Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is life threatening. DKA develops when there is a serious lack of insulin in the body. This may occur in several situations:

• at the time of diagnosis. About 10 to 25 children out of 100 with newly diagnosed diabetes end up in the emergency room with DKA.
• with a failure to take any or enough insulin
• with a failure to take enough extra insulin to cover the high sugar and ketone production caused by infection or other illness

When there is not enough insulin available, blood sugar levels rise and excess sugar spills into the urine. Then the body starts breaking down fat as an alternative supply of energy. The ketones produced by fat breakdown are acidic, causing ketoacidosis. As the condition worsens, and more and more water is lost in the urine and through vomiting, the child becomes increasingly dehydrated. DKA can be avoided by careful attention to all aspects of the diabetes treatment plan. DKA usually develops over hours or days.

How to Check Urine Glucose and Ketones

Symptoms of diabetic ketoacidosis (DKA)

• high blood sugar levels and ketones in the urine
• excessive thirst
• urinating much more often and in larger amounts
• sudden loss of weight
• complaints of stomach pains or nausea
• vomiting
• leg cramps
• a flushed appearance
• headache
• signs of dehydration: dry mouth and tongue, sore throat, dark circles under the eyes
• deep, heavy breathing, fruity-smelling breath
• drowsiness leading in time to unconsciousness

If a child exhibits any of these signs, the blood sugar level and ketones in the urine should be checked. Notify the doctor right away. DKA must be treated in a hospital.

Preventing DKA (type 1)

In the child with established diabetes DKA is totally preventable. As a parent, you need to make sure that your child or teen is getting the right amount of insulin at the right time. One of the main reasons for developing DKA is failure to get any or enough insulin. As long as you are in charge of giving the insulin, this is unlikely. Children who are left to inject their own insulin unsupervised before they have developed sound judgment (or when an illness impairs their judgment) can forget or even neglect to inject the insulin on purpose. The result can be DKA. Wise parents remain involved in supporting and supervising their children with injections long into their adolescent years. As children become more independent, you should watch for warning signs that things are not going well—for example, a return of the symptoms of hyperglycemia or of ketones in the urine. When you notice these signs, supervise again closely, or even give the insulin injections for a while, regardless of your child’s age.

The other high-risk time for developing DKA is when the body is under stress due to fever caused by infection or flu, for example. An illness may create a demand for more insulin than normal. If you don’t realize this and make the correct adjustments, DKA may result.

Common illnesses can become life-threatening if they are not adequately managed by the family with the support of their health care team. You will need to become very familiar with the sick day guidelines, and remember—if you’re taking a vacation, don’t leave home without them.

It is not possible to get diabetic ketoacidosis from eating too much sugar. The worst that can happen is high blood sugar (hyperglycemia), which is undesirable but not the life-threatening condition of DKA. The only cause of DKA is a lack of insulin.