Your breath could reveal a lot about your blood sugar levels, especially if there is an acidic fruity tinge to it. Endocrinologists and dental experts point out that this could be the indication of not just minor blood glucose fluctuations or poor oral hygiene but diabetic ketoacidosis, a condition most prevalent in type I diabetes, if not addressed in time could trigger multi-organ failure.
What causes fruity breath?
Fruity breath or acetone breath would be something like that of nail polish or decaying apples.
According to Delhi-based Dr Ritesh Gupta, MD, director, Fortis CDOC Hospital, fruity breath occurs because of excess ketone bodies in the breath. He explains it can occur in people with diabetes if there is a deficiency of insulin.
In the absence of insulin, the body tries to get energy by metabolising fat, instead of sugar. In this process, ketone bodies are produced as a by-product which is usually passed out in the urine. “If formed in excess, these can be present in the breath as well which gives it a fruity odour,” explains Dr Gupta.
For Delhi-based Dr Aman Popli, principal consultant, cosmetic dentistry, prosthodontist and implantologist, Max Multi Speciality Centre, Panchsheel Park, usually, a slight whiff of acid breath is enough to suspect diabetes, and the individual is advised to get the required tests done for confirmation.
“Most people are unaware or unable to associate fruity breath with diabetes till the time their results reflect the condition,” explains Dr Popli.
A study published in December 2019 in the Diagnostics journal suggested that breath gases, including acetone, may be related to simultaneous blood glucose (BG) and blood ketone levels in adults with type 2 and type 1 diabetes. Detecting altered concentrations of ketones in the breath, blood and urine may be crucial for the diagnosis and monitoring of diabetes mellitus. The study assessed the efficacy of a simple breath test as a non-invasive means of diabetes monitoring in adults with type 2 diabetes mellitus.
Dr Paras Agarwal, consultant endocrinology and diabetes, Max Multi Speciality Centre, Panchsheel Park, explains that fruity breath should be considered a warning sign of diabetes or prediabetes.
Ketosis vs ketoacidosis
Dr Gupta explains how ketoacidosis is different from ketosis. “Ketosis is an earlier stage when the level of ketones in the blood increase, but the patient is usually stable and does not have many symptoms.” Ketosis can also occur because of an increased intake of oils and fats especially when one takes a keto diet. “Certain medications used to treat diabetes, namely a class of drugs called SGLT inhibitors can also lead to mild ketosis,” he explains.
On the other hand, diabetic ketoacidosis (DKA) occurs when the level of ketones in the blood is very high, and this leads to an increase in the acidity of ketones.
“When ketones get accumulated in the blood, acidity of blood increases and it is called diabetic ketoacidosis. This can cause vomiting, abdominal pain, dizziness and confusion,” explains Dr Gupta.
Ketoacidosis, the most critical diabetic complication
Dr Gupta explains the increased acid levels in the blood can cause disturbances of important electrolytes like potassium and sodium. “If not treated urgently, the condition of the patient can deteriorate rapidly, and it can be fatal,” he cautions.
An article published in the World Journal of Diabetes in 2019 explains that the presence of DKA is accompanied by several electrolytes, metabolic and acid-base derangements that affect the respiratory system. Depletion of ions, such as potassium and phosphate, affects the respiratory muscles leading to acute respiratory failure.
Who is at risk of diabetic ketoacidosis?
Dr Gupta explains diabetic ketoacidosis primarily occurs in patients with type 1 diabetes.
“The risk is high if an insulin dose is missed or if there is a major dietary indiscretion. An infection, stroke or heart attack can also precipitate ketoacidosis in patients with diabetes,” he explains.
According to Dr Gupta, the presence of high glucose values and increased ketones in blood and urine help diagnose ketoacidosis. “There are convenient dipsticks available which can be used by patients at home to check urine,” says Dr Gupta.
Symptoms and prevention
Increased urination, thirst and unexplained weight loss are the common signs of diabetes. Experts recommend checking the sugar level and consulting a physician so that appropriate treatment can be started and the progression to ketoacidosis can be prevented.
Dr Gupta reckons fruity breath should always be taken seriously in a person with diabetes and should prompt an urgent visit to the emergency room of a hospital. “It is sadly true that many patients with diabetes are diagnosed for the first time when they present with ketoacidosis in the emergency room. This is especially true for children and teenagers with type 1 diabetes,” he explains.
The most important preventive step is to control the sugar level; symptoms of high sugar should not be ignored.
For patients on insulin, it is vital that they do not miss the insulin dose. If there is fever, cough, cold, vomiting or any infection, the sugar level needs to be monitored frequently and doctors might make appropriate adjustments in insulin or medications.
Also, it is very important to take enough fluids to ensure proper hydration.
A word of caution
Dr Gupta explains diabetic ketoacidosis is an emergency and patients require hospitalisation with large amounts of intravenous fluids, insulin and a correction of potassium and other electrolytes. If appropriate treatment is started early, most people recover well.
“Once they recover from ketoacidosis, people need to be careful that they don’t have an episode again. All the preventive measures should be observed,” he says.
A visit to the diabetologist is a must
Dr Agarwal reckons that people with bad breath are usually not prompt in spotting diabetes because they only consult a dentist if they have severe dental issues. Sometimes it can be spotted during a health check-up. “Mostly the dental component is handled by the dentists and sometimes we are referred to the individual by the dental department for diabetic consultation,” explains the endocrinologist.
Such individuals are always advised to control their sugar levels first and foremost. “They need to take care of their diet to bring their sugar levels under control,” he adds.