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Complications of Diabetes

Diabetic Ketoacidosis

What is Ketoacidosis?

Diabetic Ketoacidosis is a serious complication of diabetes which occurs in people with type 1 diabetes. A lack of insulin, results in high concentrations of blood sugar, progressive dehydration and collapse. It also causes uncontrolled breakdown of fat stores which results in the liver being overwhelmed leading to large amounts of ketoacids being released into the circulation. High levels of blood acidity is harmful to he body and causes damage to organs and death if not treated in time.

Why do patients get ketoacidosis?

Ketoacidosis results from an absolute deficiency of insulin. There is also a concomitant rise in various hormones which oppose insulin. People with type 1 diabetes develop ketoacidosis for a variety of reasons.

  • Often it is due to stopping insulin during times of illness.
  • ‘Stress’ due to serious infections, vomiting and diarrhoea
  • Trauma, surgery

Common infections include pneumonia, urinary infections and gastrointestinal infections.

What are the symptoms?

  • The earliest symptoms are thirst and passing large volumes of urine
  • Abdominal pain
  • weakness
  • Nausea and vomiting
  • Rapid, deep breathing (hyperventilation)
  • Confusion, drowsiness
  • Coma

The condition progresses rapidly with increasing dehydration, falling blood pressure, hyperventilation and low body temperature.

Is it serious?

Yes, if not treated in time ketoacidosis may lead to shock, kidney failure, multiple organ failure and death.

How is it treated?

Treatment consists of

  • Replacement of insulin
  • Replacement of salt and water losses
  • Treatment of any predisposing cause such as antibiotics for underlying infection

Management of DKA requires admission to hospital and it is an indication of the gravity of this condition that many centres routinely admit patients to a high dependency unit or intensive care unit.

Am I likely to get it again?

Yes. Many patients do get recurrent attacks of DKA. It is particularly common in teenagers who for various reasons miss out on their doses of insulin.

 

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Hospitals Diabetes Service
October 2002