Diabetic Ketoacidosis: myths, tips, and lesser known facts

About one in four newly diagnosed persons with type 1 diabetes (and some type 2’s) will present in diabetic ketoacidosis (DKA) to a doctor’s office, urgent care facility, or emergency department. If not diagnosed and proper treatment started, DKA can be deadly. DKA is often misunderstood by persons with diabetes. Diabetic ketoacidosis is complex and easy to misunderstand by lay and professionals alike. The following is a practical explanation of what DKA is, and what it is not. I also dispel some common myths and provide practical tips to prevent or minimize DKA recurrence. It's not intended to be comprehensive, but rather to point out some important (at least to me) facts and perspectives about this potentially preventable condition. I hope you find it informative.

This IS a lengthy post. Feel free to bookmark it and read over time as needed. It’s intended to be a reference for you.

As we start, consider the following:

Which of the following statements are true and which are myths about DKA:

1. Overeating (carbs or anything else) causes DKA.

2. Nausea and vomiting must be present.

3. Persons with diabetes who are sick or stressed typically require less,

not more insulin.

4. All ketones are bad.

5. DKA only happens when I frequently omit scheduled insulin, use

damaged insulin, or have an insulin pump malfunction.

6. Insulin alone treats severe cases of DKA.

The answers are found at the end of this post, PLUS some bonus DKA prevention tips.

WHAT IS TYPE 1 DIABETES?

Type 1 diabetes results from a loss of ability to produce enough of the hormone called insulin. In most cases the immune system attacks the insulin making cells, called beta cells. There is considerable research about what triggers this destruction to happen. Some researchers believe the immune system mistakenly believes the beta cells to be foreign and begins a highly targeted attack to eradicate them. We know this can take weeks (probably months) to years to result in diabetes. Some adults may take years to decades to lose enough beta cells to cause the diabetic state to occur. Another theory gaining in acceptance is that the beta cells somehow begin to produce a defective protein which attracts an immune system attack. There are probably many causes that trigger this process of destruction. It would be unwise to believe only one reason exists for triggering type 1 diabetes. It is a fact that half of persons with type 1 diabetes are diagnosed after 30 years of age.

These insulin-making beta cells are in the core of a ball or cluster of hormone producing cells known as the islets of Langerhans. Approximately 1 million islets are embedded throughout the human pancreas. They are unevenly distributed throughout the organ. For reference the pancreas is located behind the stomach. The job of the pancreas is to assist the process of human digestion and proper conversion of food into cellular energy for growth or powering organs and tissues. In addition to insulin, the pancreas makes dozens of other hormones and chemical messengers. One of these other hormones is called glucagon. It is made and released by cells located next to beta cells, called alpha cells. More about glucagon and its role in DKA later.

With a dwindling insulin ability due to an ongoing autoimmune attack, the body is less capable of managing the products of digestion or balancing the internal chemical environment of the body. Before any symptoms occur, the blood sugar level of a person destined to develop type 1 diabetes may spike upwards with meals, but slowly return to normal afterwards. This is what is defined as ‘impaired glucose tolerance’. Frank diabetes occurs gradually in most persons. Beta cell damage and destruction is painless. The usual patient only ‘feels’ the final stages of this loss of insulin producing ability. Increased peeing and drinking are the earliest signs. With time, weight loss happens despite a good appetite. By the time the first signs or symptoms of diabetes are apparent, most of the ability to make insulin has been lost (80-90%).