Diabetes: Ketoacidosis

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KEY POINTS

• Diabetic ketoacidosis (DKA) is a buildup of acids in the blood that can cause coma or death if not treated right away.
• DKA is a medical emergency and needs to be treated right away at a hospital. Your child will be given insulin, other medicine, and IV fluids.
• Check your child’s blood sugar level to keep it under control, as recommended by your child’s healthcare provider. Ask your child’s provider when you should check for ketones.

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What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is a buildup of acids in the blood. If the body does not make enough insulin, sugar cannot move out of your child’s blood and into the cells. Your child’s blood sugar can get very high and his body burns fat instead of sugar for energy. This makes byproducts called ketones. When ketones build up to dangerous levels, it is called ketoacidosis. This can cause coma or death if not treated right away. Ketoacidosis may happen with type 1 diabetes. It rarely happens with type 2 diabetes.

What is the cause?

DKA can happen if your child skips doses of insulin. Or it may happen if there is a change in your child’s health, such as:

• Infection
• Injury
• Surgery
• Other types of physical or emotional stress

If your child is using an insulin pump, it may happen if your child stops getting insulin because the pump is not working or there is a kink in the tube or the tube comes out.

What are the symptoms?

Symptoms of ketoacidosis may include:

• Shortness of breath
• Fruity smelling breath
• Very dry mouth
• Abdominal pain, nausea, or vomiting

Symptoms of high blood sugar may include:

• Blurry vision
• Dry mouth
• Feeling very thirsty and drinking a lot
• Urinating a lot
• Feeling tired all the time
• Confusion or a hard time paying attention

If the pancreas stops making insulin, blood sugar can get very high and ketones can build up to a high level very fast. It may happen so fast that ketoacidosis symptoms may be the first symptoms that your child has before he or she has even been diagnosed with diabetes.

Several hours to a couple of days after symptoms start, ketoacidosis may cause a coma.

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child will have blood and urine tests.

How is it treated?

DKA is a medical emergency and needs to be treated right away, usually at a hospital. Your child will be given insulin and IV fluids. With early treatment, your child will usually recover in hours to days.

How can I take care of my child and help prevent DKA?

• Keep your child’s blood sugar level under control, as recommended by your child’s healthcare provider.
• Check your child’s blood sugar level as often as your child’s provider recommends. Give additional insulin for high blood sugar as directed by your child’s provider.
• Make sure your child never takes more insulin than the regular dose unless you have double checked the blood sugar reading and made sure that the sugar level is too high and your child needs more insulin.
• Make sure your child drinks plenty of water. Dehydration can cause blood glucose levels to rise, and if not treated, ketoacidosis may happen.
• Know the early signs and symptoms of ketoacidosis.
• Ask your healthcare provider when you should check for ketones. Your provider may recommend checking for ketones if:
  • Your child’s blood sugar level is higher than recommended by your healthcare provider (usually around 240 mg/dL.)
  • Your child is ill or under more stress than usual. When your child is sick, ketones can be present even if the blood sugar is not high.

  Let your provider know right away if there are ketones in your child’s urine or blood.

• Keep extra insulin with you.
• Do not let your child exercise if his blood sugar levels are high and there are ketones in the urine.
• Make sure that your child carries a medical ID (such as a card or bracelet) that says he has diabetes.

Ask your child’s healthcare provider:

• How and when you will get your child’s test results
• How long it will take your child to recover
• If there are activities your child should avoid and when he or she can return to normal activities
• How to take care of child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.