Diabetic Ketoacidosis (DKA) and how to avoid it

Never stop taking your insulin

Why is being ill a problem for people with diabetes?

Illness is a stress on the body. You become more resistant to insulin and your blood glucose levels may rise (hyperglycaemia). You may need to take more insulin, drink more fluids and check your blood glucose levels more frequently than you usually do (i.e. 2-4 hourly). By doing this you may help stop your body developing ketones. Ketones are produced when there is not enough insulin in your body. The aim is to prevent ketones rising in your body. A person with type 1 diabetes is at risk of developing ketones which may lead to diabetic ketoacidosis. This is a serious condition which can be life threatening and require hospital treatment.

Find out more information at: Diabetes and being ill | Managing when you're sick | Diabetes UK

Doesn’t that happen to everyone?

Someone who does not have diabetes naturally releases more insulin to deal with effects of illness. However, people with type 1 diabetes cannot do this which increases the risk of hyperglycaemia and DKA.

Even though there is more glucose in your blood than usual, the lack of insulin means it cannot get your cells where it is turned into energy. As a result, your fat stores are broken down for energy instead, releasing an acidic chemical called ketones into your blood stream.

Ketones are extremely harmful, and your body will try and get rid of them. As a result you will become very thirsty as your body tries to flush the glucose and ketones out in the urine.

What happens if I’m vomiting?

Vomiting makes your body even more dehydrated and less efficient at flushing out ketones, so the levels rise faster. It may be possible for people to smell the ketones on your breath. (Ketones smell like pear drops or nail varnish remover). You may also feel short of breath and thirsty.

High levels of ketones, dehydration and the imbalance of chemicals can make you feel sick and can also lead to vomiting. High levels of ketones need to be treated immediately If DKA develops, it is treated in hospital with intravenous fluids (a drip in your arm), insulin and glucose.

What is DKA?

Diabetic ketoacidosis, known as DKA, is a life-threatening diabetes complication. It is caused by a severe lack of insulin. Without insulin your body can’t move sugar into the cells for energy so instead breaks down fat releasing harmful chemicals called ketones which build up and make your blood acidic. 

Diabetic ketoacidosis (DKA) | Ketosis symptoms and treatment | Diabetes UK

How can I avoid DKA when I’m ill?

You can avoid DKA by:

• Careful monitoring of your blood glucose levels and adjusting your insulin
• Drinking plenty of fluids
• Injecting more insulin
• Testing for ketones

When is hospital admission required?

DKA is a medical emergency that requires immediate treatment in hospital. Do not delay coming into hospital if you are concerned.

If you experience the following, please contact the Diabetes Centre (01592 648001) or accident and emergency if you suspect DKA.

•          You are unable to keep fluids down
•          Persistent vomiting
•          High blood ketones that you can’t get to return to normal
•         Breathlessness or stomach pains

Hypoglycaemia (Hypo) – How to treat a hypo

Hypoglycaemia is when the blood glucose level is less than 4mmol/l regardless of whether you feel symptoms or not.

What is hypoglycaemia? | Signs and symptoms | Diabetes UK

Hypoglycaemia (low blood sugar) | NHS inform

Hypos can be caused by:

• Eating too little carbohydrates
• Alcohol
• Late/missed meal or snack
• Stress
• Hot weather
• Illness
• Lumpy insulin injection sites
• More exercise / activity than normal e.g. shopping, gardening, sexual activity, sports
• Taking too much insulin or diabetes tablets

If you are having a hypo, you may feel:

• Sweaty
• Shaky
• Tingling in your lips or mouth
• Light-headed
• Intense hunger
• A headache (especially after waking)
• Blurred vision
• Anxious – pounding heart, butterflies in stomach
• A change in your mood e.g. tearful, irritable, unable to concentrate

You may also notice:

• Glassy eyed or pale
• Slurring words
• Behaving strangely: confused, agitated, appearing drunk, showing mood changes

Diabetes hypos | What does hypoglycaemia Feel Like?