Without insulin treatment, persons with type 1 diabetes can’t produce any insulin on their own and the body is unable to process carbohydrates from food. Glucose in the blood quickly rises dangerously high. In less than 24 hours, the blood can accumulate breakdown products of fat (which are used as an alternative source of energy) called ketones and acid. These ketones appear in the patient’s blood and urine, signaling the onset of a potentially life-threatening condition called diabetic ketoacidosis, or DKA.
The following people are at risk for DKA:
- Children, teens, and adults who do not yet realize they have diabetes. Often, DKA may be the first sign of the disease.
- Patients who normally take insulin for type 1 diabetes, but:
- Skip an injection of insulin or miscalculate and underdose repeatedly
- Stop taking insulin for any reason, because of loss of motivation, depression, simply forgetting, or not being able to afford their medications
- Are using an insulin pump that malfunctions and is not fixed in a timely manner.
- Develop an underlying illness ranging from something as mild as a urinary tract infection to a major event such as a heart attack. Persons with type 1 diabetes should alert their health care provider if they have a severe or non-healing infection to get appropriate treatment and reduce the risk of DKA.
- In rare cases, DKA can affect patients with type 2 diabetes such as those from high-risk minority groups (i.e. African Americans or Hispanics)
If you notice these signs or symptoms, seek medical attention:
- Dry mouth
- Slow or very fast heart rate
- Fast breathing
- Fruity-smelling breath
- Extreme thirstiness
- Urinating more than usual
- Feeling dehydrated even though you are drinking often
- Feeling tired or lethargic
- Seizures
- Coma
Patients with DKA are usually admitted to the hospital’s intensive care unit (ICU) because they must be watched closely as they recover.
- These patients are extremely dehydrated and must be treated with IV fluids
- The health care provider will give IV insulin to lower blood glucose and reduce the amount of acid in the blood
- Blood tests every 2 to 4 hours will monitor the patient’s blood glucose and electrolytes to make sure they return to normal
- Once the patient’s blood glucose levels improve and the blood no longer has excess acid, their IV insulin will be stopped and they will be transitioned to insulin injections to be taken at home.
