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Diabetes and ketoacidosis

Diabetic ketoacidosis, or DKA, is a medical emergency caused high blood glucose levels or hyperglycaemia.

Ketoacidosis is caused by a lack of insulin to process glucose to use as energy. The body responds by using fat stores for energy instead, releasing damaging ketones into the blood as a by-product.

The symptoms of DKA include excessive thirst, nausea or vomiting, dry skin, blurred vision and rapid, breathing.

Without treatment, dehydration is a risk to health.

High ketone levels can often be smelled on the breath of a person with DKA, with a nail varnish or pear-drop type aroma.

A related condition is a hyperosmolar hyperglycaemic state, HHS, previously known as HONK: hyperglycaemic hyperosmolar non-ketotic coma. In this condition, high blood glucose levels cause similar symptoms as DKA, but without the ketones release.

What is the treatment for ketoacidosis?

Treatment of ketoacidosis requires insulin and fluids as recommended by your doctor. He or she may suggest that you increase the dose of your insulin or change your insulin type to a short-acting form. Your doctor will also suggest you drink more fluids - sugar-free, of course. You will need to check your sugars frequently and repeat the assessment of your urine ketones.

Ketoacidosis can result in coma and possibly death if left untreated.

How can ketoacidosis be prevented?

  • To prevent ketoacidosis, take your medicines as directed. If you are on an insulin pump always check your tube connections for air bubbles and make sure that there are no leaks of insulin. Also, check your insulin to make sure it isn't past its expiry date and make sure no clumps have formed. Insulin should always be either clear or uniformly cloudy with particles.
  • Follow your meal plan closely.
  • Follow your exercise programme.
  • Test your blood sugar on a regular basis.
  • Seek medical advice if you have repeated abnormal blood sugar levels.

Diabetic coma in type 2 diabetes

Diabetic coma caused by hyperosmolar hyperglycaemic state or HHS is a serious complication that can happen to a person with type 2 diabetes who is ill or stressed. This type of diabetic coma occurs when the blood sugar gets too high and the body becomes severely dehydrated.

In most cases, the person will have been excessively thirsty and urinating for weeks before the event. Excessive urination and extreme elevations of blood sugar levels lead to dehydration. The severe loss of body water can lead to shock, coma and death.

What causes HSS?

Causes of HSS can include:

  • Infection.
  • Heart attack.
  • Kidneyfailure.
  • Medicines ( diuretics, heartmedication or steroids).
  • Illness.
  • Bleeding ulcer.
  • Blood clot.
  • Uncontrolled blood sugar.

What are the early symptoms of HSS?

Early symptoms that may lead to diabetic coma if not treated include:

  • Increased thirst.
  • Increased urination.
  • Weakness.
  • Drowsiness.
  • Altered mental state.
  • Headache.
  • Restlessness.
  • Inability to speak.
  • Paralysis.

If you have any of these symptoms, test your blood sugar and seek medical advice. Diabetic coma typically occurs when blood sugar reaches 25mmol/L (millimoles per litre) or more.

How is diabetic coma treated?

Once early symptoms of HSS are noticed, treatment typically requires intravenous fluids as recommended by your doctor and may require insulin. HSS can lead to death if left untreated.

How can diabetic coma be prevented?

Diabetic coma can be prevented by the following:

  • Check your blood sugar regularly, as recommended by your doctor.
  • Check your blood sugar every four hours when you are sick.
  • Take special care of yourself when you are sick.
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WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on March 31, 2014

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