what are the most common risk factors for diabetic ketoacidosis

Causes

Although DKA is less common in people who have type 2 diabetes, it does occur. Some people with type 2 diabetes are considered “ketone prone” and are at a higher risk of DKA. Some medications can increase the risk of DKA. Talk to your doctor about your risk factors.

Symptoms

Common precipitating factors for DKA are non-compliance, new-onset diabetes, and other acute medical illness. The most common types of infections are pneumonia and urinary tract infections. Other conditions like alcohol abuse, trauma, pulmonary embolism, and myocardial infarction can also precipitate DKA.

Prevention

DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy.

Complications

One of the major causes of recurrent DKA in the inner-city population in the United States is non-compliance with insulin. Socioeconomic and educational factors play a significant role in poor adhesion to medications, including insulin.  A recent report suggests that cocaine abuse is an independent risk factor associated with DKA recurrence.

Can type 2 diabetes cause diabetic ketoacidosis?

What are the precipitating factors for diabetic ketoacidosis?

How common is diabetic ketoacidosis (DKA)?

Is cocaine abuse a risk factor for diabetic ketoacidosis (DKA)?

What is a diabetic ketoacidosis?

What causes DKA?

What is a DKA?

What are the causes of metabolic derangements?

Can DKA be prevented?

See 2 more

About this website

What are the risk factors for developing diabetic ketoacidosis?

Causes of DKAHeart attack or stroke.Physical injury, such as from a car accident.Alcohol or drug use.Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

What is the most common cause of diabetic ketoacidosis?

Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If it's left untreated, the buildup can lead to diabetic ketoacidosis.

What are the 4 main risk factors for diabetes?

You're at risk for type 2 diabetes if you:Have prediabetes.Are overweight.Are 45 years or older.Have a parent, brother, or sister with type 2 diabetes.Are physically active less than 3 times a week.Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.More items...

What are the 3 P's in diabetic ketoacidosis?

The three Ps of DKA: Polydipsia—thirst. Polyuria—urination. Polyphagia—appetite.

At what blood sugar level does ketosis start?

We can measure one ketone body in the bloodstream, beta hydroxybutyrate (BHB), and when BHB is within a 0.5 mmol/L - 1.0 mmol/L range would be considered a “light nutritional ketosis.” BHB levels within 1.0 mmol/L- 3.0 mmol/L would be considered a more optimal ketosis.

At what sugar level is diabetic coma?

A diabetic coma could happen when your blood sugar gets too high -- 600 milligrams per deciliter (mg/dL) or more -- causing you to become very dehydrated. It usually affects people with type 2 diabetes that isn't well-controlled.

What are the 7 warning signs of diabetes?

They may develop slowly over time, causing many adults to fail to recognize key symptoms.1) Frequent Urination. ... 2) Increased Thirst or Dry Mouth. ... 3) Unexpected Weight Loss. ... 4) Persistent Hunger. ... 5) Foot Pain and Numbness. ... 6) Frequent Infections and Feminine Health Issues. ... 7) Blurred Vision.

What is the most common complication of diabetes?

Nerve damage (neuropathy): One of the most common diabetes complications, nerve damage can cause numbness and pain. Nerve damage most often affects the feet and legs but can also affect your digestion, blood vessels, and heart.

What are 10 warning signs of diabetes?

Some of the symptoms of type 1 diabetes and type 2 diabetes are:Feeling more thirsty than usual.Urinating often.Losing weight without trying.Presence of ketones in the urine. ... Feeling tired and weak.Feeling irritable or having other mood changes.Having blurry vision.Having slow-healing sores.More items...

What is the safest fruit for a diabetic?

The Best Fruits for People With Diabetesberries — Both citrus and berries are recommended as superfoods by the American Diabetes Association.cherries.plums.grapefruit.peaches.apples — High fiber fruits like apples and pears help to slow a spike in blood sugar, Rose says.pears.kiwi.More items...•

How long can you survive with diabetic ketoacidosis?

The risk for people with T1D is a quick death from DKA (insulin deficiency exacerbated by illness, stress, and dehydration). “It only takes days to progress, and it is worsening over a day or two or three — so that gets you a week or so plus/minus, outside maybe 2 weeks,” Kaufman explains.

What are the after effects of ketoacidosis?

