DIABETIC KETOACIDOSIS

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DIABETIC KETOACIDOSIS

About Your Diagnosis
Diabetic ketoacidosis (DKA) is a medical emergency caused by a lack of insulin and excess response from other hormones (e.g., adrenaline, glucagon, and cortisol). Insulin is responsible for the metabolism of fats, proteins, and carbohydrates.

Insulin converts the sugar we eat into energy that can be stored in the liver as glycogen or in the fat cells as triglycerides. Insulin also prevents the breakdown of protein into amino acids and stimulates the buildup of amino acids in muscle cells to make protein.

When there is a deficiency in insulin, the sugar cannot be stored as fuel or energy. In more severe cases of insulin deficiency, not only is there a defect in storing energy, but the already-stored fuel starts to break down to increase the sugar in the blood (e.g., glycogen breaks down into sugar). This increase in sugar is the body's mechanism of attempting to stimulate insulin production and by stimulating the release of insulin, converting the sugar back into stored energy. In patients who have no insulin in their system, the breakdown of stored fuels will not lead to increased insulin stimulation and will result in the following: 1) extremely high blood sugars and 2) the production of acids from the breakdown of fats and triglycerides called ketones. It is the excess production of these acids that leads to the disease known as diabetic ketoacidosis (DKA).

DKA is a life-threatening metabolic emergency. It commonly occurs in the young patient whose pancreas cannot produce insulin. DKA is not contagious or inherited; it is the metabolic end result in patients with no insulin.

DKA is a curable disease that absolutely requires insulin therapy. Patients with this condition truly depend on insulin to survive.

Living With Your Diagnosis
DKA is usually detected by clinical symptoms of nausea, vomiting, loss of appetite, increased urination, increased thirst, and abdominal pain. Dehydration, confusion, lethargy, and coma can all ensue if DKA is not treated. To confirm the diagnosis, blood tests measuring the sugar and acids called acetoacetate and beta-hydroxybutyrate are measured. Urine can be tested for glucose (sugar) and ketones. A blood test called an arterial blood gas test (ABG) from the artery of the wrist helps measure the acid status of the body.

DKA is typically provoked by a medical occurrence such as a heart attack, severe infection, or failure to take insulin. In 10% of the cases, DKA is the initial presentation of diabetes mellitus.

Treatment
Once the diagnosis of DKA has been made, immediate treatment is needed. The goals of treatment are to correct the acidosis (excess acid production), hydrate the patient, and correct any coexisting metabolic problems that commonly occur with DKA, such as low potassium, low sodium, and low phosphorus levels. Treatment must also be directed at the precipitating cause (e.g., heart attack or infection). Finally, insulin must be given to the patient.

Many patients in DKA are profoundly dehydrated when they present to the emergency room and will require more than 5 liters of fluid. Intravenous fluid is administered while monitoring specific blood tests. If the acidosis is significant, sodium bicarbonate given intravenously helps correct this metabolic abnormality. Again, close monitoring of the blood test and acid status is necessary. Insulin therapy is given intravenously at first until the metabolic condition is corrected. Thereafter, the patient is returned to their usual subcutaneous insulin.

The DOs
Remember, if you are a true insulin-dependent diabetic, do not miss your insulin.
Keep a close diary of your blood sugar readings. This may mean checking your blood sugar three or four times a day until it is under good control.
Seek the opinion of an endocrinologist (a physician specializing in the treatment of diabetes and other hormone abnormalities).
Understand that DKA is a true medical emergency.
The DON'Ts
Don't skip your insulin if you are an insulin-dependent diabetic. Your body depends on the insulin you give it because your body cannot produce any insulin.
Don't wait. It is safer to go to the emergency room or to call your doctor if you know you are having problems with your blood sugar and have had prior episodes of DKA.
Don't forget that tight control of insulin-dependent diabetes has been shown to prevent late complications of eye, kidney, and nerve involvement. Tight control means keeping the blood sugar as close to normal range as possible.
When to Call Your Physician
If you have a fever.
If you cannot hold any food down.
If you are having chest pain.
If you are having abdominal pain.
If you have no insulin.