Diabetic Ketoacidosis – Part II

Although all of these tests are not necessary in every case, the tests can include:

• Blood sugar levels
• Ketone levels in blood and urine
• Acidity level of the blood
• Electrolyte levels in the blood
• Urinalysis
• Chest X-ray
• EKG – Shows the electrical activity of the heart

• Fluid replacement, usually through an IV – Most patients with DKA are dehydrated, which could have been part of the trigger for developing DKA, or due to the high urination level and nausea and vomiting that can be symptoms of DKA.  Rehydration with fluid replacement can help to dilute the high blood sugar level and help relieve some of the symptoms of DKA.
• Insulin therapy – The underlying cause of DKA is too little insulin for the circumstance.  Insulin, usually given IV, will reverse the processes that cause DKA.  If your blood sugar goes down during treatment, but your blood is still too acidic, you will be given sugar in the IV along with the insulin, until the acid level improves.
• Electrolyte replacement – When there is not enough insulin in the blood, this can result in lower levels of several electrolytes in the blood.  Replacing the electrolytes will help maintain normal function of your heart, as well as your muscles and nerves.
• Treatment or evaluation of any underlying trigger – If the tests show a specific trigger for DKA, such as pneumonia or a kidney infection for example, then that would need to be treated with the appropriate medication.  If your doctor suspects the DKA was triggered by a heart attack, further heart tests would likely be recommended.

• Educate yourself and family members about DKA – Knowledge is power!
• Close management of your diabetes – Take all medications as directed by your doctor.  Follow up regularly. Make healthy eating and physical activity a routine part of your day.
• Monitor your blood sugar levels regularly – Check your blood sugar levels as recommended by your doctor.  Check blood sugar levels more often if you are sick or stressed.
• Adjust insulin dosage and other diabetic medications when needed – Talk with your doctor ahead of time to learn how to adjust the dosage of your diabetic medications, especially insulin, depending on activity level, what you eat, whether you are sick or stressed, etc.  When you feel ill or stressed, or have had a recent illness or injury, you should check your blood sugar often and adjust your insulin dosage as needed.
• Check your ketone levels – When you are ill or stressed, and especially if your blood sugar is above 240 mg/dl, you should use an over-the-counter urine ketone test kit every 4-6 hours until your blood sugar is consistently back to your target levels.  If your ketone level is moderate to high, contact your doctor right away, go to the emergency room, or call 911.  If your ketone levels are low, you may need to take more insulin to bring your blood sugar down.  Talk with your doctor for instructions.
• Be ready to act quickly when necessary – Learn where the closest emergency room is well before you need it.  Find out what health care facilities are covered by your insurance.  Know how to contact your doctor after hours.  Make sure your kids know how to call 911 in case you quickly become too ill to do so yourself.  If your blood sugar is high and ketones are moderate to high, you need to act quickly to seek emergency care.  It could save your life.

Dr. Anita Bennett MD – Health Tip Content Editor