Diabetes: Preventing Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a rare but serious condition. It can happen if your diabetes is not managed properly. Left untreated, DKA can cause you to go into a coma. In some cases, it can even cause death. But you can take action to keep from having DKA. 

Understanding Ketones

The body’s cells need glucose to burn for energy. If glucose is not getting into the cells, the body has to burn fat instead. But burning fat produces a waste product called ketones. Ketones can build up dangerously in the blood and urine. Your body can’t handle large amounts of ketones.

What Are the Causes of DKA?

When large amounts of ketones build up in the blood, it can cause diabetic ketoacidosis. This means that the chemical balance of the blood is upset. DKA may be more common in those with type 1 diabetes than in those with type 2. The following are the most common causes of DKA:

• A lack of needed insulin in your blood (this can happen if you miss your insulin shots)

• Illness (flu, cold, or infection)

• An insulin pump that is broken or not working properly

• Insulin that has expired or has not been stored properly

What Are the Symptoms of DKA?

Often, symptoms of DKA can look like the flu. Contact your healthcare provider or seek emergency care right away if you notice any of these symptoms:

• Ketones present in urine or blood (see “How to Check for Ketones” below)

• Nausea

• Vomiting

• Fruity-smelling breath

• Stomach cramps

• Very dark urine or no urine in 6 hours

• Rapid, deep breathing

• Thirst or very dry mouth

• Drowsiness or trouble concentrating

When to Check for Ketones

Always check for ketones when you have any of the above symptoms, or has:

• Blood sugar above 240.

• Diarrhea or vomiting.

• Fever of 100.4°F (38°C) oral or higher, or as directed by your healthcare provider

How to Check for Ketones

Ask your healthcare provider to show you how to check for ketones at home. Ketone testing is most often done with urine test strips. Follow the directions on the test strip package. Some blood glucose meters may also be used to check for ketones in your  blood. Ask your  healthcare provider for more information. If ketones are present in the blood or urine, call your  healthcare provider right away. 

Preventing DKA 

DKA can be prevented. The best way to do this is to give yourself insulin as directed. Be sure to follow your treatment plan as given to you by the healthcare provider. When your blood sugar is high, treat yourself right away. Remember that your blood sugar can be harder to manage when you are sick. To be safe, check your blood sugar every 4 hours when you are sick. Ask the healthcare provider for sick-day guidelines. This includes learning to adjust your insulin dose safely. And always keep a “sick-day” box available. This box should include:

• Ketone strips

• Thermometer

• Can of soup

• Crackers

• Juice boxes

• Flavored gelatin, such as Jell-O, with and without sugar (these can be kept in the refrigerator)

• Frozen juice bars with and without sugar (these should be kept separately in the freezer)

• Suppository medication to stop nausea and vomiting, if needed

Be sure to check the expiration dates of everything in the sick-day box once a month. Replace items as needed.

Resources

For more information about diabetes, visit these websites:

• American Diabetes Association www.diabetes.org

• American Association of Diabetes Educators www.aadenet.org

• American Association of Clinical Endocrinologists www.aace.com

• National Diabetes Information Clearinghouse www.diabetes.niddk.nih.gov