How to prevent (or treat) DKA In Type 1 Diabetes

Medical Disclaimer: Stephanie Johnson is not a medical professional and anything she says is based on her own personal experience and should not be used to diagnose or treat any medical condition. She does not represent Matt Vande Vegte or FTF Warrior LLC in any way. Please consult your medical team and/or doctors before making any changes to your diabetes management, and seek immediate medical attention if you think your life may be in danger.

DKA at Diagnosis?

Diabetic ketoacidosis (DKA) may be the first sign that an individual is diabetic, in a patient with no known history of diabetes as was the case with me when I presented to my primary care physician with a blood glucose level of 350 mg/dl. DKA can be life-threatening and we'll talk about why. Typically, a blood glucose reading will be obtained to help determine a diagnosis of DKA. A person might present with what seems like a simple matter of dehydration, regardless of a positive or negative history of diabetes.   

What IS diabetic ketoacidosis?

DKA is associated with an insulin deficiency (a person is either all or mostly deficient in insulin) and a severely elevated blood glucose level, typically greater than 300 mg/dL, per medical documentation. Individuals can experience DKA even if they have a low/normal blood glucose level, which can occur in the beginning of an illness if a person reduces their insulin in fear of hypoglycemia. The slow progression of DKA can result in a slow increase to the higher blood glucose levels usually seen by the time a person goes to the doctor. DKA is from a severe LACK of insulin, not from the high level of blood glucose.

Let’s Simplify Things…

Insulin transports glucose into tissue (muscle, fat, and the liver). Without insulin, those tissues are unable to support glucose uptake even though the blood has an extremely elevated amount of circulating glucose available. If you think of  Blood Glucose as Gasoline, Insulin as a Car, and Muscles as the Destination; it doesn't matter how much Gasoline you have if you don't have a car to get to the Destination. You may know that the brain runs on glucose. The brain is the only exception to this transportation dilemma since glucose does not require a vehicle to reach the brain. So, the brain can function (unlike during hypoglycemia when you may notice confusion), but the body begins to degrade.   

When the body finds that it is not receiving the fuel it needs to function, it initiates a snowball effect that exacerbates the issue of too much glucose in the bloodstream. It begins to break down fat & protein, as you may be familiar with when you see your blood sugar rise hours after a high fat/protein meal. This breakdown of fat & protein causes the blood sugar levels to rise further. Fat breakdown generates ketones, which during ketosis can be used by the muscles as fuel if insulin is available for transport. However, without a transport vehicle, even these ketones cannot be used by the body and begin to build up. Once the levels of glucose and ketones build up extensively, they begin to spill over into the urine. Back in the 1500s, tasting urine was the main mode of diagnosing a person with diabetes (and there was no treatment). The buildup of Ketones causes the blood to become acidic (the acidosis part of DKA), ketones turn into acetone. You may be familiar with the disintegrating properties of acetone and its ability to easily remove nail polish. Imagine having this acid coursing through your veins. Shortly before I was diagnosed, one of my most painful symptoms of DKA was the contact dermatitis I experienced during my menstrual cycle due to the high acidity level of the fluids. 

Did You Know?

Fun fact, the release of small amounts of acetone through your breath is responsible for the "fruity" smell that some people also experience. DKA can also cause symptoms of fatigue, feeling faint, rapid breathing, and rapid/irregular heart rate. These were additional symptoms I experienced prior to my diagnosis of T1D. They can easily be missed and attributed to something else. In my case, I exercised 5 days per week and followed a diet conducive to an NPC Bikini Competitor. I thought these feelings of being faint, having a rapid heart rate, and feeling exhausted were possibly due to overtraining or not eating enough. 

So, how does the body try to remove these toxic levels of Ketones and Glucose? As mentioned earlier, they begin to spill over into the urine. Typically, you will feel extremely thirsty and urinate often. And since Ketones are acidic, the body will try to buffer that acidity with Sodium. As you may know, Sodium also draws out water. Have you ever salted sliced tomatoes or zoodles and let them sit and returned to find that water had been drawn out? This can further dehydrate you, in addition to depleting needed electrolytes causing an electrolyte imbalance. 

Once the body has dehydrated, DKA has already progressed pretty far by this point. The dehydration is typically what then causes nausea, vomiting, and flu-like symptoms. DKA can be slow to present, thus it is generally at this late stage when a person will seek medical attention. So what can be done? If you present to your primary care physician or hospital in a state of DKA, they will most likely monitor your blood glucose levels and begin rehydrating you with IV fluids. You will be monitored for improvement or decline.

What Can You Do?

What if you are experiencing DKA at home? As we mentioned, ketones spill over into the urine. This allows you to check your ketone levels at home with ketostix or something similar that you may have received from your doctor. If you find that you have ketones, be sure to also check your blood glucose levels. If your blood glucose levels are high, try to determine the cause. Perhaps you missed a bolus, have an issue with an infusion site, or for some reason have not been receiving your regular basal insulin. Whatever the case, take the missing insulin. Drink fluids to rehydrate. And continue checking your blood glucose and ketone levels every 1-4 hours. If your condition worsens or you feel faint or find it difficult to remain conscious, seek medical attention immediately.

Determining the cause of DKA is the first step in prevention. Learning about advanced insulin management techniques can help you avoid DKA. 

For the full video interview with Matt Vande Vegte and Stephanie Johnson, CLICK HERE

- Stephanie Johnson, M.S.

@the_cranky_panky

www.TheCrankyPanky.com