Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. It develops when the body produces high levels of acidic substances called ketones. While more commonly associated with Type 1 diabetes, DKA can also affect individuals with Type 2 diabetes. This condition demands immediate medical attention.
Understanding Ketoacidosis
Ketoacidosis occurs when the body lacks sufficient insulin to utilize glucose, its primary energy source. The body then breaks down fat for fuel, generating acidic byproducts known as ketones. These ketones accumulate in the bloodstream, making the blood overly acidic.
Ketone accumulation leads to ketosis, which can become dangerous. While the body normally produces ketones for energy, in DKA, their overproduction overwhelms the body’s ability to process them, leading to blood acidification. This imbalance creates an emergency medical situation.
Triggers and Risk Factors in Type 2 Diabetes
Type 2 diabetes can develop DKA, even with some insulin production. This occurs with relative insulin deficiency combined with other stressors. Severe illness, such as infections like pneumonia, urinary tract infections, or the flu, can trigger DKA because the body releases hormones that counteract insulin’s effects. Vomiting due to illness can also contribute by causing dehydration.
Other risk factors include missed or insufficient insulin or diabetes medication doses. Alcohol use can also make it difficult for the body to use insulin effectively.
Certain medications, particularly SGLT2 inhibitors, are a known risk factor. They can lead to euglycemic DKA, where blood sugar levels may be normal or slightly elevated despite ketoacidosis. SGLT2 inhibitors work by increasing glucose excretion in urine, which can lead to reduced insulin secretion and increased ketone production.
Recognizing the Symptoms
Recognizing ketoacidosis signs is important for timely intervention. Early symptoms often include increased thirst and frequent urination. These can progress rapidly, sometimes within 24 hours.
As the condition worsens, severe symptoms like nausea, vomiting, and abdominal pain may appear. Individuals might also experience fatigue, confusion, or decreased alertness.
Fruity-smelling breath, caused by the presence of acetone, is a distinct symptom. Rapid, deep breathing (Kussmaul respirations) can occur as the body attempts to expel excess carbon dioxide to counteract blood acidity.
Emergency Response and Treatment
If ketoacidosis is suspected, immediate medical attention is essential. This life-threatening condition requires urgent hospital treatment. Call emergency services or go to the nearest emergency room without delay.
Hospital treatment for DKA focuses on several areas. Intravenous fluids are administered to correct dehydration and dilute excess sugar and ketones in the blood. Insulin is then given, often intravenously, to lower blood sugar and stop ketone production. Electrolyte replacement, particularly potassium, is important to correct imbalances during DKA and its treatment. Healthcare providers will also look for and treat any underlying cause, such as infection.
Preventive Measures
Preventing ketoacidosis in Type 2 diabetes involves consistent management and awareness. Regular blood sugar monitoring is a primary step in diabetes management. Adhering to prescribed medication schedules, whether insulin or oral, is also important.
Following “sick-day rules” is important when ill, as illness can elevate blood sugar and increase ketone production. This includes checking blood sugar and ketone levels more frequently, staying well-hydrated, and knowing when to contact a healthcare provider for guidance on adjusting medication or seeking urgent care. Maintaining open communication with your healthcare team allows for personalized advice and proactive management strategies to minimize DKA risk.