Diabetes Ketoacidosis

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious complication of mainly type 1 diabetes that occurs when your body produces high levels of ketone bodies. Ketone bodies are acids that your body produces when it breaks down fat for energy because it doesn't have enough insulin. Insulin is a hormone that helps your body use glucose for energy.

DKA can develop quickly, over a few hours or days. It is most common in people with type 1 diabetes, but it can also occur in people with type 2 diabetes.

What are the symptoms of DKA?

Symptoms of DKA may include:

Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
Fatigue
Blurred vision
Slow-healing sores
Frequent infections
Fruity-scented breath
Nausea and vomiting
Stomach pain
Shortness of breath
Confusion

If you think you may have DKA, it is important to seek medical attention immediately. DKA is a medical emergency, and it can be fatal if it is not treated.

DKA is treated with fluids and insulin. Fluids are given to replace the fluids that have been lost through urination and vomiting. Insulin is given to lower blood sugar levels and stop the production of ketone bodies.

Once DKA has been treated, it is important to identify and address the underlying cause of the DKA episode. This may involve adjusting your diabetes medication, changing your diet, or treating an infection.

How can you prevent DKA?

Here are some tips to help prevent DKA:

Monitor your blood sugar levels regularly.
Take your diabetes medication as prescribed by your doctor.
Eat a healthy diet.
Get regular exercise.
Avoid sugary drinks.
Manage stress.
Contact your doctor if you are sick or if you experience any changes in your blood sugar levels.

Unfortunately too many children I see at my hospital diabetes clinic with unrecognised Type 1 Diabetes presenting for the first time present with DKA. As many as 40% develop DKA in many different health areas.

I am particularly passionate about preventing DKA in children and adolescents with T1DM as too often it is due to a missed diagnosis by the general practitioner or mistaking the symptoms for a urinary tract infection (polyuria or excessive urination, but without dysuria or painful stinging urination) or for acute asthma for increased breathing associated with the child developing blood acidosis with severe DKA.

Children with diabetes who were toilet-trained prior start bed-wetting and have extreme thirst and frequent urination and eventually start losing weight. This can be going on for days only or weeks to months, and the longer the delay the higher the risk of DKA and the child becoming very sick and needing to be transferred by road or air ambulance to a paediatric intensive care unit for management which I can tell you is a frightening and stressful thing for the child and his parents and the doctors and nurses caring for the child.

Sometimes the family or teacher or pre-school care simply do not pick up the child having these classical “4T symptoms of diabetes” in children.

Please see our 4T posters and links to the two versions of our DKA prevention videos that my team at Nepean Hospital at Western Sydney have made. These include several translated versions into 12 or more common world languages of the 4T posters and subtitled translated videos into Arabic, Farsi, Turkish and Samoan.

You will be in for some inspiring positive messages about children with type 1 diabetes and if you know anyone whose child is having these 4T symptoms now do have him the child seen urgently by your GP who hopefully will not try to reassure you that drinking lots of water is a good thing or that he could not have diabetes as he is an infant!

The youngest child I have treated was only 6 months old so you can imagine how sick that child would have gotten if their parents were not persistent about getting his unusual 4T medical symptoms addressed in a timely helpful manner.

Always listen to a Mother’s concerns – she is usually correct!

See poster and video links below to Dr Gary’s Diabetes Team posters at Nepean Hospital with special acknowledgement in all the wonderful families who participated in the making of the videos and the whole amazing Paediatric Diabetes Team at the Nepean Hospital serving the Nepean Blue Mountains Local Health District (NBMLHD)

We are launching on Nov 14^th World Diabetes Day a 3-year DKA prevention campaign in the Nepean Blue Mountains LHD called “DKA Down to <10”.

So join in as a community member, a parent or a grandparent or a relative of a child with diabetes whether that be a child has Type 1 Diabetes or Type 2 Diabetes, or a person yourself with pre-diabetes or diabetes (i.e. 1 in 6 to 1 in 8 persons in Australia) to raise awareness about making the making the diagnosis of diabetes earlier in all persons, but particularly in children to prevent this potentially life-threatening complication of diabetes!

Keep smiling and keep moving and eating whole real “Rainbow Food”

Dr Gary “ Koala” Leong