Diabetic ketoacidosis is a failure of metabolism. Affected here in type 1 diabetics. Diabetic ketoacidosis occurs suddenly and can lead to death. Diabetic ketoacidosis is caused by too high a blood glucose level in the presence of a marked insulin deficiency.
What is diabetic ketoacidosis?
Diabetic ketoacidosis is a metabolic derailment. Insulin-dependent (type 1) diabetics are particularly affected. Diabetic ketoacidosis can occur when blood glucose levels are not well controlled. However, metabolic failure can also occur suddenly. A lack of insulin causes blood glucose levels to rise sharply. This condition is also called hyperglycemia. Due to excessive thirst and constant urination, the body loses fluid and slowly dries out (desiccation). In addition to cardiovascular and kidney problems, there is impaired consciousness, which can lead to coma if left untreated. Diabetic ketoacidosis must be treated immediately in the hospital, as it can lead to death if left untreated or even inadequately treated.
Causes
Diabetic ketoacidosis can be caused by several factors. One of the causes is often diabetes mellitus that has not yet been recognized. Another cause is an improperly adjusted blood glucose level. Diabetics who require insulin inject themselves with too little insulin or only take tablets. Depending on the severity of the diabetes, insulin can be administered via an insulin pump. In this case, it can sometimes happen that the inserted catheter is blocked, so that insulin can no longer be administered. Diseases, infections or operations can also trigger diabetic ketoacidosis, as there is often an increased need for insulin in these cases. Alcohol can also be a trigger. Furthermore, there are hereditary diseases in which there is a congenital deficiency of succinyl-CoA acetoacetate transferase that cause the metabolic disorder. However, all these factors have one thing in common, insulin deficiency. The body needs insulin so that individual cells can absorb sugar. If there is a deficiency of insulin, sugar can only be absorbed to a limited extent. The result is that sugar accumulates in the blood and the blood sugar level rises dramatically. Since the cells still need energy, so-called ketone bodies (ketones) are formed in the liver, causing hyperacidity of the blood. The excess sugar and ketones deprive the body of water and electrolytes, which are excreted in the urine, so that dehydration, Kussmaul respiration, cardiovascular disorders, impaired consciousness, coma and death can occur as a result.
Symptoms, complaints, and signs
Diabetic ketoacidosis is characterized by hyperacidity of the blood in the setting of diabetes. In this case, blood glucose levels are greatly elevated. The patient suffers from severe thirst, polyuria, lightheadedness, physical weakness, and vomiting, among other symptoms. The high water loss causes dehydration of the body. Dehydration or exsiccosis is then characterized by standing skin folds on the back of the hand, weight loss, cramps, anuria, constipation and thickening of the blood. Subsequently, disturbances of consciousness up to diabetic coma occur. A typical sign is the so-called kissing-mouth breathing. This is very deep and regular breathing, which is intended to prevent a further drop in the PH value, i.e. further acidification of the blood. Since glucose can no longer be utilized due to the lack of insulin, increased fat burning occurs. This produces ketone bodies, which lead to hyperacidity of the blood. Typically, the breath has an intense odor of acetone, which is also one of the ketone bodies. It is a fruity, foul or sweetish odor. Without treatment, diabetic ketoacidosis leads to death. What determines the severity of the condition is not the level of blood glucose, but the extent of dehydration as well as the PH level. Therefore, in addition to treatment with insulin, only intravenous infusion of larger amounts of fluid can save lives in this complication.
Diagnosis and course
If diabetic ketoacidosis is suspected, the emergency medical services must be called immediately or the affected person must be taken to the hospital without delay. Diabetic ketoacidosis is diagnosed by the physician. At the beginning, the blood glucose level is determined.Furthermore, the sugar as well as the ketone bodies in the urine are determined. In addition, the pH value of the blood is measured, the values of sodium and potassium, as well as the blood gases are determined. A diabetic ketoacidosis can also be recognized by the breath of the affected person, as it smells strongly of acetone (similar to the smell of nail polish remover). The course of diabetic ketoacidosis can be fatal. Only if the symptoms are recognized in time and treatment can be initiated immediately will the patient recover. If inadequately treated, permanent damage to the kidneys, heart, brain, etc. can occur. Because the circulatory system fails very quickly in diabetic ketoacidosis, many affected individuals fall into a coma, from which most recover only incompletely.
Complications
Diabetic ketoacidosis is considered a serious complication of diabetes mellitus. To avoid further sequelae, it should be treated as soon as possible. Possible complications arise firstly from the symptoms of ketoacidosis. For example, confusion and visual disturbances can lead to further dangers such as falls and bone fractures. Care must be taken when normalizing blood glucose levels. If regular blood glucose is adjusted too quickly, there is a risk of cerebral edema. As a result, various complications can occur. Impaired vision or even complete loss of vision is possible. Memory loss, fainting and seizures are further risks. If the intracranial pressure increases too much as a result of the edema, arteries in the brain can be damaged. In the worst case, the damage is irreversible. The respective consequences depend on the affected area of the brain. Another possible complication is potassium deficiency. As a further consequence, this can lead to cardiac arrhythmias. In summary, it must be emphasized that ketoacidosis must be treated as quickly as possible. With proper and rapid therapy, the likelihood of further complications occurring is very low. However, if treatment is inadequate, there is a risk of falling into a diabetic coma. In a few cases, therefore, ketoacidosis can have a fatal outcome.
When should you see a doctor?
