The body then begins to burn fat stores for food. As these fat stores are burned, a by product is released called Ketones. It is ketones that are responsible for lowering the body's pH level below 7.35. Metabolic acidosis occurs when the pH of the body drops below 7.35. The body attempts to excrete the ketones via the kidneys, causing ketones to be released in the urine, a term called ketonuria. However along with the negative ketones, the body's positively charged electrolytes are also excreted. This leads to an electrolyte imbalance. The body continues to burn other glucose stores in the body such as proteins, causing nitrogen losses.
Now the body has depletion in electrolytes. This can cause nausea and vomiting, depleting more electrolytes. The individual is now in a severe hyperglycemic state and is hypovolemic as well. If these conditions are left untreated, the person can go into hypovolemic shock, become comatose and die.
Outward signs and symptoms of DKA include the following; eyeballs are soft and appear sunken, skin turgor is poor, (Dehydration of tissues can be tested by pinching the skin fold on the sternum. If the skin stays in one place or does not loose its shape rapidly, then dehydration can be assumed.), the person is very pale, cold, clammy, and exhibits deep rapid respirations, an effort the body makes to eliminate excess carbon dioxide. The individual may also exhibit severe abdominal pain and tachycardia, (heart rate greater than 100 beats per minute.) Diagnostic laboratory findings from arterial blood gases would indicate a pH less than 7.35, blood glucose level greater than 250 mg/dL, serum bicarbonate level less than 15 mEq/L, as well as ketones in the urine.
Interventions must be immediate to prevent irreversible destruction to the body's organs and prevent coma or death. Ensure a patent airway, and begin to administer oxygen via nasal cannula or mask. Establish an intravenous access with a large bore needle (18 to 20 gauge). Begin fluid stabilization with 0.9 Normal Saline. This is an isotonic fluid, compatible with the body's pH. The purpose of using an isotonic infusion initially is to re-establish blood pressure which was low and to increase urinary out put to 30-60ml/hr. When urinary output is less than 30 ml/hr, kidney failure can rapidly occur. Fluids should continue for one hour or until stabilization occurs. Next begin insulin infusion with a drip rate or 0.1U/kg/hr. During this time it is important to monitor the person's vital signs every fifteen minutes until stable or for at least one hours after treatment begins. If necessary, potassium should be administered to correct for hypokalemia, and sodium bicarbonate to correct for metabolic acidosis, if the pH is less than 7.0. The person should also have electrocardiogram leads placed on chest to monitor heart rhythms.
When the diabetic is at home and feels these bodily signs and symptoms beginning to occur, they should take the following steps; call 911, check their blood sugar, administer insulin per sliding scale, drink an electrolytic fluid, (i.e., sports fluids), breath into a paper bag, use oxygen if available, lie down, raise feet level with the heart and wait for the ambulance.
Preventative measures to avoid DKA include consistent control of blood sugar with administration of insulin per protocol. The diabetic should avoid too much food intake, and avoid taking too much or too little insulin. Stressful life situations can also cause elevations in glucose levels. Therefore the diabetic should prepare to check their blood sugar more often during times of stress and administer insulin as prescribed.
Understanding the complications of diabetes can help the diabetic take the necessary actions to prevent DKA from occurring and help them live a healthy life.
Much of the treatment of diabetes is the prevention and avoidance of complications. The complications of diabetes include heart disease, stroke, eye problems which can cause blindness, kidney disease, and vascular problems that can lead to foot amputation. Sixty percent of those with type 2 diabetes have one or more serious health problem related to the disease.
Heart disease: This is the most common complication of diabetes. The risk of heart disease doubles when a person develops the disease. The arteries that supply blood to the heart become blocked with fat and cholesterol, blocking blood flow and increasing the chances for a heart attack.
Kidney failure: The kidneys remove waste products from the blood and then return it back to the body. Kidney failure occurs when the kidneys can no longer filter these waste products. Diabetes mellitus, a form of the disease that is associated with high blood sugar, is one cause of kidney failure. In due course, these high blood sugar levels damage the millions of tiny filtering units within each kidney. This eventually causes kidney failure.
Vision problems: The most common complications of diabetes involving vision are cataracts and glaucoma. However, diabetic retinopathy can occur which is the most serious complication. This complication, caused by high blood sugar, causes damage to the tiny blood vessels that supply blood to the retina. The vessels swell and leak liquid into the retina, causing blurred vision and sometimes blindness.
Nerve damage: Numbness, pain and weakness due to nerve damage is a complication of diabetes. This often occurs in the legs, feet, arms and hands. The heart, digestive tract, and other organs can also have damage.
Infections: Those with diabetes have an elevated risk of getting infections. Foot infections are common in people with diabetes. Nerve damage and poor blood circulation puts those with diabetes at a higher risk for developing infected foot ulcers. Yeast infections on the skin and urinary tract are also common.
Sexual problems: Men with diabetes are three times more likely to have erectile dysfunction than men who do not have the disease. They are also more likely to have it earlier in life. About one third of women with diabetes may experience little or no sexual desire. Women often report a lack of sensation in the genital area, inability to reach orgasm and vaginal dryness resulting in pain or discomfort during sexual relations.
Foot problems: Nerve damage associated with diabetes can lead to serious foot problems. The inability to feel pain may result in the patient neglecting cuts and bruises which can lead to chronic infections. The loss of feeling can also result in Charcot foot which is a condition that affects the joints in the feet. The joints are repeatedly subjected to trauma and injury, resulting in damage to the ligaments, cartilage, and bones.
It's important to know how serious the complications of diabetes can be. The person with the disease is the one most responsible for doing the things necessary to minimize or avoid them. Think of diabetes care as full time job, and avoiding complications is well worth the effort. It's also important to know that keeping blood sugar levels as close to normal as possible is always the first line of defense.
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