Diabetic Ketoacidosis (DKA)
On the other end of the spectrum is hyperglycemia, or blood glucose highs. If glucose levels reach 250 mg/dl (13.9 mmol/l) or higher and ketones are present in the blood or urine, diabetic ketoacidosis (DKA) may be present.
DKA is most common in type 1 diabetes, although it can also occur in people with type 2. It happens when, in the absence of sufficient insulin (which enables the body to use glucose for energy), the body starts to break down fat for energy instead. Fat metabolism causes ketone bodies to form, throwing the acid balance off kilter in the bloodstream. Meanwhile, the liver continues to pump out more and more glucose, and blood glucose climbs higher and higher. The result is ketoacidosis.
When the body is under a severe degree of stress, hyperglycemia and possible DKA are possible. Infection, injury, surgical procedures, and even a simple cold or flu are all known offenders in causing blood glucose to rise. Sometimes people skip their insulin or medication because they are ill, which boosts blood glucose even higher. Dehydration caused by vomiting and diarrhea can also worsen blood glucose levels.
Insulin manipulation can also be an underlying cause of DKA, particularly in adolescents and young women with type 1 diabetes. This phenomenon is sometimes called diabulimia. One Joslin Diabetes Center study of women with type 1 found that 31 percent intentionally skipped an insulin dose at some point, while 8.8 percent of those did it regularly. Reasons given for intentionally omitting insulin treatment included fear of weight gain and fear of hypoglycemia. The researchers also hypothesized that emotional issues related to living with chronic diabetes could be a cause of insulin omission.
Never skip a dose of medication just because you are ill. Illness usually causes blood sugars to climb, and skipping your meds can make the problem worse. In many cases, you may require more insulin when you are ill. Talk to your doctor about a “sick day plan” for your medications and/or insulin dose.
Signs and Symptoms
Often, the symptoms of DKA are ignored initially because many closely resemble the flu or a viral infection. The fact that the flu itself causes blood sugars to rise and can trigger DKA complicates matters further. This is why frequent testing and staying on your treatment schedule is so important when you are ill.
Symptoms of DKA include the following:
Fruity smell on the breath (from acetone)
Muscle aches and stiffness
Extreme thirst and frequent urination
Rapid breathing or difficulty breathing
Unconsciousness or, in extreme cases, coma
A rare but potentially fatal complication of DKA is cerebral edema (swelling of the brain). Signs of cerebral edema include severe headache, irritability, drowsiness, and confusion.
Diabetic ketoacidosis should always be treated by a health care professional. Treatment consists of lowering blood glucose levels with insulin and restoring fluid and electrolyte balance with oral fluids or intravenous saline. In some cases, potassium or other electrolytes may also be administered intravenously. If the underlying cause of the DKA is illness or infection, it should be treated appropriately to prevent recurrence.
When to Test for Ketones
If your blood glucose levels are over 240 mg/dl (13.3 mmol/l), you should test for ketones. Ketone testing is particularly important when you are ill. Home urine tests, which consist of reagent strips that can be dipped in a urine sample and checked against a diagnostic color chart, are easy to perform and are an excellent tool for avoiding DKA. There are also combination blood glucose and ketone meters available in the United States that are useful for home testing (Precision Xtra, Abbott Diabetes Care; CardioChek, Polymer Technology Systems).