How to Avoid Diabetic Ketoacidosis

Diabetic Ketoacidosis is a life-threatening diabetes complication caused by hyperglycemia. Here's what you can do to avoid this problem.

red emergency department signDiabetic ketoacidosis is a life-threatening complication. (Photo:123rf)

Diabetic ketoacidosis (DKA) is a possible complication of diabetes caused by extreme hyperglycemia, or high blood sugar.  It is a serious and potentially life-threatening acute complication, Diabetic ketoacidosis mainly affects people with type 1 diabetes, but it can be a very rare possible complication for people with type 2 diabetes.

Your healthcare provider and certified diabetes educator will be able to teach you how to recognize and manage diabetic ketoacidosis with a plan that is individualized for you. It's critical to know and recognize the signs and symptoms of DKA, as well as how to treat it.

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis happens when your blood glucose level gets too high for too long —generally above 250 mg/dL with the presence of ketones in the blood and confirmation of acidosis

When we talk about basic physiology in the context of how our bodies work, our brain, muscles and nerves all use sugar for fuel.  Insulin is essentially ushers the sugar from our bloodstream to the places that need it.  If there is no insulin or not enough insulin, sugar cannot pass into the brain, muscles or nerves.  Without that fuel, the body starts to break down fat, which produces ketones, chemicals that the body creates when fat is broken down.  As more ketones enter the bloodstream, they make it more acidic, and higher levels lead to acidosis.  

DKA usually develops slowly, but if someone is without any insulin for longer than five hours (if someone is wearing an insulin pump and it is not working or someone with type 1 diabetes stops taking long acting insulin for a few days), ketoacidosis can occur.

Your body can handle a small amount of ketones circulating in your blood. However, the sizeable amounts from DKA lead to the blood becoming acidic and the body reacting negatively to that.

Diabetic Ketoacidosis Causes

Illness, infections, physical and mental stress, injuries, and missing insulin doses for periods of time can cause DKA.

Diabetic Ketoacidosis Symptoms

Initial symptoms of DKA may be elevated blood sugars, but then can progress to include a stomach ache, nausea, and vomiting. It is important to consider that people may mistake the symptoms of DKA for the stomach flu or food poisoning and let it progress too far that the only remedy would be a trip to the emergency room.  With diabetes, it is crucial that if blood sugars are above 250 mg/dL for more than 4 hours without coming down using insulin and vomiting is present, it may be necessary to go to your local hospital emergency room.

Other symptoms of diabetic ketoacidosis include:

  • fruity breath
  • fatigue
  • when fat is broken down by the body, it creates a chemical called acetone that smells fruity
  • frequent urination
  • intense thirst
  • headache

If any of these symptoms are present, you should check your blood glucose level. If your blood glucose is greater than 250 mg/dL for a prolonged period of time and you are not feeling well, you may be at risk for DKA.

Diabetic Ketoacidosis Diagnosis

In order to confirm if ketoacidosis is present, the next step is to test for ketones. It is recommended that those with type 1 diabetes should always have ketone strips handy.  There are two types of ketone strips: urine and blood ketones test strips.    Urine ketones tests strips are available over-the-counter and less expensive than blood ketone test strips.  However, urine ketone strips will be giving you urine ketone test results that may be several hours old.  Blood ketone test strips are reading the ketones in your blood and are the most up-to-date reading. If blood ketone test strips are covered on your insurance, you will need a prescription from your prescribing healthcare provider to obtain a meter and the strips.  If using urine ketone strips, be sure to read the expiration date.  Once the bottle is opened, the strips will only be able to be used for 6 months.

What Should I Do If I Suspect DKA?

Talk to your healthcare provider now about how to manage different ketone levels in your body. Slight ketones may be treated at home, while higher levels with the presence of nausea, vomiting and abdominal pain along with trouble breathing indicate the possibility of DKA and require medical intervention. As a general rule, if your blood glucose level is above 250 mg/dL for several hours and will not come down and you have confirmed high levels of ketones with a ketone test, you should seek emergency care at a hospital.

The doctors and nurses there will use insulin and IV fluids to treat the ketoacidosis episode.

Diabetic Ketoacidosis Prevention

Good blood glucose control and always taking your diabetes medications and insulin is the best way to keep blood glucose levels low enough to avoid DKA.

However, because illness and infections are responsible for many DKA episodes, you should have a plan to reduce the risk of DKA.

If you have not already done so, it is important to see a diabetes educator at least annually for updates on overall diabetes care.  Sick day management is a required part of the information provided to people with diabetes and it is important to have a plan that is specific to you.

Topics should include:

  • When to contact your healthcare provider
  • How to adjust medications during illness to help reduce high blood sugars
  • What should be used to reduce fever and possible infections
  • Types of food to eat during an illness including easily digestible foods containing carbohydrates and salt, like crackers, soups, and pretzels. They will help encourage you to drink fluids as well, to reduce risk of dehydration.
  • Have urine ketone strips in the house. Make sure they are not expired – once you open the bottle, the test strips will only work correctly for
  • Report your illness to the healthcare provider when it causes your blood glucose levels to rise and causes urine ketones.
  • Test blood glucose levels and ketones frequently, about every 2 to 4 hours, until they are normal again.  Based on ketone levels, extra insulin may be required.
  • Get advice from your health care team if your blood glucose levels are above 250 mg/dL for more than 6 hours, if you are unable to take fluids or food for more than 4 hours, if you have a fever (101.5° F), if you are ill for more than 24 hours, or if you have these symptoms we spoke of such as dehydration, severe abdominal pain, or other unexplained symptoms.

    NEVER discontinue taking insulin and to seek professional advice early in an illness.  Continue to take your insulin even if you can't eat solid foods. Your insulin needs will probably increase with illness. If you take pills for diabetes, continue to take them too. If you cannot keep the pills down or if your blood sugars are <70 mg/dL, call your healthcare provider.
  • Continue to try to eat and drink even if your blood glucose levels are high, if you are vomiting or if you have diarrhea. Take some carbohydrate every 3 to 4 hours to prevent low blood glucose. If you can't eat, try carbohydrate containing liquids or soft foods. These include 1/2 cup regular soft drinks, 1 double Popsicle, 1/2 cup regular Jell-O, 1 cup Gatorade, 1 cup soup, 1/2 cup fruit juice, 1 slice toast or 6 soda crackers.
  • To prevent dehydration, drink at least 8 ounces of fluid every hour. If you are vomiting, limit fluid to 1-2 tablespoons every 20 minutes, or suck on a Popsicle. Fluids with electrolytes like potassium and sodium can help prevent dehydration.
  • Limit your activity if your blood glucose levels are above 250 mg/dL and ketones are moderate to large or if blood sugars are >300 mg/dL without ketones.

While the above recommendations are general rules, be sure you work with your healthcare provider and a diabetes educator to create a plan that is right for you.

Updated on: July 11, 2019
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