Diabetic Ketoacidosis
Diabetic Ketoacidosis
Leticia Pickering
Nutrition 302
7 March 2008
ketoacidosis (DKA), a condition caused by the build up of toxic ketone bodies as a result
glucose, dry mouth, excessive thirst, and a sweet, fruity smell on the breath, a symptom
indicative of the presence of ketone bodies (2). There are many factors that cause diabetic
ketoacidosis in the type I diabetic patient, but four causes stand out as the most prevalent:
insulin deficiency, stress hormone excess, fasting, and dehydration (1). Prevention and
treatments of this toxic condition have become increasingly more effective and accessible
in the past couple of decades. Once thought to be a death sentence, diabetic ketoacidosis
is now more easily recognized and treated before significant damage can be sustained.
factors has lowered this assumption (1). In the context of ketoacidosis, relative insulin
when the plasma glucose concentration exceeds 250 mg/dl” (1). A lack of insulin in
metabolize lipids, leading to the formation of toxic ketone bodies. Although the body is
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equipped with mechanisms known as organic alkalis to remove toxins from the body, an
excess of toxins surpasses their ability to neutralize the acidic environment, allowing the
ketones to accumulate in the blood stream (2). Poor insulin compensation is usually due
to a lack of education and general ignorance as to the serious consequences it may have.
For this reason DKA is most often observed in children and newly diagnosed adults who
lack the experience to recognize the characteristic symptoms. Another area of diabetes
management that is often difficult to master and which can also influence the
Hypoglycemia, or low blood glucose levels, can negatively effect the progression
ratio utilizes approximately one unit of fat to every two units of carbohydrates. Deviation
from this balance will interfere with lipolysis, the decomposition of fat molecules. “When
sufficient glucose is not being burned there is excessive and abnormal oxidation of fat,
and instead of carbonic acid there is a production of toxic ketone substances” (4). Fasting,
used in the context of DKA to describe an inconsistent eating pattern in a diabetic patient,
is often secondary reaction to the “nausea, vomiting, and abdominal pain which
accompany the ketoacidotic state” (1). Another dietary matter that is an integral part of
recognize dehydration by observation of unusually dry mucous membranes, dry skin, loss
of firmness in the skin and elevated heart rate (1). Dehydration and a general deficiency
of fluid in the system only serve to exacerbate the condition as a lack of fluid in the body
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prevents the renal system, namely the kidneys, from functioning properly, which
bodies” (4). Water allows important bodily functions to be carried out and so rehydration
ketoacidotic patients usually experience extreme nausea, vomiting and diarrhea which
decrease their tolerance of the food and beverages that would normally help to restore
appropriate fluid levels. For this reason, immediate hospitalization is required so that
emergency intravenous fluids can be administered. The cause of dehydration, along with
stress hormones.
the development of diabetic ketoacidosis. Although the other causes are serious, they
correlation between its development and stress hormone secretion. One study found that
after a stimulus, the fever inducing drug pyrogen, was purposefully administered on a test
results were observed. The stress hormone groups, including catecholamines, cortisol,
growth hormone, and glucagon, were all secreted in response to the internal stress
causing an increase in plasma glucose and ketone bodies. Despite frequent insulin
injections in an attempt to stabilize those levels, they maintained high levels which
indicated the role that stress hormone secretion played in initiating ketoacidosis (1). This
observation makes sense, especially considering the role that glucagon has in regulating
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the concentration of ketone bodies. Glucagon is primarily responsible for regulating the
production of glucose through a process called gluconeogenesis and for regulating the
the body, results in an increase in the rate of lipolysis. This increase in lipid
decomposition “leads to a higher concentration of free fatty acids which leads to higher
the expertise of specialized medical professionals. The first issue that must be treated is
dehydration. This takes priority because once fluid and electrolyte balance is restored the
body will have the water that is essential for its metabolic processes. Rapid volume
cerebral edema, or swelling of the brain (3). As previously mentioned, many patients
and diarrhea. These patients should have their fluids administered intravenously to
improve absorption rates. Although the first priority in treatment is to restore fluid
balance to the patient, the other causes of DKA must also be addressed before a full
Treatment and Teaching Programs (DTTPs). This method’s effectiveness was tested in
laboratory research experiment that was recently published in Diabetes Care. DTTP is a
program that focuses on education on proper insulin dosage and administration to control
blood glucose levels. Subjects were individuals with type I diabetes who experienced at
least three occurrences of ketoacidosis over the course of a year, which qualified them as
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being at high risk for severe ketoacidosis. As the first step in the procedure, the subjects
underwent a “five day structured in patient course for intensive insulin therapy” (6). This
therapy focused on teaching the diabetic patient how to more accurately calculate the
appropriate dose of insulin in correspondence to the foods that they eat. The results for
this experiment indicated that patients that DTTP is in fact a beneficial method of
participants had no recurrent severe ketoacidosis the year after intervention”, which
seemed to also decrease the incidence of hypoglycemia in the long term (6).
it has many toxic effects on the body. Although research in recent years has produced
should be treated with urgency and, due to its volatile nature, should only be treated by a
Although prevention is the best method of treatment, it is important for the diabetic
patient to know and recognize the symptoms of acidosis so that, in the event of its