How to Prevent Diabetic Ketoacidosis ?

Preventing Complications is Essential in Managing Diabetes Mellitus

Diabetic Ketoacidosis is one the more dangerous complications of uncontrolled Diabetes Mellitus, commonly seen in Type I Diabetes, which requires insulin treatment. It results from the combination of glucose getting lost in urine and body cells resorting to fat metabolism to get energy, producing ketones and acidosis, which can be fatal if left untreated. In preventing Diabetic Acidosis, awareness is the key and medical attention must be sought as early as possible.

Pathophysiology, Diagnosis & Management of Diabetic Ketoacidosis

What is Diabetic Ketoacidosis and what Leads to it ?

Diabetes Mellitus is a disease of glucose metabolism which affects a fairly large number of people in the world today. In this condition there is either a deficiency of insulin in the body, requiring Insulin injections (hence also known as Insulin dependent or Type I Diabetes Mellitus), or the body does not respond properly to insulin, a condition known as Insulin Resistance, requiring various measures to reduce the need for Insulin (hence also known as Non-Insulin dependent or Type II Diabetes Mellitus). Both the conditions are marked by a high glucose level in blood which may be associated with the presence of glucose in urine. It common symptoms are Polyuria (high frequency of urination), Polydipsia (high intake of water) and often weight loss (especially in Type I Diabetes) in spite of reasonable appetite.

Diabetic Ketoacidosis is generally a complication of Insulin dependent or Type I Diabetes Mellitus. In such persons, a severe deficiency of Insulin can lead to very high levels of glucose in blood, often over 300 mg/dl. Insulin is required by the cells of the body for absorbing glucose from blood, and in its absence, glucose levels tend to shoot up due to release of glucose from lever. When glucose levels rise too high, they tend to result in more urine formation as kidneys are unable to hold back glucose and glucose in urine takes a lot of water along with it. Simultaneously, the body cells which are dependent upon glucose for survival respond by converting fat to ketones which are used as a substitute to glucose. The rising level of ketones leads to Diabetic Ketoacidosis. It is marked by very high level of blood glucose, presence of ketones in blood and urine and dehydration.

What are the Dangers of Diabetic Ketoacidosis?

Diabetic Ketoacidosis is a medical emergency.

If untreated, Diabetic Ketoacidosis can lead to death. However, this actually happens in less than two percent cases, since with intensive medical care, the life can usually be saved.

What are the Risk factors for Diabetic Ketoacidosis?

Those with Type I or Insulin dependent Diabetes Mellitus with uncontrolled high blood glucose levels are at highest risk for this complication.

The high level of blood glucose can result from several conditions. These include missing doses of Insulin, insufficient dosage, infections or any other reason leading to stress. Infections like pneumonia, urinary tract infections, influenza and gastroenteritis are common causes.  Occasionally it can also be due to heart attack, surgery or stroke. It can occur in pregnancy, and rarely, it can also occur in Type-II Diabetes Mellitus, either in very severe illnesses, or in a small category of inherently prone cases, called Ketosis prone Type II Diabetes.

All these conditions raise the Insulin requirement, and if the Insulin dose is not increased accordingly, Glucose levels may continue to rise, finally leading to this condition.

What are the Symptoms & Signs of Diabetic Ketoacidosis?

There are several signs and symptom which can serve as warning bells and should alarm the person about the possibility of Ketoacidosis.

These include deep rapid breathing, dry mouth, dry skin, flushed face and a typical fruity breath odour. The patient may complain of nausea and vomiting and stomach pain along with fatigue, restlessness, headache, decreased consciousness and lack of appetite. Gradually, the breathing may become more disturbed and the consciousness level may deteriorate to a level of stupor and finally unconsciousness, leading to a state of coma.

The acidosis resulting from Ketones leads to a very typical, heavy breathing which is called ‘Kussmal respiration’ and is characteristic of Diabetic Ketoacidosis.

What to do when Diabetic Ketoacidosis is suspected?

If one can observe the symptoms and signs suggesting even a possibility of Diabetic Ketoacidosis, it should be treated as an emergency, seeking urgent medical attention, preferably in a Hospital setting.

The physicians confirm the diagnosis by the presence of High blood glucose, Ketones and Acidosis. Other tests are also undertaken to estimate the need for treatment.

Once admitted, the patient is treated with Insulin, which is the mainstay of treatment, along with large amounts of intravenous fluids to reverse the dehydration. Simultaneously, the treatment of precipitating condition like infections is also initiated.

How to prevent and avoid Diabetic Ketoacidosis?

The key to preventing Diabetic Ketoacidosis lies in a better control of blood sugar. However, keeping in mind the factors that can precipitate it may help and aid in early diagnosis.

In Insulin dependent Diabetes Mellitus, Insulin is the mainstay of treatment. To ensure that the dose being taken is adequate, one needs to monitor the blood glucose levels, as well as undergo regular medical evaluation. More importantly, one should always be aware about the factors that can increase the Insulin requirement of the body, like higher degree of physical exercise or stress. In all cases of illness, or infections, one needs to particularly watch for blood glucose level. In those unable to monitor blood glucose regularly, there is a greater need to be aware of the symptoms of Diabetic Ketoacidosis. In such cases, the Hemoglobin A1c level can also be helpful, as it reflects the mean blood glucose level over a period of last three months. A level of 7.0 or less indicates well controlled Diabetes, while a level of 8.0 and above suggests urgent need for more radical efforts to control Diabetes.

The first, and often the most important step in preventing Diabetic Ketoacidosis may be the awareness about what it means and when is it more likely to happen. Knowledge can be an important tool in keeping it away.