DKA, Hyper/Hypoglycemia

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin. Insulin is what breaks down sugar into energy. When insulin is not present to break down sugars, our body begins to break down fat. Fat break down produces ketones which spill into the urine and cause glucose build up in the blood, thus acidifying the body. Because sugar is not entering into our body’s cells for energy breakdown, the sugar is being processed by the kidneys and excreted through the urine; as a result, we become dehydrated and our blood becomes even more acidic. This leads to sickness and hospitalization if not treated.

If a person’s blood sugar is over 240, they should start checking their blood for ketones. If you have diabetes, or love someone who does, being aware of warning signs of diabetic ketoacidosis (DKA) can help save a life.

Early Symptoms of DKA:

  • High blood glucose level, usually > 300
  • High volume to ketones present in blood or urine
  • Frequent urination or thirst that lasts for a day or more
  • Dry skin and mouth
  • Rapid shallow breathing
  • Abdominal pain (especially in children)
  • Muscle stiffness or aches
  • Flushed face

As DKA Worsens:

  • Decreases alertness, confusion – brain is dehydrating
  • Deep, labored, and gasping breathing
  • Headache
  • Breath that smells fruity or like fingernail polish remover
  • Nausea and/or vomiting
  • Abdomen may be tender and hurt if touched
  • Decreased consciousness, coma, death

If you think you might have DKA, test for ketones. If ketones are present, call your health care provider right away.

To treat high blood sugar, hydrate with water or sugar free, caffeine free drinks. Sugar free popsicles and snacks are also good alternatives. Always call the doctor if vomiting goes on for more than two hours. Symptoms can go from mild to life-threatening within hours.

What Causes DKA?

Common causes for DKA are:

  • Underlying or concomitant infection
  • Skipping or missing insulin dosages
  • Undiagnosed diabetes
  • Other factors include: medical, surgical or emotional stress, brittle diabetes, defective insulin pump infusion, catheter blockage, mechanical failure of the insulin infusion pump, medication or even pregnancy

The Numbers:

  • Diabetic ketoacidosis is typically characterized by hyperglycemia (high blood sugar) over 300 mg/dLm a bicarbonate level less than 15 mEq/L, and a pH less than 7.30m with ketones present in the blood and urine.
  • While definitions vary, moderate DKA can be categorized by a pH less than 7.2 and a serum bicarbonate less than 10 mEq/L, whereas severe DKA has a pH less than 7.1 and bicarbonate less than 5 mEq/L.
  • Numbers from MEdscape

High Blood Sugar Treatment (Hyperglycemia)

If an individual’s (child or adult) blood glucose test result is higher than 240, the individual needs to test for ketones. If ketones are present and blood glucose is above 240, they should treat with medication, dilution (drink water, diet drinks or other sugar free drinks), and not participate in physical activity.

High Blood Sugar Treatment:

  • Check urine for ketones
  • Drink water or other sugar free drinks/snacks

*For children in school: Notify parents if ketones are present in urine. The child should not exercise if ketones are present or if blood sugar is over 300.

Low Blood Sugar Treatment (Hypoglycemia)

Low blood sugar, or hypoglycemia, occurs when there is not enough sugar for the body to use as energy. Hypoglycemia is classified by a blood sugar that is usually less than 70 mg/dL. Low blood sugar comes on quickly and must be treated quickly. It is important for individuals, family members and friends to recognize low blood sugar symptoms.

Low Blood Sugar Symptoms Include:

  • Irritable or hungry
  • Incoherent or spacey
  • Drowsy/inattentive
  • Glassy or dilated eyes
  • Shaky or perspiration
  • Unusual behavior/slurred speech

Low blood sugars can be treated by checking the blood glucose level with a meter. If the blood glucose is <70 mg/dL, treat with 15 grams of fast-acting sugar.

Examples of fast-acting sugars are:

  • 3-4 glucose tabs
  • 1 small tube of cake gel
  • ½ cup of apple or orange juice
  • Half a can of soda (not diet)
  • 1 cup of milk
  • 1 air head

Frequent Causes of Low Blood Sugar May Include:

  • Late or skipped meals and snacks
  • Extra exercise, or exercising without adjusting insulin dosage
  • A dose of insulin or oral medication that is too high
  • Insulin dose peaking at a different time than normal
  • Administering a shot of insulin into a muscle results in rapid absorption
  • Taking a hot shower or bath less than 90 minutes after an insulin shot
  • Administering or drawing up insulin injection incorrectly