Medicines for Diabetic ketoacidosis

What it is

Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes that needs urgent hospital treatment. It happens mainly in people with type 1 diabetes (and, less commonly, type 2), and occurs when there is a severe lack of insulin. Without enough insulin, the body cannot use glucose for energy, so it starts breaking down fat instead; this produces acidic chemicals called ketones, which build up in the blood and make it too acidic — along with high blood sugar and dehydration — leading to the dangerous state of ketoacidosis. DKA can be triggered by: not taking enough insulin (or missing doses, or a problem with an insulin pump); being unwell or having an infection (a very common trigger, as illness increases insulin needs); and, sometimes, it is the way type 1 diabetes first presents in someone not previously diagnosed. The symptoms of DKA develop over hours to a day or so and can include: feeling very thirsty and passing a lot of urine; feeling very tired; feeling or being sick (nausea and vomiting); tummy pain; deep or rapid breathing; breath that smells fruity (like pear drops or nail varnish); confusion or drowsiness; and, if untreated, it can progress to loss of consciousness and be fatal. High blood sugar and, importantly, the presence of ketones (which people with type 1 diabetes may be advised to test for when unwell or when blood sugar is high) point to DKA. Because DKA is life-threatening and can develop relatively quickly, it is a medical emergency: the warning signs — particularly feeling very unwell, vomiting, tummy pain, rapid breathing, fruity breath, and drowsiness, especially with high blood sugar and ketones — need urgent medical help. Treatment is in hospital, with insulin, fluids, and correction of the body’s chemistry. Preventing DKA (through good diabetes management, not missing insulin, and following "sick day rules" when unwell) and recognising it early are very important. The key messages are that DKA is a life-threatening diabetic emergency, that its warning signs need urgent help, and that good diabetes management and sick-day rules help prevent it.

How it is treated

Diabetic ketoacidosis is a medical emergency and is treated urgently in hospital, so the priorities are recognising it early, seeking urgent help, and preventing it through good diabetes management. Recognition and urgency are critical: if someone with diabetes (or someone with symptoms of undiagnosed diabetes) develops the warning signs of DKA — feeling very unwell, vomiting, tummy pain, feeling very thirsty and passing lots of urine, deep or rapid breathing, fruity-smelling breath, drowsiness or confusion, particularly with high blood sugar and ketones — this is a medical emergency, and urgent medical help (emergency services, or as advised by their diabetes team) is needed without delay. In hospital, DKA is treated with: insulin (usually given into a vein) to switch off the production of ketones and allow glucose to be used; fluids (into a vein) to treat the dehydration; and careful correction and monitoring of the body’s salts (electrolytes, such as potassium) and chemistry, along with treating any underlying trigger (such as an infection) and supportive care; treatment is in a closely monitored setting, sometimes intensive care for severe cases. With prompt treatment, most people recover, though DKA is serious. Prevention is very important, especially for people with type 1 diabetes: taking insulin as prescribed and never omitting it (even when not eating, unless specifically advised — the body still needs background insulin); following "sick day rules" when unwell (which include continuing insulin, monitoring blood sugar and ketones more frequently, staying hydrated, and knowing when to seek help — people with diabetes are given specific guidance); checking for ketones when blood sugar is high or when unwell, as advised; and managing diabetes well with the support of the diabetes team. Knowing the warning signs and having a plan for illness are key. For people not previously diagnosed with diabetes, DKA can be the first presentation of type 1 diabetes, so the symptoms should never be ignored. The reassuring message, within the seriousness, is that DKA is treatable with prompt hospital care, and that good diabetes management — taking insulin as prescribed, following sick-day rules, and monitoring — largely prevents it; the essential message is that its warning signs are a medical emergency needing urgent help.