Ketoacidosis.
Also called diabetic acidosis, diabetic ketoacidosis (DKA) or sometimes metabolic acidosis or "diabetic coma".
This is a condition usually found in Type 1 diabetics and is often what leads them to a diagnosis.
(Occasionally Type 2's can get it as well, though they are more prone to another condition, called Hyperglycemic Hyperosmolar Nonketotic Syndrome - HHNS ).
Ketoacidosis is a dangerous complication because it is life threatening!
It occurs when there is a lack of insulin. The blood glucose rises and the body attempt to get rid of it in the urine.
This leads to dehydration. So the body pulls water from it's cells to try and keep the vital organs supplied. This upsets the electrolyte balance in the body.
Because there is no insulin to enable the body to use the glucose present as energy your body suffers from an 'energy crisis'- your cells are crying "I'm starving!" while surrounded with a feast - so it has to turn to using alternative energy sources, in this case stored fats, with the resultant release of ketones, (which are fatty acids that are breakdown products from the use of stored fat for energy), into the blood. As ketones are acidic they make the body acidic.
Blood sugar gets very high and glucose and ketones appear in the urine. Type 2's usually make enough insulin to keep process this under control.
Ketones may be tested for, both in the urine and in the blood.
Our ketone tests page gives the details of the various tests.
Causes.
1. Failing to take your insulin.
2. Not taking enough insulin.
3. A serious infection e.g. pneumonia, acute gastroenteritis or urinary tract infections.
4. Injury.
5. Emotional stress.
Sometimes no obvious cause can be found.
Symptoms
At first are the same as those of uncontrolled diabetes eg:-
1. Excessive thirst.
2. Frequent urination.
3. Headache and Light-headedness.
4. Nausea, vomiting and abdominal pain. If you have been vomiting
for 1-2 days see a doctor!!
5. Loss of appetite.
6. Weight loss.
As the ketoacidosis becomes more severe other symptoms appear eg:-
1. Sleepiness
2. Blurred vision
3. Deep rapid breathing (hyperventilation)
4. Confusion
5. A fruity odour on the breath, often described as 'smelling of pears' or like nail polish remover (acetone).
6. Though not common cerebral oedema (swelling of the brain) can occur (particularly in children).
If ketoacidosis is untreated it can progress and worsens until eventually coma occurs.
This is from a combination of severely high blood sugars, dehydration, shock, and exhaustion. Occasionally death follows.
This is a condition that requires urgent medical treatment!
To prevent ketoacidosis if you have an illness that has resulted in vomiting and inability to eat then do the following:-
1. Drink 1 to 2 glasses of fluid (about 340ml) every hour. If you cannot manage this then try 1 tablespoon every ten to fifteen minutes or, in desperation, suck on ice.
2. Alternate between sweet and salty drinks, eg, drink fruit juice/sodas or Bovril/ bouillon. You can even make ice cubes out of these liquids!
3. Take your insulin even if you are not eating.
4. If you can eat then follow your prescribed diet and make your drinks sugar free eg. water or diet sodas.
5. Be sure to monitor your BG every 3-4 hours, day and night, until the levels are within the normal range. Even if you are feeling very sick and cannot do this yourself you need to get someone to do it for you.
6. Avoid exercise until your BG levels are under control again - REST.
Treatment.
If you develop any of the symptoms above, you need to call your doctor.
He will be able to judge whether you can be treated at home by increasing your insulin levels and curing the dehydration or whether the problem is so severe that you need to be hospitalised.
Generally you will be put into the ICU (Intensive Care Unit) because they want to be able to keep a close watch on your vital signs.
You will be put on a drip that contains fluids to re-hydrate you, plus replace lost electrolytes (especially sodium and potassium).
Insulin will also be given intravenously to lower the blood sugars and reverse the ketosis. It can take a few days before your levels are back to normal but usually treatment results in a full recovery.
A note must be added here :-
Do not confuse Ketoacidosis and Ketosis.
Ketosis is one of the bodies natural and essential processes. It involves the metabolism of body fat for fuel when carbohydrates are lacking.
Unused portions of the fat, called ketones, pass out of your body in the urine. As ketones are acidic the removal of these keeps the body's acid/alkaline balance stable.
The process is regulated by a number of different hormones and does not lead to acidosis.
Ketosis is the bases of many low carbohydrate diets.