Diabetic ketoacidosis is a complication of diabetes mellitus which is characterized by high levels of ketones in the body. One of the typical signs when a diabetic suffers from this condition is the appearance of a fruit-scented breath.
Diabetic ketoacidosis is an emergency condition that requires immediate medical attention. This condition is more common in people with type 1 diabetes than in people with type 2 diabetes.
Causes of Diabetic Ketoacidosis
Sugar or glucose is the main source of energy for the body. Insulin will help glucose that is there to enter the cells for further processing into energy.
When suffering from diabetes mellitus, a person will experience a lack of insulin or the insulin produced cannot work normally (insulin resistance). This causes the glucose in the blood to accumulate and cannot be used, while the body's cells still need food to produce energy.
To still be able to meet energy needs, the body's cells eventually process fat into energy. One of the waste products of fat processing is an acidic substance, namely ketones. If this continues, ketones will build up in the body. As a result, the body becomes more acidic (acidosis).
Risk factors for diabetic ketoacidosisik
Patients with diabetes mellitus 1 are more at risk of developing diabetic ketoacidosis than patients with type 2 diabetes. However, not all people with diabetes mellitus will experience diabetic ketoacidosis. There are several factors and conditions that increase the risk of a person with diabetes experiencing diabetic ketoacidosis, namely:
- Have an infectious disease, such as the flu, urinary tract infection, or pneumonia
- Forgot to inject insulin or use insulin doses that are too low
- Not following the diabetes treatment program given by the doctor
- Having a heart attack
- Experiencing emotional injury or trauma
- Have an addiction to alcohol or drug abuse, especially cocaine
- Taking certain medications, such as corticosteroids and diuretics
- Are pregnant and menstruating
In some people who have not been diagnosed with diabetes mellitus, sometimes diabetic ketoacidosis can be an early marker of this condition.
Symptoms of Diabetic Ketoacidosis
Symptoms of diabetic ketoacidosis can get worse quickly. When diabetics experience acidosis due to the buildup of ketones, a number of complaints and symptoms will appear, such as:
- Increased frequency of urination
- There is a very thirsty feeling that doesn't go away even after drinking
- Dehydration
- Weak and tired
- Muscles feel sore or stiff
- Hard to breathe
- Breath smells like fruit or nail polish remover (acetone)
- Nausea and vomiting
- Stomach ache
- daze
- Decreased consciousness to fainting
When to go to the doctor
Go to the ER immediately if you experience the above symptoms or have blood sugar consistently above 300 mg/deciliter. If this happens to people around you, immediately take the patient to the hospital for treatment because diabetic ketoacidosis that is not treated immediately can be fatal.
Diabetics must follow the treatment program given by the doctor and carry out routine control. More frequent blood sugar checks are also recommended when you are injured, sick, stressed, or feeling unwell.
Talk to your doctor if your blood sugar is higher than usual, although it can be controlled with medication. Early detection can help you avoid complications of diabetes mellitus.
Diabetic Ketoacidosis Diagnosis
If the patient comes with decreased consciousness, the doctor will ask the person who brought the patient the symptoms and medical history. While conducting a thorough examination to determine the general condition of the patient, whether there are signs of dehydration, fruity aroma, the doctor will provide first aid.
Furthermore, to confirm the diagnosis, the doctor will carry out supporting examinations, such as:
- Blood tests, to determine blood sugar levels, blood ketone levels, blood acidity levels (blood gas analysis), and blood electrolyte levels
- Urine test, to see urine ketone levels and possible urinary tract infections
- Chest X-ray, to look for possible infections, such as pneumonia
- Electrocardiogram (ECG) test, to see if the patient's condition was caused by a heart attack
Diabetic Ketoacidosis Treatment
The goal of diabetic ketoacidosis treatment is to stabilize the patient's condition, treat the acidosis condition, and ensure that the condition does not recur. Some of the methods used by doctors to stabilize the patient's condition are:
- Provide fluid therapy through infusion to overcome dehydration and dilute glucose in the blood
- Giving insulin by intravenous infusion (through a vein) followed by insulin administration by subcutaneous injection (through under the skin), to lower blood sugar levels
- Provides electrolytes, such as potassium, sodium, and chloride to balance the body's electrolyte levels
To ensure that diabetic ketoacidosis does not recur, the doctor may change the type or level of insulin the patient is taking and instruct the patient to do the following:
- Use medicine according to doctor's instructions
- Consuming food according to the recommended diet program
- Doing sports according to the program
- Do blood tests regularly
- Always check the expiration date of the drug and make sure the insulin used does not contain clots
- Call your doctor if your blood sugar is higher than your expected target range
If using an insulin pump, make sure the insulin pump is not leaking and there are no air bubbles in the tube.
Complications of Diabetic Ketoacidosis
Ketoacidosis that is left untreated can be fatal. In addition, there are several complications that can occur due to diabetic ketoacidosis, namely:
- Heart attack and cardiac arrest
- Kidney failure
- Infection and sepsis
- stroke
- Acute gastric dilation (acute gastric dilation)
- erosion of the lining of the stomach (erosive gastritis)
- Difficulty breathing
In addition to the above complications, complications can occur due to treatment of diabetic ketoacidosis with fluids, insulin, and electrolytes, such as sodium, potassium and chloride. Some of the complications that may occur as a result of treatment for diabetic ketoacidosis are:
- Low blood sugar levels (hypoglycemia) due to treatment with insulin
- Low potassium levels (hypokalemia) due to treatment with fluids and insulin
- Swelling of the brain (brain edema) due to a drop in blood sugar levels too quickly
Prevention of Diabetic Ketoacidosis
Diabetics need to comply with treatment recommendations by doctors to avoid diabetic ketoadosis. Some things that can be done to prevent diabetic ketoadosis are:
- Do not forget to take medication or use insulin according to the schedule.
- Change insulin levels as needed based on doctor's instructions.
- Meet the needs of body fluids by drinking 8 glasses of water a day or as needed.
- Eat healthy foods and exercise regularly.
- Check your blood sugar 3-4 times a day or more if you are sick or stressed.
- Check ketone levels in the hospital when you have an infection, stress, or other illness.
- Check with your doctor if your blood sugar level is higher than usual while doing an independent blood sugar test.