When diabetics are experiencing prolonged periods of very high blood glucose in which they are unable to use carbohydrates (glucose) to fuel the body, then the body may go into starvation mode and begin to break down fats-triglycerides-for fuel. This process of breaking down fats for fuel is called fat metabolism and results in the formation of ketones. When a person experiences prolonged high blood glucose combined with ketone build up in the blood, the condition is known as diabetic ketoacidosis (DKA) and can be life threatening.
DKA is more common in persons with type 1 diabetes than type 2 diabetes. It occurs in people with type 1 diabetics who have not yet been diagnosed with type 1 diabetes and therefore are not yet taking the required insulin. In addition, those with type 1 diabetes taking insulin may also experience DKA if they have an infection, undergo surgery or miss an insulin dose. People with type 2 diabetes can also experience DKA which may be triggered by a severe illness. Type 2 diabetics who are Hispanic or African-American are at higher risk of experiencing a DKA episode.
Ketones in high levels in the blood stream are poisonous. Left untreated the toxic build up of ketones results in DKA. It is important to be aware of the signs and symptoms of DKA which include the signs and symptoms of high blood glucose called hyperglycemia. When testing blood glucose, hyperglycemia is a fasting glucose > 126mg/dL or a random glucose test > 200mg/dL). The classic signs of hyperglycemia are excessive thirst called polydipsia, excessive hunger called polyphagia and an excessive urge to void called polyuria. A type of ketones called acetones can cause a fruity smelling breath. This fruity smelling breath is an indication of DKA. Here is a list of signs and symptoms of DKA:
Excessive thirst (polydipsia)
Excessive urination (polyuria)
Excessive hunger (polyphagia)
Weakness/Fatigue
Nausea and/or vomiting
Fruity smelling breath
Deep , rapid breathing
Confusion
Abdominal Pain
If left untreated, DKA events can result in death. Serious complication of DKA include heart attack, kidney failure and fluid build up in the brain which is a condition known as cerebral edema. If DKA is suspected, seek immediate medical attention.
References:
1. Beard V. K, EdD, GNP-BC, NP-C, ACNP-BC, Diabetic Ketoacidosis Early prevention, recognition and early management can improve clinical outcomes. From the World Wide Web: https://nursing.advanceweb.com/CE/TestCenter/Content.aspx?CourseID=932&CreditID=1&CC=248160&sid=3285
