The condition known as diabetic ketoacidosis occurs when the body has no insulin. This leaves the muscle, fat, and liver cells unable to use glucose (sugar) in the blood as fuel. Other hormones such as glucagon, growth hormone, and adrenaline cause fat to break down within the cells of these tissues into glucose and fatty acids. These fatty acids are converted to ketones by a process called oxidation. The body is literally consuming muscle, fat, and liver cells for fuel.

In diabetic ketoacidosis the body shifts from its normal metabolism using carbohydrates for fuel to a fasting state using fat for fuel. The resulting increase in blood sugar because it cannot be transported into cells for future use causes increased urination and dehydration. Commonly, 10% of total body fluids may be lost. Significant loss of potassium from urination is also common.

• The most common events that cause person with diabetes to enter a state of diabetic ketoacidosis are these:
   
  • Infection (40%)
     
  • Missed insulin (25%)
     
  • Newly diagnosed or previously unknown diabetes (15%)

Various other causes may include a heart attack, stroke, trauma, stress, and surgery. There is no identifiable cause 5-10% of the time.

When to call the doctor

• If you have diabetes, contact your doctor if you have very high blood sugars (generally more than 350 mg) or moderate elevations that do not respond to home treatment.

• If you have diabetes and develop a fever or start vomiting, contact your doctor for instructions.

• If you have home access to urine ketone test strips, and if urine sampling indicates moderate or greater urine ketones, notify your doctor.

When to go to the hospital

People with diabetes should be taken to the hospital's emergency department if they appear significantly ill, dehydrated, confused, or very weak. Other reasons to seek immediate medical treatment include shortness of breath, chest pain, severe abdominal pain with vomiting, and high fever

By Khim Lyn Lim

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