These three letters strike fear into the heart of anyone dealing with Type 1 diabetes. Shorthand for
What Is It?
Diabetic ketoacidosis is a condition in which the body is so deprived of insulin that it becomes desperate for fuel and begins breaking down fatty tissue and muscle. Ketones are the by-product of this process, and the liver can only process a certain amount of ketones at a time. When the body produces too many ketones, they spill over into the bloodstream and, like an acid, basically poison the person. This process also results in a lack of bicarbonate, as well as other lab abnormalities that your medical or ER team will look for in your child at presentation. Symptoms include frequent urination, dehydration, excessive thirst, and sometimes stomach pain and even some cramping. Vomiting often occurs as well.
Causes of DKA
The cause is, put simply, a lack of insulin in the body. But how that lack of insulin comes to be can be more complicated. At diagnosis, DKA is usually because parents and/or the patient did not know the signs of the onset of diabetes, and the patient hovered at a high blood glucose number for an extended period.
Well into treatment, DKA can be caused by a massive infection or major illness and sometimes by a malfunctioning pump or site. In some cases, particularly with teens and adults, DKA can be caused by the purposeful withholding of insulin. Sometimes, teens with diabetes don't take insulin so they'll lose weight quickly. Other times, teens stop caring for themselves because they are sick of the lifestyle diabetes has forced on them.
It can be tough for a parent or caregiver to notice DKA the first time, particularly if a child is handing all her own care. By seeing your child's meter at least a few times a day, you may help avoid DKA.
Diabetic ketoacidosis is a true emergency. If you suspect it, call your medical team immediately and plan on heading to the emergency room. You need hands-on professional help to correct the situation.
This condition doesn't always occur as a result of high blood sugars. Some children struggle with ketones when they have a stomach bug or other kind of vomiting situation. If your child is vomiting, you absolutely need to check regularly for ketones, no matter what his blood sugar reading is. It is possible to be low and have a large number of ketones, a situation that needs medical intervention as well.
How to Avoid DKA
The best way to avoid DKA is to be vigilant about checking for ketones. Although it's driven into the minds of most parents at diagnosis time, many parents cease checking for ketones every time a blood sugar reading is over 260, because they understand the reason a child is high and feel confident they know how to correct the situation.
But in reality, the best-care scenario always includes checking for ketones when a child's reading is over 260, or when a child is experiencing any kind of illness.
It's also important to remember that when ketones are present, the correction factor is higher. You'll want to talk to your medical team ahead of time about what they'd like you to do when ketones are present (many will give a percentage increase for you to go by; others will ask you always to call for help with ketones). Either way, the first couple of times you'll want to call for help just to gain confidence.
Avoiding DKA can come with vigilance and oversight as well. If you look at your child's meter at least three times a day, she won't have enough time to slip into DKA without you knowing.
Some parents feel ashamed after their child is diagnosed with DKA. It's a prideful thing, caring for your child with diabetes. But remember, we are all human. Some parents also experience grief after a DKA incident, almost like the feeling at diagnosis time. Talk to your social worker if you experience grief or shame. He or she will help you see that you are not alone.