Download Diabetes - Keto-Acidosis A guide for patients

Diabetes - Keto-Acidosis
A guide for patients with Type 1 Diabetes
What is Diabetic Keto-Acidosis (DKA)?
DKA is a serious condition caused by a severe lack of insulin in the body. As a result of
this lack of insulin glucose is unable to enter the body cells to be used for energy and so
fat stores are broken down for use as energy instead. This breakdown of fat causes
dangerous acidic substances called ketones to be produced.
DKA is most likely to occur in people with Type 1 diabetes, often as a result of having an
illness or infection, or because insulin is stopped. This is because blood glucose levels
usually rise during times of illness and the body requires more insulin than normal.
Treatment needs to be prompt in the early stages to prevent severe illness or
hospitalisation.
What are the Signs and Symptoms of DKA?
Early symptoms:
Thirst
Frequent urination
Tiredness
Raised blood glucose levels,
ie. Constantly above 15mmol/l
Presence of small to moderate amounts of
ketones in the urine + or ++ (0.6 to 3.0mmol/l)
Later symptoms:
Nausea and/or vomiting
Abdominal pain
Breath smelling of pear drops
Moderate to large amounts of ketones in the
urine or blood +++ to ++++ (>3mmol/l)
Laboured breathing
Drowsiness or Unconsciousness
What action should be taken?
If your blood glucose levels are constantly above 15 mmols/l test the urine for ketones
If you are unwell or have an infection test for Ketones.
If ketones are present in small to moderate amounts: Drink 4-6 pints of sugar free fluids per day (this dilutes the acidic ketones and prevents
dehydration).
 Test blood glucose levels every 2-4 hours. You may need to give rapid acting insulin
every 4 hours and increase each dose.
 NEVER OMIT YOUR INSULIN even if your blood glucose level is low or you feel unable
to eat. Your body needs insulin 24 hours a day to be able to function.
 If you are unable to eat properly, replace your usual food with foods and drinks containing
carbohydrates to provide energy such as sips of lucozade or non – diet drinks, milk, thick
soup, ice cream, fruit juice, milk pudding.
 Test the urine or blood for ketones 3-4 times per day until they have disappeared for 24
hours.
 Contact your Diabetes Nurse.
If Ketones are present in large amounts, if you have any of the later symptoms of DKA or if
you are unable to keep fluids down you may be dehydrated and the acid level in your blood
may be rising. Go to the Accident & Emergency department at your nearest hospital
immediately.
How can DKA be prevented?


Take your insulin regularly as advised by your diabetes team.
During times of illness test your blood glucose and ketone levels more often and increase
the dose and frequency of your insulin.
Always have a supply of ketone testing sticks that are in date. These are available on
prescription. NEVER STOP TAKING YOUR INSULIN
Further Information – please speak to your diabetes team.
Diabetes Day Unit, Kingston Hospital, Galsworthy Road, KT2 7QB
Open: 08.30am-4.30pm Mon - Fri
Tel: 020 8934 6370 (Answerphone)
Fax: 020 8547 3837
If using Novo insulin the Novocare Helpline is available for out of hour’s service.
Tel: 0845 600 5055
If you have any comments about the service, please contact:
PALS – Patient Advice & Liaison Service
020 8934 3993 or 020 8546 7711 ext. 3993 Email: [email protected]