Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes mellitus brought about by a lack of insulin in the body causing an inadequate uptake of glucose from the blood. It is characterized by a severe rise in blood sugar or hyperglycemia along with dehydration that may lead to shock and even loss of consciousness.
Insulin is an important hormone that helps the body uptake and utilize glucose present in blood, therefore reducing the blood sugar level. If there is a lack of insulin, the blood sugar is not used and instead body fats are broken down to provide an alternative energy source. This breakdown of fat however, causes the release of acidic by-products called ketones that build up in the blood and urine.
High glucose levels cause increased amounts of glucose to move into the urine, a process termed osmotic diuresis. During osmotic diuresis, water and solutes such as potassium and sodium also move into the urine. This leads to frequent excretion of large volumes of urine or polyuria, dehydration and compensatory thirst or polydypsia. Who is affected?
DKA is more common among people with type 1 diabetes or those with type 2 diabetes who take insulin to regulate their blood sugar levels. Nearly a quarter of all type 1 diabetics are admitted to hospital with DKA at some point in their lives. Young children with type 1 diabetes are at particular risk of developing the condition.
Common causes or triggers of DKA typically include situations that raise the body's requirement for insulin. Examples include:
During infection, the body has an increased need for glucose that may not be met by an adequate amount of insulin for stimulating the uptake of glucose from the blood. Examples of infections that can cause this problem include the flu, urinary tract infection, pneumonia and gastroenteritis.
Missing doses of insulin
Missed insulin doses may result in inadequate insulin levels, leading to DKA. This may also occur if an insulin pump is damaged or ineffective in delivering the required dose of insulin to a patient.
Major injuries or surgeries
Major injury or surgery can cause a rise in the levels of stress hormones that counteract the effects of insulin.
Major illnesses such as stroke or heart attack can also raise levels of these insulin-counteracting hormones.
Alcohol or drug abuse
Binge drinking or the use of certain drugs such as ecstasy, cocaine or ketamine can increase the body's glucose requirements and raise the risk of DKA.
Patients who are unaware they are diabetic
Some patients with type 1 diabetes who have never been diagnosed may present with DKA, especially after exposure to DKA triggers such as infection, injury, surgery or illness.
Reviewed by Sally Robertson, BSc