Diabetic Ketoacidosis

What is diabetic ketoacidosis?

Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly called the pancreas makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems.

People with type 1 diabetes are at risk for a problem called diabetic ketoacidosis (DKA). It is very rare in people with type 2 diabetes. DKA happens when your body does not have enough insulin to move glucose into your cells, and your body begins to burn fat for energy. The burning of fats makes a byproduct called ketones. With DKA, the ketones can build-up to dangerous levels and cause an imbalance of chemicals (acids and bases) in your blood. At the same time, glucose also builds up in the blood. DKA is an emergency that must be treated right away. If it is not treated right away, it can cause coma or death.

What can I expect in the hospital?

You will need to stay in the hospital in order to bring your blood glucose level under control and treat the cause of the DKA. Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your blood glucose will be checked regularly. This may be done as often as every hour.
• A heart (cardiac) monitor may be used to keep track of your heartbeat.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.
• Your fluid intake will be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.
• You may have a small tube (catheter) placed into your bladder to drain and measure urine.

Testing

Testing may include:

• Blood tests (Hemoglobin A1C) to check your average blood glucose over the past 3 months. This is the best way to see if you are keeping your diabetes under control. Hemoglobin A1C is also known as HbA1C and A1C.
• Blood or urine tests to check for infections
• Blood tests to test for sodium and potassium levels
• Blood, urine, or other tests to monitor how well your organs are functioning
• Arterial blood gas (ABG), which is a blood test that measures the levels of oxygen and carbon dioxide in your blood. It also measures the balance of acids and bases in your blood (called the pH).
• X-rays, which use energy called radiation to make pictures of bones, tissues, and organs to check for infection

Treatment

The treatment for DKA depends on the cause and how well you respond to treatment. The goal of treatment is to return your blood glucose to a normal level and keep it in a normal range.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• Your provider may prescribe medicines to:
  • Lower your blood glucose to normal levels
  • Treat other medical problems that may have been caused by or made worse by diabetes
  • Treat pain
  • Treat or prevent an infection
  • Treat or prevent side effects, such as nausea or constipation, from other treatments
  • Replace vitamins and minerals
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face.
• You may need to stop taking medicines that you were taking that may have caused the DKA.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Increased urination or trouble emptying your bladder
  • Increased thirst and dry mouth
  • Shortness of breath
  • Nausea or vomiting
  • Abdominal pain
  • Confusion
  • Weakness
  • Fruity odor to breath
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, why you are in the hospital, and the treatment you need. Talk with your provider about how long your stay may be.