If diabetic ketoacidosis is suspected, emergency medical services must be called immediately or the affected person must be taken to the nearest hospital immediately. So anyone who notices excessive thirst, frequent urination and other warning signs should have these clarified quickly. If symptoms such as impaired consciousness or severe abdominal pain occur, the emergency medical services are the right people to contact. If serious cardiovascular problems or even diabetic coma occur, the emergency physician must be alerted. Diabetic ketoacidosis is often triggered by undiagnosed diabetes mellitus. An incorrectly adjusted blood glucose level as well as various diseases, infections or operations can also lead to metabolic failure. Anyone who suspects that one of these factors may be present should consult a doctor immediately. If there is a concrete suspicion, it is best to consult the hospital directly. After the initial treatment, the cardiologist, diabetologist, neurologist or podiatrist should be consulted, always depending on the respective symptoms. Under certain circumstances, a visit to the psychologist may also be advisable.
Treatment and therapy
Treatment of diabetic ketoacidosis must always take place in the hospital. In cases with severe symptoms, even intensive monitoring is usually required. The first treatment step involves lowering blood glucose levels. This involves injections and infusions of insulin directly into the veins. In addition to lowering the blood glucose levels, it is also important to stop the acidification of the blood. If the ketone body value is strongly increased and the overacidification of the blood does not decrease by the injected insulin, bicarbonate is additionally administered if necessary. Together with the first part of the treatment, fluids are administered so that the fluid loss is compensated. Dehydration causes the body to lose valuable minerals such as sodium and potassium. The electrolyte loss is compensated by means of infusions so that the circulation stabilizes as a result of the increased fluid intake. If diabetic ketoacidosis was caused by a disease or infection, these are specifically treated with drugs – including high-dose antibiotics.
Outlook and prognosis
Immediate emergency medical treatment is critical for the progression of diabetic ketoacidosis. Without treatment, this condition usually leads rapidly to death. Death occurs mainly because of the very severe fluid loss that results as a consequence of severe polyuria. However, with immediate treatment, there is a very good chance of rapid improvement of symptoms. Fluids must be given immediately to overcome the dehydration of the body. In addition, an infusion of insulin is needed immediately to restore high blood glucose levels to normal. Although the rapid emergency measures can treat the hyperacidity of the blood and the desiccosis well, a cure is not possible because diabetic ketoacidosis is based on diabetes mellitus with absolute insulin deficiency. Incurable here means that diabetic ketoacidosis would recur without constant treatment. Absolute insulin deficiency frequently occurs in the context of severe forms of diabetes mellitus. In most cases, this is type I diabetes mellitus. In this condition, the patient is constantly dependent on insulin administration to avoid diabetic ketoacidosis. Under these conditions, health problems no longer occur. After successful treatment of diabetic ketoacidosis, usually no consequential damage remains. However, as part of the therapy, care should be taken to maintain good blood glucose control.
Prevention
To prevent diabetic ketoacidosis, the following measures can be taken. The most important point is good blood glucose control. Furthermore, type 1 diabetics should always carry an emergency dose of insulin. The blood glucose level must be checked regularly. If an infection is present, diabetics should – after consulting their doctor – increase the insulin dose. The same applies before operations as well as in the case of illnesses such as gastrointestinal infections. Alcohol should be avoided. This applies in particular to diabetics. Another preventive measure is so-called emergency management. This involves training family, friends, relatives and acquaintances. Courses are offered by doctors, health insurance companies and associations, in which it is taught how to recognize diabetic ketoacidosis and what immediate measures must be taken.
Follow-up
After ketoacidosis, regular follow-up visits with a diabetologist are essential. In all cases, the cause should be determined. The risk for further ketoacidosis may be increased. Therefore, increased attention should be paid to the correct amount of insulin as well as correct injection. In cases of severe illness, injury, or surgery, the amount of insulin may need to be adjusted. Checking the insulin pump can be useful, as a defective pump often contributes to the development of hyperacidity. Also helpful are special blood glucose meters with ketone test strips, which can detect subsequent ketoacidosis early. Prescribed medications may need to be continued even after blood glucose has normalized, otherwise there is a high risk of ketone acidosis recurring. Therefore, it is important to follow the instructions of the treating physician carefully. Those living with the patient should be informed of the ketoacidosis and then work with the patient to develop an emergency plan for its recurrence. To do this, it is important to identify and pay increased attention to the symptoms that occurred during the first episode of ketoacidosis. In addition, family members should be informed about what to do during ketoacidosis so that they can respond in an emergency.
Here’s what you can do yourself
Diabetic ketoacidosis is usually caused by insulin deficiency in type 1 diabetes. Very rarely, the condition also occurs in type 2 diabetes. In either case, it is an acute, life-threatening emergency that requires immediate medical attention. In the event of sudden onset of symptoms indicating ketoacidosis, a hospital must be visited as quickly as possible so that insulin can be administered intravenously by direct route and the affected person can receive intensive medical care if necessary. Self-help measures can be helpful in these cases as an adjunctive therapy.Above all, the supply of electrolytes – especially potassium – is important for maintaining or restoring a normal heart rate and ensuring other organ functions and metabolic processes. After successfully overcoming diabetic ketoacidosis, which in many cases also requires the administration of bicarbonate (hydrogen carbonate) to raise the pH, it is advisable to identify the reason(s) that led to the lack of insulin in the blood and thus to the lack of glucose in the cells and ultimately to the acidification of the blood. Causes of sudden ketoacidosis can also include urinary tract infections, an infection in the gastrointestinal tract, or alcohol abuse. If the causes have been properly clarified, appropriate self-help and preventive measures can help to ensure that diabetic ketoacidosis does not recur. Above all, strict control and adjustment of the recommended blood glucose concentration is required as a self-help measure.
