Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur with diabetes. It happens when the body doesn't have enough insulin and can't use the sugar needed for energy. The body uses fat for energy instead. This makes ketones, which build up in the blood. Without treatment, this can lead to coma or death.

Early symptoms of DKA include increased thirst and urination, high blood sugar, and high ketone levels. Other symptoms are breath that smells fruity and trouble staying awake. Belly pain, vomiting, and feeling confused are also symptoms. Anyone who has these symptoms needs emergency treatment.

Your doctor will do a physical exam and ask questions about your health. You will also have tests, including blood and urine tests.

If the symptoms of DKA are severe, you may need to be treated in an intensive care unit. Treatment includes fluids and insulin given through a vein (intravenous, or I.V.). Fluids treat dehydration and balance electrolytes. Insulin lowers blood sugar and keeps the body from producing ketones.

To reduce your chance of ketoacidosis:

• Take your insulin and other diabetes medicines on time and in the right dose.
  • If an infection caused your DKA and your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Test your blood sugar before meals and at bedtime or as often as your doctor advises. This is the best way to know when your blood sugar is high so you can treat it early. Watching for symptoms is not as helpful. This is because you may not have symptoms until your blood sugar is very high. Or you may not notice them.
• Teach others at work and at home how to check your blood sugar. Make sure that someone else knows how to do it in case you can't.
• Wear or carry medical identification at all times. This is very important in case you are too sick or injured to speak for yourself.
• Talk to your doctor about when you can start to exercise again.
• Follow your meal plan to know how much carbohydrate you need for meals and snacks. This will help keep your blood sugar steady.
• When you are sick:
  • Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. Your blood sugar may go up because you are sick. If you are eating less than normal, you may need to change your dose of insulin. Talk with your doctor about a plan when you are well. Then you will know what to do when you are sick.
  • Drink extra fluids to prevent dehydration. These include water, broth, and sugar-free drinks. If you don't drink enough, the insulin from your shot may not get into your blood. So your blood sugar may go up.
  • Try to eat as you normally do, with a focus on healthy food choices.
  • Check your blood sugar at least every 3 to 4 hours. Check it more often if it's rising fast. If your doctor has told you to take an extra insulin dose for high blood sugar levels (for example, above 240 mg/dL) be sure to take the right amount. If you're not sure how much to take, call your doctor.
  • Check your temperature and pulse often. If your temperature goes up, call your doctor. You may be getting worse.
  • If you take insulin, check your urine or blood for ketones, especially when you have high blood sugar (for example, above 240 mg/dL). Call your doctor if your ketone level is moderate or high.

If you know your blood sugar is high, treat it before it gets worse.

• If you missed your usual dose of insulin or other diabetes medicine, take the missed dose or take the amount your doctor told you to take if this happens.
• If you and your doctor decide on a dose of extra-fast-acting insulin, give yourself the right dose. If you take insulin and your doctor has not told you how much fast-acting insulin to take based on your blood sugar level, call your doctor.
• Drink extra water or sugar-free drinks to prevent dehydration.
• Wait 30 minutes after you take extra insulin or missed medicines. Then check your blood sugar again.
• If symptoms of high blood sugar get worse or your blood sugar level keeps rising, call your doctor. If you start to feel sleepy or confused, call 911.