DKA can cause complications, such as: Low levels of potassium (hypokalemia) Swelling inside the brain (cerebral edema) Fluid inside your lungs (pulmonary edema)

What are the chances of surviving diabetic ketoacidosis?

DKA is a life-threatening medical emergency with a mortality rate just under 5% in individuals under 40 years of age, but with a more serious prognosis in the elderly, who have mortality rates over 20%.

How long can you survive with diabetic ketoacidosis?

The risk for people with T1D is a quick death from DKA (insulin deficiency exacerbated by illness, stress, and dehydration). “It only takes days to progress, and it is worsening over a day or two or three — so that gets you a week or so plus/minus, outside maybe 2 weeks,” Kaufman explains.

How long does it take to recover from diabetic ketoacidosis?

DKA is fully treated when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. DKA is usually corrected within 24 hours. Depending on the severity of the DKA, it could take multiple days before the DKA is fully treated and you can leave the hospital.

How can you prevent diabetic ketoacidosis?

The most important thing you can do to prevent DKA is to keep your diabetes well-managed. If you have been diagnosed with type one diabetes, make sure to take monitor your sugar levels, and take your insulin. Dr. Apovian notes that “omission of insulin is a highly common occurrence in children with DKA.”

Risk factors and prevention strategies for diabetic ketoacidosis in ...

Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. Sociodemographic and modifiable risk factors were identified with strong evidence for an increased risk of DKA, including socioeconomic disadvantage, adolescent age (13–25 years), female sex, high HbA1c, previous DKA ...

Diabetic ketoacidosis risk factors - wikidoc

↑ Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, Harris B, Dubose SN, Miller KM, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry". J. Clin. Endocrinol.

Risk factors and prevention strategies for diabetic ketoacidosis in ...

Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. Sociodemographic and modifiable risk factors were identified with strong evidence for an increased risk of DKA, including so …

Identifying Risk Factors for Diabetic Ketoacidosis Associated with ...

Introduction: Sodium glucose co-transporter-2 inhibitors (SGLT2) are commonly prescribed to patients with type 2 diabetes mellitus, but can increase the risk of diabetic ketoacidosis. Identifying patients prone to diabetic ketoacidosis may help mitigate this risk. Methods: We conducted a population-based cohort study of adults initiating SGLT2 inhibitor use from 2013 through 2017.

Diabetic Ketoacidosis (DKA): Causes, Symptoms, Treatments - WebMD

Diabetic Ketoacidosis Diagnosis and Tests. Test your ketones when your blood sugar is over 250 mg/dL (milligrams per deciliter) or you have any of the above symptoms of high blood sugar, such as ...

What causes DKA in diabetics?

Missing insulin shots, a clogged insulin pump, or the wrong insulin dose. Other causes of DKA include: Heart attack or stroke. Physical injury, such as from a car accident. Alcohol or drug use. Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

What is DKA in diabetes?

DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too ...

What does DKA mean in Spanish?

Español (Spanish) minus. Related Pages. Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated right away. Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes.

How to prevent DKA?

Prevent DKA. DKA is a serious condition, but you can take steps to help prevent it: Check your blood sugar often, especially if you’re sick. Keep your blood sugar levels in your target range as much as possible. Take medicines as prescribed, even if you feel fine.

What happens when you have too many ketones?

When too many ketones are produced too fast, they can build up to dangerous levels in your body. Read on to learn more about DKA, how you can prevent DKA, and how to treat it if needed.

Can you test for ketones if you have DKA?

You should also test for ketones if you have any of the symptoms of DKA. Call your doctor if your ketones are moderate or high. Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated immediately.

Is DKA a sign of diabetes?

Sometimes DKA is the first sign of diabetes in people who haven’t yet been diagnosed.

What causes ketoacidosis?

Diabetic ketoacidosis is usually triggered by: An illness. An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis.

What is the treatment for diabetic ketoacidosis?

Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.

Why is potassium low in diabetics?

Low potassium (hypokalemia). The fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves. To avoid this, electrolytes, including potassium are usually given along with fluid replacement as part of the treatment of diabetic ketoacidosis.

What is the name of the condition where the body produces high levels of blood acids?

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.

How to adjust insulin dosage?

