Now I had a slight knowledge of what DKA or Diabetic Ketoacidosis is, thanks in part to my being an Administrator of this site, but no REAL knowledge. So I set out to find what I didn’t know. I asked lots of my friends with diabetes, many of whom are T1’s. They either haven’t had a case of DKA or experienced it when they were young, at the time of diagnosis. I wanted to search out the facts, as there is such a fear related to DKA, and I wanted to truly know why.
WHAT WE KNOW:
“According to the Wikipedia entry,”… Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). Near complete deficiency of insulin and elevated levels of certain stress hormones combine to cause DKA. DKA is characterized by hyperglycemia, acidosis, and high levels of circulating ketone bodies. Onset of DKA may be fairly rapid, often within 24 hours.
A key component of DKA is that there is no or very little circulating insulin so it occurs mainly (but not exclusively) in type 1 diabetes (because type 1 diabetes is characterized by a lack of insulin production in the pancreas). It is much less common in type 2 diabetes because the latter is closely related to cell insensitivity to insulin, not, at least initially, to shortage or absence of insulin. Some type 2 diabetics have lost their own insulin production and must take external insulin; they have some susceptibility to DKA, somewhat like Type 1s.
What are the signs and symptoms of DKA?
The symptoms to watch for are not always obvious. They can start slowly and can be mistaken for other illnesses. Often toddlers do not show the classic signs of DKA.
• Feeling tired or fatigued
• Excessive thirst and/or excessive urination
• Signs of dehydration such as dry mouth
• Abdominal pain
• Rapid, deep, labored breathing (Kussmaul’s respirations)
• Breath that smells fruity
WHAT WE DON’T KNOW:
What damage can be incurred by DKA? Renal failure, chronic heart failure, and respiratory distress can happen due to DKA. Even after someone has survived DKA, the resulting damage can be extensive. The long term damage can inflict the value of life as we know it. “It is the metabolic acidosis that pushes you into respiratory distress and is what can kill you,” according to Holly Brewer, MS RD CDE
WHAT WE NEED TO KNOW:
I spoke with my good friend, Dr. Michael B. Davidson, who is an Endocrinologist in New Hampshire, he gave me this analogy: “Starvation in a time of plenty. Insulin is the key that lets glucose into cells, if you have no insulin, the cells think they are starving. When insulin binds to the surface of the cells, little channels open up to let the glucose move from the blood to the cells. When there is no insulin, there is a lot of sugar in the blood stream, but the cells are blind to it. Your body’s response it to try to find MORE glucose. Glucagon, and other ‘stress hormones’ are released and tell the liver to break down storage glucose (glycogen) and to make new glucose (gluconeogenesis). When the liver makes new glucose, it needs building blocks. One of the important building blocks comes from the breakdown of triglycerides. The liver uses glycerol to make glucose, but the remaining part of the triglyceride breakdown becomes ketone bodies. All of these factors act as a vicious cycle to worsen DKA.”
One of the ways that DKA is becoming recurrent, that I learned while doing the research for this article was insulin manipulation. We are seeing more cases of DKA in women now more than ever before. Taking less insulin so as to lose weight, which is truly an eating disorder in type 1 diabetics, it is known as “diabulimia,” Women with eating disorders and diabetes typically struggle with symptoms similar to those of women with eating disorders who do not have diabetes. However, they exhibit a very dangerous symptom of calorie purging in the form of insulin restriction. This was something I was quite unaware of, it is very scary to know that someone may be “starving” their bodies of insulin. I’m sure a lot of people have never heard of this condition.
How to be on the lookout for DKA:
Testing of ketones MUST be done:
• Anytime your blood glucose is over 250 mg/dl for two tests in a row.
• When you are ill. Often illness, infections, or injuries will cause sudden high blood glucose and this is an especially important time to check for ketones.
• When you are planning to exercise and the blood glucose is over 250 mg/dl.
• If you are pregnant, you should test for ketones each morning before breakfast and any time the blood glucose is over 250 mg/dl.
Call your diabetes educator or physician, as you may need additional insulin. Drink plenty of water and fluids containing no calories to “wash out” the ketones. Continue testing your blood glucose every 3 - 4 hours, testing for ketones if the blood glucose is over 250 mg/dl. Do not exercise if your blood glucose is over 250 mg/dl and ketones are present.
Have you had DKA? What has been your experience? What can you share that will help others?