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Diabetic Ketoacidosis (DKA) is a serious condition that affects those with diabetes. It generally occurs when the body begins to break down fat at a rate that is abnormally fast. The liver, then, processes this fat into fuel, which is called ketones, causing the blood to become acidic in nature.
DKA occurs when the signal from the insulin produced in the body is so low that:
- Blood glucose cannot enter cells to be used as a source of fuel
- The liver produces a vast quantity of blood sugar
- Fat is broken down abnormally high for your body to process
The fat is eventually broken down by the liver into a fuel known as ketones. Ketones are generally produced by the liver when the body begins to break down fat after the consumption of your last meal. Such ketones are generally used by the heart and muscles. When ketones are produced far too quickly and begin accumulating in the blood, they prove to be toxic by making the blood acidic. This condition is known as ketoacidosis.
Now, let’s see how diabetic ketoacidosis is diagnosed and treated.
Diagnosis Of DKA
If your doctor suspects that you have developed diabetic ketoacidosis, they may conduct a physical exam and order some blood tests. In certain cases, further tests may be required to help in determining the precise trigger behind diabetic ketoacidosis.
Blood Tests
Blood tests that are used in the diagnosis of DKA will typically measure the following:
- Blood Glucose Level: If there is not sufficient insulin in your body to permit glucose to enter your cells, your blood glucose levels will rise, leading to hyperglycaemia. As your body continues to break down protein and fat for generating energy, your blood glucose levels will continue to rise.
- Ketone Level: While your body efficiently breaks down fat as well as protein for energy, acids that are known as ketones will enter your bloodstream.
- Blood Acidity: When there is an excess of ketones in your blood, your blood will turn out to be acidic (leading to a condition called acidosis). This can hamper the normal functioning of all organs in your body.
Additional Tests
Your doctor may order further tests to help in identifying underlying health conditions that could have contributed to DKA and checking for complications. Some of these additional tests may include:
- Blood Electrolyte tests
- Chest X-ray
- Urinalysis
- ECG (Electrocardiogram) of the heart
Treatment Of DKA
If you are diagnosed with DKA, you may be successfully treated in an emergency or casualty room or be admitted to a hospital. Treatment usually involves the following:
- Fluid Replacement: You will receive fluids (either through a vein or by the mouth) until you are rehydrated. These fluids will replace fluids lost through excessive urination and dilute excessive sugar present in your blood.
- Electrolyte Replacement: Electrolytes are minerals present in your blood that carry an electric charge, such as potassium, sodium, and chloride. When insulin is absent in your blood, there could be a drop in the number of electrolytes present. In such a scenario, you will receive electrolytes intravenously to help in keeping your heart, muscle, and nerve cells functioning optimally.
- Insulin Therapy: Insulin reverses the processes that lead to DKA. Besides fluids and electrolytes, you may receive insulin therapy: typically, through a vein. When your blood glucose levels fall to approximately 200 mg/dL and your blood is no longer acidic in nature, intravenous insulin therapy may be stopped, and your routine subcutaneous insulin therapy may continue.
As your body chemistry normalises, your doctor may consider additional testing to thoroughly check for probable triggers for DKA. Based on circumstances, you may require further treatment.
For instance, your doctor will help in creating a diabetes treatment plan. In case of presence of bacterial infections, antibiotics may be prescribed. In addition, if a heart attack seems probable, you may be told to conduct further evaluation of your heart.
On a Final Note:
Diabetic ketoacidosis (DKA) is a severe complication of diabetes mellitus that can prove to be life-threatening when not treated properly. Initially thought to occur only in those with type 1 diabetes, DKA has also been noted in those with type 2 diabetes, under certain circumstances. The fundamental underlying mechanism for DKA is a deficiency of insulin coupled with elevated levels of counter-regulatory hormones, such as cortisol, glucagon, growth hormone, and catecholamines.
