DIABETIC KETOACIDOSIS:
It is a serious condition that occurs in people with high and uncontrolled sugar levels in their blood.
Mostly seen in people with Type 1 diabetes as in this type of diabetes there is a deficiency of insulin production.
The risk factor of diabetic ketoacidosis in people suffering from diabetes are :
1. INSULIN DEFICIENCY: insulin controls the sugar level in our blood and in its deficiency, the sugar level can go abnormally high and if not controlled by medication then it can lead to diabetic ketoacidosis.
2. OBESITY: uncontrolled weight gain can lead to diabetes and if weight and blood sugar levels are not controlled properly then diabetes can slowly progress to diabetic ketoacidosis.
3. PRE EXISTING HEALTH CONDITION: Conditions like heart disease (myocardial infarction), pancreatic disease, and liver disease can lead to an uncontrolled increase in blood sugar levels.
4. PREGNANCY: Pre-existing diabetes in a pregnant woman or gestational diabetes can be a serious risk factor and sugar level should be controlled adequately to prevent diabetic ketoacidosis.
5. INFECTION: Infective diseases like respiratory tract infection, urinary tract infection, the gastric infection can lead to an uncontrolled increase level in blood sugar.
PATHOPHYSIOLOGY OF DIABETIC KETOACIDOSIS:
DKA results from a combination of two factors :
1) Deficiency of insulin
2) Excess of counter-regulatory hormones like glucagon, catecholamines, cortisol.
When the insulin level in the body gets low and there is a decrease in the ratio of insulin and glucagon then it leads to the activation of three pathways in the liver which are :
A) GLUCONEOGENESIS: This is a process of the generation of glucose from lactate and glycerol.
B) GLYCOGENOLYSIS: it is a process of breakdown of glycogen to glucose 6 phosphates.
C) KETONE FORMATION.
Our body depends on glucose to produce energy and this energy is produced by the metabolism of glucose which occurs inside our muscle cells.
Glucose can enter into muscles with the help of a glucose transporter known as GLUT 4
When there is insulin deficiency then the GLUT 4 transporter is reduced in number and this leads to decreased entry of glucose in muscle and higher blood glucose levels which leads to hyperglycemia.
Due to a decreased amount of glucose uptake by cells, fat cells are broken down to produce energy for the body which leads to the production of free fatty acid production.
In our body, these free fatty acids are converted into lipoproteins like very low-density lipoproteins (VLDL) or triglycerides in the liver.
When the glucose level in our body falls down then glucagon secretion is increased to regulate the energy production and it activates an enzyme called carnitine palmitoyltransferase 1.
This enzyme controls the transport of free fatty acid into the mitochondria where they undergo oxidation and are converted into ketone bodies.
Normally also our body produces ketone by free fatty acid oxidation but they are inactivated by the bicarbonates in the body but when the sugar level gets too high then the concentration of bicarbonates is decreased in our body because of which ketoacids are not neutralized and it causes metabolic acidosis and this is how diabetic ketoacidosis occurs.
CLINICAL FEATURE OF DIABETIC KETOACIDOSIS
Symptoms:
1) Increased urination
2) Increased thirst
3) Difficulty in breathing
4) Vomiting
5) Stomach pain
6) Weakness
Signs:
1) Increased heart rate
2) Increased breathing rate
3) Stomach pain increases while touching it.
4) Low blood pressure
5) Patients can be less alert or can go into a coma which is a serious condition.
INVESTIGATION:
1) Increased blood sugar level
2) Increased blood urea nitrogen level (serum BUN)
3) A decrease in the level of serum bicarbonate.
4) A decrease in the level of serum sodium, chloride, phosphorus, and magnesium.
5) Increase in serum creatinine levels.
6) An increase in serum amylase levels can be seen.
7) Abnormal levels of lipids can be seen in the lipid profile test.
8) A routine urine test is done to check for urine infection.
9) Urine ketone can be present.
10) ECG should be done to look for any cardiac disease.
11) Chest x-ray to rule out any chest infection.
12) CT HEAD to look for any edematous changes.
PREVENTION :
Prevention is better than cure and keeping diabetes in control will prevent the patient from ketoacidosis. So it is important to follow a good diabetic diet and take medicine regularly as prescribed by the doctor.
TREATMENT:
It is an emergency condition and the patient should be shifted to ICU and adequate treatment is needed in time to save the patient.
If a patient presents with symptoms of diabetic ketoacidosis then after proper physical examination and laboratory investigation doctor generally starts treatment which includes
1) Proper fluid therapy to replace fluid loss and bring blood pressure to a normal level.
2) Insulin is given to the patient to bring down the sugar level.
3) Electrolyte levels are checked and treated adequately to keep them at a normal level.
4) Any infection like pneumonia, or urinary tract infection should be treated properly.
5) Proper monitoring of vitals and blood sugar levels is important.
TAKE HOME MESSAGE
Diabetes should be kept under control at all times otherwise it can produce many serious complications.
It is important to take medicine as advised by the doctor and also follow a good healthy diet.
Always keep the weight under control.
If suffering from any other disease then get proper treatment from the doctor to prevent diabetes from getting serious.
Always go for routine health checkups to keep yourself healthy.
STAY HEALTHY AND STAY SAFE.
