What happens in the body
Insulin acts as a key that allows cells to access glucose. When there is almost no glucose, glucose accumulates in the blood, but the cells starve. The body switches to a spare path - the breakdown of fats, the by-product of which are ketone bodies. In small quantities they are harmless, but when massively formed, the blood becomes acidic. At the same time, high sugar draws water into the urine, and the person loses fluid and important salts, especially potassium. The combination of acidification, dehydration and loss of electrolytes determines the severity of the condition.
- Insulin deficiency and cell starvation
- Breakdown of fats with the formation of ketone bodies
- Blood acidification
- Dehydration due to excessive urination
- Loss of potassium and other electrolytes
Why is it developing?
Most often, ketoacidosis occurs in people with type 1 diabetes, but it is also possible in type 2 diabetes against the background of a serious illness. Often, newly diagnosed diabetes begins with ketoacidosis, especially in children and adolescents: parents pay attention to severe thirst, weight loss and night urination, and the condition worsens quickly. In people with a known diagnosis, the main cause is a lack of insulin: missed injections, pump failure, expired drug. The second major reason is acute infections, in which the need for insulin increases.
- Newly diagnosed diabetes mellitus
- Skipping or reducing insulin doses
- Malfunction of the insulin pump or spoiled drug
- Infections: pneumonia, intestinal infection, urinary infection
- Heart attack, stroke, trauma, surgery
- Taking certain medications that increase sugar levels
Symptoms by stage
First, signs of high sugar increase: dry mouth, thirst, copious and frequent urination, weakness, weight loss. Then comes nausea, vomiting and abdominal pain, which is sometimes mistaken for poisoning or appendicitis. A characteristic fruity smell of acetone appears from the mouth, breathing becomes deep and noisy. The skin and mucous membranes are dry, the eyes look sunken. At a severe stage, a person becomes drowsy, stops responding to treatment and loses consciousness. You can’t wait for this: help is needed at early signs.
- Thirst and frequent urination
- Weakness and weight loss
- Nausea, vomiting, abdominal pain
- Smell of acetone from the mouth
- Deep noisy breathing
- Drowsiness and impaired consciousness
What to do before the ambulance arrives
The main thing is not to try to cope on your own. Call an ambulance on 103. If the person is conscious and not vomiting, give him small sips of plain water. Measure your blood sugar and, if possible, blood or urine ketones with a test strip. Avoid giving sugary drinks and food. You should not stop insulin due to lack of appetite - when you are ill, the need for it usually increases, and changing the dose yourself without the instructions of a doctor is dangerous. Prepare information about medications taken and last doses of insulin for medical professionals.
- Immediate call for ambulance 103
- Drinking plain water in small sips while maintaining consciousness
- Measuring Sugar and Ketones
- Don't give sugary drinks
- Do not stop insulin on your own
- Place on side if vomiting or loss of consciousness
Treatment and prevention of recurrences
Treatment is carried out in a hospital, often in an intensive care unit. The main directions are to replace lost fluids, continuously administer insulin, carefully replace potassium and look for the cause, such as infection. Doctors regularly monitor blood sugar, ketones, electrolytes, and acidity, so self-treatment at home is not possible. After discharge, it is important to understand what led to the episode and learn the rules of behavior during illness: how often to measure sugar, when to check ketones, how to adjust doses and when to seek help.
- Fluid replacement therapy
- Continuous insulin administration under medical supervision
- Correction of potassium and other electrolytes
- Treatment for infection or other cause
- Training in the rules of behavior in case of concomitant diseases
- Home ketone monitoring for high blood sugar
- Regular monitoring by an endocrinologist