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The dreaded DKA

Diabetic Ketoacidosis (DKA). What is it and why is it so scary?

DKA is a very serious complication of diabetes that occurs when there is a partial or complete lack of insulin in the body. Although it more commonly occurs in people with type 1 diabetes, it can happen to type 2 diabetics as well!


Insulin is essential to carry glucose from the bloodstream into the cells to be used for energy. When insulin is unavailable, these tissue and muscle cells starve. Out of necessity the body will begin breaking down fat and muscle for fuel. This breakdown causes a buildup of acids in the blood called ketones (fatty acids), which shift the body’s chemical balance into metabolic acidosis.

What causes it?

Commonly, DKA can be caused by missed insulin dosages or inadequate insulin therapy leading to an insufficient amount of insulin in the bloodstream. Many times, type 1 diabetics will present in DKA at the time of diagnosis. It can also be caused by an illness (bodily stress can lead to increased insulin demands and therefore extreme hyperglycemia). Other causes include; heart attack, trauma, alcohol or drug abuse, and use of certain medications (most commonly, corticosteroids). DKA should always be treated in the hospital. It is therefore very important for diabetics and their loved ones to recognize the symptoms of DKA and when to seek help.

Common presenting symptoms include; altered mental status, nausea, vomiting, abdominal pain, shortness of breath, polyuria (frequent urination), polydipsia (frequent thirst), polyphagia (frequent hunger), generalized weakness, fruity odor, and weight loss.

If you have diabetes, are feeling any of these symptoms, and/or your blood glucose level is high (>240mg/dl is the current recommendation by ADA), then you should test your urine ketones. It is also good to check ketones when you come down with the flu or the common cold, because of your increased risk of DKA while sick. If your ketone tests show a moderate to high number of ketones, then contact your healthcare professional. More than likely, you will be told to go to the emergency room.

DKA is considered a diabetic emergency. It is very dangerous and if left untreated it can even lead to death. It is therefore feared by diabetics and healthcare professionals alike. Luckily it CAN be prevented. Please, commit to taking control of your diabetes! Monitor you blood glucose levels and adjust your insulin accordingly. When you are hyperglycemic, check your ketone levels and be prepared to act if they are high. If you have any questions, please ask your clinician. I’m sure they will be happy to help you come up with a plan to keep healthy and safe!

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