diabetes. If a diabetic suffers ketoacidosis at any time other than diagnosis it is probably due to another illness triggering it or because they don’t control their diabetes. Ketoacidosis can build slowly, but in most cases it goes from mild and barely noticed to an outright life threatening emergency in the blink of an eye.

I personally have been in DKA (Diabetic ketoacidosis) twice in my life. I did not go into DKA at diagnosis because I come from a family of diabetics and my symptoms were caught early (though I may have been on the verge of DKA). I actually had never even heard of DKA until I experienced it for the first time. Yup, no doctor or family member had ever told/warned me about DKA.

I was 19 years old and had been a type 1 diabetic for almost a dozen years already. I caught a bad cold that just wouldn’t go away. I was working but poor, stressed all the time, and had no insurance. I was not taking care of my diabetes at all other than my standard three shots a day. I was pretty much living off of fast food. One day I began to feel very sick, I still had this damned cold but now I was also feeling like I had the flu. I was achy all over, nausea and vomiting like every five minutes, I was so thirsty I would take a sip of water and feel it wet my mouth and then literally feel my entire mouth dry up immediately, I began to lose control of my own breathing, I couldn’t help but breathe fast and shallow, I had to concentrate and force my body to breath normally, but then it would just go back to short, shallow, fast breaths.

Finally I asked to be driven to the ER, I had been putting it off because I had no insurance and knew it would cost me thousands of dollars just to go to ER, but I now felt as if I was going to die.

And I was…

I had to be just about carried into the ER. The triage nurse took one look at me as my sister-in-law told her I was diabetic and she knew what was happening. I was rushed to a bed. I remember the nurse having trouble finding a vein.

“Her veins are collapsed.” She said, but eventually got a line in on the back of my hand.

I remember signing forms. When I looked at them several days later my signature was just a scribble and nowhere near the line it should have been written on.

I lost consciousness just after signing the forms. I came to almost 24 hours later. I had to pee soooooo bad, and my muscles were still very achy, but I did feel better. I was told by the doctor that if I had been brought in even a half hour later I would have probably died. I was told I had a bad bronchitis infection and diabetic ketoacidosis.

I spent almost four days in the hospital and learned a lot about why I needed to take better care of my diabetes.

One year later I fell into DKA again. Once again I was sick with a cold, under a lot of stress, and had no insurance. I recognized the symptoms early this time and went to ER. I was in the hospital for only two days this time but I felt miserable that I would let this happen again.

How do you treat DKA? First: Recognize the symptoms. Second: Test for ketones using a home test kit (you can buy these at any pharmacy for pretty cheap). Three:Go to your doctor or ER right away!

At the hospital you will be hooked up to an IV and given fluids, insulin, and electrolytes to rehydrate and replace lost electrolytes and reduce your blood sugar level to normal range. Many times your doctor will put you on a low carb (diabetic) and/or liquid diet for your duration of stay in the hospital. You also will be treated for any other illness you may have that could have caused you to fall into DKA (cold, flu, infection, etc.).

Diabetic Ketoacidosis is serious business but by no means should a diabetic live in constant fear of it. The vast majority of the time it can be prevented by keeping your blood sugar under tight control. When you get sick or have any kind of infection you should work even harder at controlling your numbers.

And drink plenty of water! Stay hydrated!

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when you go into a diabetic coma, do you remember anything while being in the coma itself? right before you go into the coma, are you in pain?

Thanks for the review. I’ve never been in DKA. I think I was approaching it, however, when I was diagnosed 32 years ago. My diabetes overtook my slowly. I’m a LADA T1D. I now know I had hyperglycemia symptoms about a year before my diagnosis. This slow onset saved me from DKA, I’m sure.

Hydration, as you mentioned, is a key factor in DKA and I’m beginning to realize it’s important for my CGM consistency.

Nice write-up!

All I remember before I lost consciousness is feeling like I was going to die (really, really sick). Then I woke up and had no idea how long I’d been out. I was shocked to hear it was nearly 24 hours! I was sure I had only been out for an hour or two. I didn’t dream or anything, it was like when you are put under for surgery, your out… and then you wake up.

The pain I was in before I lost consciousness was caused from the DKA and dehydration, headache, stomach upset, and achy all over, and muscle cramps…severe muscle cramps.

Had it once (thankfully) over all the decades. Long story short I got assaulted by a tree which jumped out at me, whacked my pump first and coupled with being ill, dehydrated from a ride, pump taking the impact, the infusion set damaged as well I went DKA.

Things just kept going up, changed sets, to no avail. Tried injections, didn’t make much effect, Kept drinking, kept being sick, it was a mess. Ketones kept going up so got a lift to hospital and booked myself in before midnight. Ketones were up to over 3 by this point and blood pH dropping quickly. Thankfully never lost consciousness though, but the docs took 23 attempts (they ran out of docs and nurses in A&E at the time as they are only allowed allowed to try 3 times before having to give up and let someone else try) to get the 3 drips into me as veins were collapsing (glucose, hydration and insulin drips). Think the trip to the hospital was the worst part as it seemed everything I touch hurt, every nerve in my arms as I tried to rest them on the car door, my head pounding, eyes stinging, drinking and being instantly thirsty again with my mouth feeling like glass paper.

I was out of hospital after about 16hrs. For me it was just a combination of many little things which on their own or only a few at a time would be pretty easily managed. The dehydration from the bike ride, my body recovering after the ride, the pump taking an impact, infusion set being damaged, and me having an infection.

But no matter we need to know when to give up and allow someone else to take over.

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i never been in dka, i been in a diabetic coma,.

I suspect that “diabetic coma” is a layperson’s term for DKA. Eric, if this “diabetic coma” was occurring when you were diagnosed with Type 1 diabetes, you almost definitely were in DKA.

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i don’t remember much about it, all i remember, is i lost consciousness,. & just feeling very sick, like i was going to die, it was 4 weeks, after i was diagnosed,. stuff from it do, come back,. so i do remember more & more everyday from it,.

Thank you Tamra and Nyadach for sharing your experience with DKA. It is not until you read the stories of those who have experienced DKA that you realize the seriousness of this condition.
I have never had DKA or ketones show up in blood tests. My HbA1c is always below 7 but my BGL control is poor. I stopped testing for ketones because tests strips are expensive and even when my blood glucose readings were extremely high no ketones ever showed up.
I thought I was going down the DKA pathway(and probably I was) a few month ago. I had to process a large catch of fish which should have been completed in a day but I was still filleting three days later.
My muscles and back were sore from catching the fish and my kidneys became sore as I stood and filleted the fish. I did not feel sick but my muscles, back and kidneys were aching. I struggled to keep BGL below 10 mmol/L (180 mg/dL) even although I had greatly increased my bolus and cut back on carbs. (I am a MDI) Although I was drinking sufficient fluids my urine went from dark yellow to brown. I was not running a temperature but I did not feel well. The next available doctors’ appointment was late on the afternoon when I had finished processing the fish.
A urine test strip showed ketones of about one, traces of blood and a BGL of about 9 mmol/L. My meter showed a reading of 8.6mmol/L. I was more worried about the positive blood result but because I was starting to recover, I was put on antibiotics. A few days of rest and things were back to normal.
May be the increased bolus and reduced carbs stopped me going into DKA but I have invested in ketones urine test strips and so far I have not had to use them.

Was it a hypoglycemic coma (extremely low blood glucose levels) erice? I had to inject my son once who is also T1 to bring him out of a hypo coma.

i think it might have been, but as i have, already say, i don’t remember much about it, some-stuff i do, some i don’t,