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Diabetic Ketoacidosis

The most dreaded acute complication of Type 1 diabetes is diabetic ketoacidosis, a condition resulting from an absolute lack of insulin in the body. Most commonly, it occurs when a Type 1 diabetic has been sick and unable to eat. The patient skips his insulin dose, believing no insulin is needed because he is not eating.

When insulin is not present in the blood, fat breaks down in abnormal ways, forming powerful acids (e.g. ketoacids, ketones) which stay in the blood. This makes the individual very ill. Left untreated, the individual will die. Inevitably, he/she has symptoms from very high blood sugar including thirst, very dry mouth, increased urine, marked fatigue and tiredness. Other symptoms may include stomach pains, cramping, diarrhea, nausea, vomiting. The individual is also likely to be short of breath.

All individuals with diabetic ketoacidosis must be treated in hospital with a continuous drip of insulin into a vein. Large amounts of fluid will need to be given intravenously as well, to treat the severe dehydration.

How to prevent Diabetic Ketoacidosis

  1. People with Type 1 diabetes must not skip their insulin doses, even if they are not eating. In fact, if they are sick enough to lose their appetite or are suffering from nausea, they will usually need more insulin.

  2. Test blood more frequently when sick. Ketoacidosis generally does not occur if blood sugars are reasonable. (Insulin must be present to make the blood sugar level reasonable. In this case, enough insulin is available to prevent the ketoacidosis.) If blood sugars are high, or rising, take larger doses of insulin and take them more frequently (take extra shots).

  3. Some people find it useful to test their urine for ketones when they are sick. When the sugar is high, and the urine is becoming strongly positive for ketones, ketoacidosis may be developing. New meters are being introduced that test for ketoacids directly from a finger-poke blood sample, and may be useful.

  4. If prevention doesn't work and the individual gets sick to the point that he or she cannot keep fluids down, it is best to go to the hospital.
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