Introduction to Diabetic Ketoacidosis

Diabetic Ketoacidosis is a condition in which the body cells are unable to get glucose for producing energy. Due to insufficiency of insulin, the cells cannot use glucose. To avoid starvation the body begins to break down fat, for energy. The constant break down of fat, releases fatty acids and ketone bodies causing chemical imbalance (metabolic imbalance) called Diabetic Ketoacidosis.

SYMPTOMS OF DIABETIC KETOACIDOSIS:
* Excessive thirst
* Frequent urination
* General weakness
* Vomiting, Loss of appetite
* Confusion
* Abdominal discomfort
* Gasping breath
* Dry and hot skin
* Dry mouth
* Increased heart rate
* low blood pressure
* Sometimes a distinctive fruity odor on the breath
* Blurred vision
* Drowsiness or difficulty waking up
* Coma and finally death

CAUSES OF DIABETIC KETOACIDOSIS :
The condition known as diabetic ketoacidosis occurs when the body has no insulin. This leaves the muscle, fat, and liver cells unable to use glucose (sugar) in the blood as fuel. Other hormones such as glucagon, growth hormone, and adrenaline cause fat to break down within the cells of these tissues into glucose and fatty acids. These fatty acids are converted to ketones by a process called oxidation. The body is literally consuming muscle, fat, and liver cells for fuel.
In diabetic ketoacidosis the body shifts from its normal metabolism using carbohydrates for fuel to a fasting state using fat for fuel. The resulting increase in blood sugar because it cannot be transported into cells for future use causes increased urination and dehydration. Commonly, 10% of total body fluids may be lost. Significant loss of potassium from urination is also common.
The most common events that cause person with diabetes to enter a state of diabetic ketoacidosis are these:
- Infection (40%) - Missed insulin (25%) - Newly diagnosed or previously unknown diabetes (15%)
Various other causes may include a heart attack, stroke, trauma, stress, and surgery. There is no identifiable cause 5-10% of the time.

WHEN TO SEEK MEDICAL CARE ?
- If you have diabetes, contact your doctor if you have very high blood sugars (generally more than 350 mg) or moderate elevations that do not respond to home treatment.
- If you have diabetes and develop a fever or start vomiting, contact your doctor for instructions.
- If you have home access to urine ketone test strips, and if urine sampling indicates moderate or greater urine ketones, notify your doctor.

TREATMENT FOR DIABETIC KETOACIDOSIS :
1. Self-Care: Home care usually includes preventing Diabetic Ketoacidosis and treating moderately elevated high blood sugar. It includes:
- Monitor your blood sugars at least 3-4 times a day. You should check it more frequently if you feel illness, fever and vomiting sensation.
- If you can see moderate elevations in blood sugar, try to adjust with insulin injections (short-acting form of insulin).
- Try to identify related signs of infection and keep yourself well hydrated by drinking non-sugary fluids throughout the day.

2. Medical-Care: When ketoacidosis goes on increasing we should immediately seek doctor's help. Treatment involves giving insulin and fluids through a vein and closely monitoring the chemicals in the blood (electrolytes). If the case is critical, it requires admitting the patient in the Intensive Care Unit.
- Intravenous fluid replacement to reverse the dehydration, and dilute glucose and acid levels. Many liters of fluid is passed, intravenous to correct losses(Potassium is added, if required).
- Insulin administration to prevent further ketone formation.
- Further test and investigation are carried out depending upon the status of the patient.