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Patient education: Diabetic ketoacidosis (The Basics)

Patient education: Diabetic ketoacidosis (The Basics)

What is diabetic ketoacidosis? — Diabetic ketoacidosis is a serious problem that can happen to people with diabetes. It happens when chemicals called "ketones" build up in the blood. It can affect people with either type 1 or type 2 diabetes, but it is more likely to affect people with type 1.

Normally, the body breaks down sugar as a source of energy. For this to happen, sugar gets into cells with the help of a hormone called "insulin." If there is not enough insulin, or if the body stops responding to insulin, sugar builds up in the blood. That is what happens when a person has diabetes.

If sugar cannot get into the cells, the body is unable to use it for energy. This is how diabetic ketoacidosis can happen:

Blood sugar levels continue to increase

The body starts burning fat for energy instead

Burning fat can cause the body to make too many ketones

Ketones build up, making the level of acid in the blood too high

Diabetic ketoacidosis is an emergency and needs treatment right away.

What causes diabetic ketoacidosis? — People can get diabetic ketoacidosis for a few reasons:

They do not know they have diabetes so they aren't taking insulin, and their body starts breaking down fat

They have a major illness or health problem, such as a heart attack or infection

They take certain medicines or illegal drugs

They don't take their insulin as directed

Their insulin pump does not work correctly

What are the symptoms of diabetic ketoacidosis? — The symptoms can include:

Feeling very thirsty and drinking a lot

Urinating a lot, including at night

Nausea or vomiting

Belly pain

Feeling tired or having trouble thinking clearly

Having breath that smells sweet or fruity

Weight loss

Should I see a doctor or nurse? — See your doctor or nurse right away if you have the symptoms listed above. Also, see your doctor or nurse if your blood sugar levels keep being higher than they should be. They might need to adjust your insulin dose.

Is there a test for diabetic ketoacidosis? — Yes. If the doctor or nurse thinks you have diabetic ketoacidosis, they will order several blood tests, including tests to check your blood sugar and ketone levels. They will also check your urine for ketones. These tests can show whether you have diabetic ketoacidosis.

Because diabetic ketoacidosis can cause problems with the heart, you might also need an electrocardiogram. This is a test that measures the electrical activity in the heart.

Your doctor or nurse will also talk to you about checking your urine for ketones at home. If you have type 1 diabetes, you might need to do this in certain situations, such as:

If your blood sugar gets above a certain level

If you are sick

If you start having symptoms of diabetic ketoacidosis

You can buy urine test strips in a pharmacy or online. Some people use a meter to check for ketones in their blood instead of testing their urine.

Your doctor or nurse will tell you what to do if your ketone level is high.

How is diabetic ketoacidosis treated? — Treatment is usually done at the hospital. This can include:

Fluids and electrolytes – During diabetic ketoacidosis, the body loses a lot of fluids. It also loses "electrolytes." These are chemicals in the body, such as sodium and potassium, that keep cells working normally. As part of treatment, doctors must replace lost fluids and electrolytes.

Insulin – When the body has enough insulin, it can use sugar as fuel and it does not need to break down fat.

These treatments are usually given through a thin tube that goes into a vein, called an "IV."

During treatment, doctors will do regular tests to make sure you are improving. These include:

Blood sugar – This will be checked every hour, at least until it improves.

Other blood tests – These will be done about every 2 to 4 hours. They include tests to check your electrolyte levels and how your kidneys are working. One of the electrolyte tests lets the doctor monitor the level of acid in your blood.

Your doctor will also calculate something called the "anion gap." The electrolytes in your body have an electrical charge. The anion gap is the difference between the number of "positively charged" and "negatively charged" electrolytes. The anion gap is usually high when there are a lot of ketones in your blood. When it returns to normal, it is a good sign that you are getting better.

Can diabetic ketoacidosis be prevented? — You can reduce your chances of getting diabetic ketoacidosis by:

Taking your insulin exactly as directed

Measuring your blood sugar often to make sure it is not too high or too low

If you have any symptoms of diabetic ketoacidosis, tell your doctor or nurse right away. If you are thirsty, drink fluids that do not have sugar. Sugary drinks, like juice, will increase your blood sugar more.

More on this topic

Patient education: Type 1 diabetes (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: Treatment for type 2 diabetes (The Basics)
Patient education: The ABCs of diabetes (The Basics)
Patient education: Hemoglobin A1C tests (The Basics)

Patient education: Type 1 diabetes: Overview (Beyond the Basics)
Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Overview (Beyond the Basics)
Patient education: Type 2 diabetes: Treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Blood glucose monitoring in diabetes (Beyond the Basics)
Patient education: Preventing complications from diabetes (Beyond the Basics)

This topic retrieved from UpToDate on: Jan 01, 2023.
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