Diabetic ketoacidosis is a severe complication of diabetes, commonly developed in people with type 1 diabetes due to insulin deficiency. Those who miss insulin doses are most vulnerable.
What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a severe complication of diabetes that occurs when there is not enough insulin in the body, and it begins to break down fat and produce ketones as an alternative energy source. “When the ketone levels are high, it leads to acidosis, a condition in which the pH level in the blood decreases, making it acidic,” explains Dr Namratha Upadhya, endocrinology and pediatric endocrinology specialist at Aster RV Hospital, Bangalore.
Who is at risk?
Dr Gurulakshmi Moorthy, consultant endocrinologist at Gleneagles Hospitals, Chennai, says that DKA can develop in those recently diagnosed with type 1 diabetes and also seen in those with uncontrolled type 1 or type 2 diabetes. This is due to insulin deficiency, which leads to fat breakdown and ketone (high blood acid levels) production.
According to Dr V Mohan, diabetologist and founder chairman, Dr Mohan’s Diabetes Specialities Centre (DMDSC), DKA is more common in children with type 1 diabetes. “They are more at risk even if they miss one or two doses daily,” he adds.
“People with type 2 diabetes usually have enough insulin in the body to prevent ketoacidosis. However, spiking sugar levels (above 400 mg/dL), stress, and infections can lead to DKA,” adds Dr Mohan, who is also the chairman at Madras Diabetes Research Foundation (MDRF).
Causes of diabetic ketoacidosis
Dr Upadhya explains the factors that cause insulin deficiency leading to DKA:
- Missing or skipping insulin doses
- Poor sugar control in those with diabetes
- Inadequate insulin intake
- Unhealthy diet
- Those having undiagnosed diabetes
Dr Richa Chaturvedi, senior consultant, endocrinology, Indraprastha Apollo Hospitals, New Delhi, recalls the case study of a 15-year-old girl with type 1 diabetes who was brought to her with typical signs of DKA, including breathlessness. Her sugar levels had shot 450 mg/dL, against the normal range of less than 140 mg/dL post-meal. “DKA can occur if the person does not adhere to the required amount of insulin shots. I had prescribed her insulin four times a day. However, she didn’t follow the same. The family members were also not well informed about the condition. She missed insulin for a few days and often resorted to unhealthy food,” said Dr Chaturvedi.
Tests for diabetic ketoacidosis
Dr Moorthy suggests the following tests to diagnose diabetic ketoacidosis (DKA)
Urine ketone test: A simple point-of-care test that checks if urine ketone levels are high, which could indicate DKA if the person is also experiencing nausea, vomiting, and other symptoms.
Fingerstick blood ketone test: Another point-of-care test to check blood ketone levels.
Monitoring blood sugar and anion gap levels: Checking the blood sugar level, the acid-base balance (anion gap levels), and ketone levels helps diagnose DKA. The anion gap is checked every 2-4 hours to see if decreasing with treatment.
How to prevent diabetic ketoacidosis
Dr Moorthy says that hospitalization and close monitoring are required to treat diabetic ketoacidosis. “We need to give intravenous (IV) fluids to replenish fluids and electrolytes lost through increased urination. We also administer IV insulin to reduce blood sugar levels and ketone production. Blood sugar levels should be checked every hour,” says Dr Moorthy.
Dr Moorthy shares a few ways to prevent diabetic ketoacidosis (DKA) such as:
- Those with type 1 diabetes must take insulin as prescribed and ensure a steady supply while traveling. Insulin cannot be missed.
- Those with type 2 diabetes must closely monitor blood sugar levels and visit a doctor to determine if insulin is needed.
- Stay well-hydrated and maintain good nutrition to avoid ketosis from malnutrition.
- Beware of diabetic ketoacidosis risk factors like immune disorders and take extra precautions during illnesses.
Those following low carb should also monitor their ketone levels to avoid ketoacidosis. Dr Mohan advises following a balanced approach of carbohydrates, protein, and fat, physical activity, and good sleep.
Ketosis vs diabetic ketoacidosis
While many get confused between ketosis and diabetic ketoacidosis, they are not the same. Ketosis occurs when the body burns fat for energy without sufficient glucose. It can occur during fasting, prolonged exercise, or a low-carbohydrate diet. Ketosis is considered a mild and temporary condition.
For individuals with type 2 diabetes, obesity is a common concern that can worsen the condition. Ketosis helps in weight loss by using fat as the primary energy source, which can, in turn, improve glycemic control.
Dr Mohan says that in those who are losing weight through intermittent fasting or the keto diet, by cutting off carbohydrates completely, the body starts breaking down fat as a source of energy so that they go into the ketosis phase. This leads to the rapid loss of fat and aids in bringing down the blood sugar level.
“For people with type 2 diabetes, a keto diet can help control blood sugar levels and weight loss, as the body breaks down fat stores for energy when carbohydrate intake is very low in the short term. However, this is usually not sustainable in the long-term,” says Dr Mohan.
He adds that switching to ketosis through a keto diet (very low carbohydrate, moderately low in protein, and high fat) requires management and proper guidance from experts. A low-carb diet can be challenging to maintain in the long run and may not be suitable for people with certain health conditions. A keto diet is not recommended for people with type 1 diabetes.
Takeaways
- DKA is a serious complication of diabetes caused by a lack of insulin and ketone buildup in the blood.
- It is commonly present in newly diagnosed people with type 1 diabetes or those with poor blood sugar control.
- Symptoms include excessive urination, breathing issues, and nausea.
- Monitoring blood sugar levels and taking prescribed insulin is a must.
