As dangerous as it sounds...

When you have diabetes it's crucial to make sure there's enough insulin in your body. One reason is that insulin controls you blood glucose and helps you avoid the complications of diabetes. But there is another reason: If you do not have enough insulin, you run the risk of developing a dangerous condition called diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) can occur when you don't have enough insulin to meet your body's needs. As your blood glucose goes up, you lose glucose in your urine. When glucose is lost in urine it pulls fluid out with it. If you don't replace the fluids you lose, you can become dehydrated.

Meanwhile, your body begins burning fat and protein from muscle tissue in order to maintain energy. Normally your body uses carbohydrate (glucose) for maintenance, but because there isn't enough insulin in your body, your cells can't access the glucose in your blood. Your body then resorts to burning fat in an unhealthy way. Your liver becomes involved in fat-burning, and the by-product is ketones. The ketones build up and your blood becomes acidic which is very bad news indeed.

As your blood becomes acidic, your system starts shifting electrolytes around to counter the acid and you retain sodium and lose potassium. This is where the condition becomes very dangerous and your blood becomes a toxic environment for your organs.

The bad news

An imbalance of potassium may affect your heart rhythm. Your brain may be affected too because it needs electrolytes as well as glucose to function. If your brain isn't getting either the glucose or electrolytes it needs, you run the risk of a coma.

Symptoms

As DKA first takes hold, you might feel nauseous, very thirsty, and tired. This usually happens over a period of hours or days. From there you may become confused and short of breath. If you don't get your blood glucose levels down and replenish the fluids in your body, you may eventually need an IV. Untreated DKA can result in coma or death.

Who is at risk?

The risk of DKA is highest when you're sick. It can also occur when you aren't eating and don't take enough insulin. Often a person with diabetes will think that not eating means that blood glucose won't go up and you don't need as much insulin. This is not the case. When you're sick, your blood glucose rises and if anything, you might need more insulin when you're ill, so check your blood glucose every two to four hours when you're feeling under the weather.

Your risk of DKA rises when you're injured or have an infection like a foot ulcer. This is because your body releases stress hormones during illness, injury or infection. Stress hormones counteract insulin, so your blood glucose will rise.

DKA can also occur when your insulin has "gone off" or your insulin pump is clogged. Your body won't be getting the insulin it needs, putting you at risk of DKA.

Type 1 or Type 2

In general, people with type 1 have a much higher risk of developing DKA than people with type 2. This is because people with type 2 still produce small amounts of insulin to help compensate for high blood glucose when they are ill.

DKA is rare in people with type 2; however, if you are sick with the flu, recovering from injury or fighting an infection, there is a small chance that you may be at risk for DKA.

Treating DKA

High or moderate ketones require immediate treatment. If you have type 1, your doctor may prescribe extra insulin or recommend that you go to the hospital. Sometimes it may be necessary to check your blood glucose every two hours and give yourself small amounts of insulin throughout the day or night in order to keep your blood glucose levels down. If you have type 2 and don't normally take insulin, your doctor may prescribe some for you.

You should drink plenty of fluids to help yourself rehydrate. Check with your doctor to see what kinds of fluids you should drink. Water is usually best but some people swear by diet cola (sugar free).

If you are vomiting and cannot keep fluids down, get help at once.

The last thing you should do when you have DKA is exercise. Activity will only cause more fat-burning, and not in the good way normally associated with exercise.

DKA is serious business, but you can avoid it if you are aware of the risks, stick with your diabetes care regimen when you're ill or injured, and keep track of your blood glucose and ketones.

CALL YOUR DOCTOR IF YOU EXPERIENCE:

• Lack of appetite
• Muscle stiffness or aching
• Dry mouth
• Pains in your abdomen
• Vomiting or feeling nauseous
• Dry or flushed skin
• Difficulty breathing
• Feelings of weakness
• Sleepiness
• A fruity odour on your breath

-- Published by "Diabetes Focus"