DKA; Ketoacidosis; Diabetic coma

Definition    Return to top

Diabetic ketoacidosis is a complication of diabetes. It is caused by the buildup of by-products of fat breakdown, called ketones. This occurs when glucose is not available as a fuel source for the body, and fat is used instead.

Causes    Return to top

People with diabetes lack enough insulin, a hormone the body uses to process glucose (a simple sugar) for energy. When glucose is not available, body fat is broken down instead. The by-products of fat metabolism are ketones. When fat is metabolized, ketones build up in the blood and "spill" over into the urine. A condition called ketoacidosis develops when the blood becomes more acidic than body tissues.

Blood glucose levels rises (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem, but the cells cannot take up that glucose without insulin. Diabetic ketoacidosis may lead to the initial diagnosis of type 1 diabetes, as it is often the first symptom that causes the person to come to medical attention. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases.

People with type 2 diabetes usually develop ketoacidosis only under conditions of severe stress. Not following the prescribed diet and treatment is usually the cause when episodes are repeated.

Symptoms    Return to top

Additional symptoms that may be associated with this disease:

Exams and Tests    Return to top

This disease may also alter the results of the following tests:

Treatment    Return to top

The goal of treatment is to correct the elevated blood glucose level by giving additional insulin, and to replace fluids lost through excessive urination and vomiting. A person with diabetes may be able to recognize the early warning signs and make appropriate corrections at home, before the condition progresses.

If ketoacidosis is severe, hospitalization is required to control the condition. Insulin replacement will be given, fluid and electrolytes will be replaced, and the cause of the condition (such as infection) will be identified and treated.

Outlook (Prognosis)    Return to top

Cell damage from acidosis can lead to severe illness or death. Improved therapy for young people with diabetes has decreased the death rate associated with this condition. However, it remains a significant risk in the elderly, and in people who fall into a profound coma when treatment has been delayed.

Possible Complications    Return to top

When to Contact a Medical Professional    Return to top

This condition can become a medical emergency. Call your health care provider if you notice early symptoms of diabetic ketoacidosis.

Go to the emergency room or call the local emergency number (such as 911) if nausea, vomiting, fruity breath, mental stupor, difficulty breathing, or decreased consciousness occur.

Prevention    Return to top

Diabetics should learn to recognize the early warning signs and symptoms of ketoacidosis. Measurement of urine ketones in people with infections or people on insulin pump therapy can give more information than glucose measurements alone. Insulin pump users need to frequently check to see that insulin is still flowing through the tubing, and that no blockages, kinks, or disconnections have occurred.