Six Warning Signs of Diabetic Ketoacidosis

February 22nd, 2011

Ketoacidosis is a diabetic emergency which occurs as a result of a lack of insulin. Without insulin, the body is unable to use sugar for energy. Unable to use sugar, the body burns its fat stores for energy.

As the fat is broken down, byproducts called ketones are released, building up in the blood and urine. Ketones are acid waste products, and are dangerous at high levels. Blood sugar rises as the liver produces more glucose in an attempt to fuel the body, causing further acidity.

A diabetic who experiences two or more of the following warning signs, and has high glucose readings (over 300mg/dl) should contact their doctor or go to the hospital immediately:

  1. Breath that smells like fruit or nail polish remover
  2. Labored breathing (gasping)
  3. Pronounced thirst
  4. Stomach or abdominal pain
  5. Nausea and vomiting
  6. Flushed complexion

Diabetic ketoacidosis (DKA) usually develops slowly over 24 hours, starting with symptoms such as fatigue, mental stupor, decreased appetite, loss of appetite, headache, and fading consciousness. Often the symptoms of ketoacidosis lead to an initial diagnosis of type 1 diabetes.

Once the patient starts vomiting, their condition can deteriorate very quickly. If treatment is delayed, the diabetic can fall into a life threatening coma. Ketoacidosis is especially dangerous in the elderly.

Immediate treatment involves an insulin injection to reduce blood glucose levels, and the administration of fluids and electrolytes to combat the dehydration that accompanies DKA. The average adult DKA sufferer loses about one and a half gallons of fluid.

Ketoacidosis is a concern for insulin dependent type 1 diabetics, but occurs much less frequently in type 2 diabetics. Diabetics who are Hispanic or African American are more at risk of DKA. DKA is more common in children and adolescents, and, for unknown reasons, slightly more common in women.

DKA is often the result of an illness. Diabetic ketoacidosis can also result from:

  • A missed insulin dose
  • Incorrect insulin dosing
  • A malfunctioning insulin pump
  • An increased need for insulin (sometimes as a result of a growth spurt in children)
  • Infection
  • Surgery
  • Trauma
  • Heart attack
  • Use of cocaine

Diabetics can easily test their urine for ketones are using a test strip similar to a glucose test strip. Ketone testing should be done whenever the blood sugar is higher than 240 mg/dl, during an illness or health crisis such as a stroke, during pregnancy, and whenever a diabetic is experiencing nausea and/or vomiting. Diabetics who are ill should check their ketones every 4 to 6 hours to ensure adequate diabetes control.

DKA can largely be avoided with proper diet and self care when diabetics are ill or otherwise at risk, including adjusting insulin levels when needed. Before the introduction of insulin injections in the 1920's, DKA was almost always fatal. Since the 1950s, the mortality rate has, thankfully, been reduced to between one and ten percent.