Adjust your insulin dosage as needed. Talk to your doctor or diabetes educator about how to adjust your insulin dosage in relation to factors such as your blood sugar level, what you eat, how active you are, and whether you're ill. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.

Why is there so little insulin in my system?

Missed insulin treatments or inadequate insulin therapy or a malfunctioning insulin pump can leave you with too little insulin in your system, triggering diabetic ketoacidosis.

How long does it take for ketoacidosis to develop?

Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst. Frequent urination. Nausea and vomiting. Stomach pain. Weakness or fatigue.

What is a diabetic ketoacidosis?

What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body. Ketoacidosis shouldn’t be confused with ketosis, which is harmless.

What happens when you have too many ketones?

That fuel is called ketones. When too many ketones build up, your blood becomes acidic. This is diabetic ketoacidosis.

How many times should you test for ketones?

If you have type 1 diabetes and have a blood sugar reading of over 250 milligrams per deciliter (mg/dL) twice, you should test your urine for ketones. You should also test if you are sick or planning on exercising and your blood sugar is 250 mg/dL or higher. Call your doctor if moderate or high levels of ketones are present.

How to treat DKA?

The treatment for DKA usually involves a combination of approaches to normalize blood sugar and insulin levels. If you’re diagnosed with DKA but haven’t yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring. Infection can increase the risk of DKA.

How do you know if you have DKA?

Symptoms of DKA can appear quickly and may include: frequent urination. extreme thirst. high blood sugar levels. high levels of ketones in the urine. nausea or vomiting. abdominal pain. confusion. fruity-smelling breath.

What happens if you have DKA?

DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. If left untreated, DKA can lead to a coma or death. If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place.

What happens when your insulin levels are too low?

When your insulin levels are too low, your body’s electrolytes can also become abnormally low. Electrolytes are electrically charged minerals that help your body, including the heart and nerves, function properly. Electrolyte replacement is also commonly done through an IV.

What are the symptoms of ketoacidosis?

Conclusion: Diabetic ketoacidosis presents with vague symptoms such as nausea, vomiting, and pain in abdomen. Characteristic findings of DKA such as Kussmaul breathing was present in limited patients. Infections in diabetic patients should be carefully monitored as they are the most common precipitating factors for DKA.

What is DKA in diabetes?

Introduction: Diabetic ketoacidosis (DKA) is a complication of hyperglycemia. Through this study we plan to study the clinical features of DKA and precipitating factors responsible for DKA in type 1 and type 2 diabetes.

What are the symptoms of DKA?

DKA presents with vague symptoms such as nausea, vomiting, and abdominal pain. Other symptoms include increased thirst and urination. Kussmaul breathing (labored deep breathing) and fruity odor are specific signs present on examination of a patient with diabetic ketoacidosis [3]. Various precipitating factors of DKA are reported in studies, especially missed insulin dose and an ongoing infection [4]. Other precipitating factors include stressful events such as stroke, myocardial infarction, and trauma, as well as substance abuse [5]. The clinical outcome of DKA depends upon the patient’s response to initial medical intervention, the precipitating factor for DKA, and biochemical values. Factors such as advanced age, bedridden state, and the use of mechanical ventilator are independent predictors associated with 30-day mortality [4].

What are the precipitating factors for diabetics?

In our study, infection and non-compliance to treatment were major precipitating factors. This result is similar to other studies, which also reported infections and non-compliance as major precipitating factors [2,3]. These precipitating factors are particularly important as both infection and non-compliance are common in patients with diabetes. The greater incidence of infection in diabetic patients is due to numerous factors including damage to neutrophil function, impairment of humoral immune system, and neuropathies [8]. In developed countries, the rate of non-compliance in long-term diabetic patients is 50%. World Health Organization (WHO) predicts that the rate of non-compliance to diabetic treatment may be even higher in developing countries [9]. According to a study in Pakistan, 62% of the diabetic population is non-compliant to their treatment regime [10]. Various studies have identified other factors as well which are responsible for diabetic ketoacidosis. These factors include events such as myocardial infarction, pulmonary embolism, and pancreatitis as well as the use of alcohol and drugs [7].

Where was the DKA study conducted?

This was a cross-sectional, observational study, conducted in the emergency department of a tertiary care hospital in rural Sindh, Pakistan. The study duration was August 2019 - February 2020 during which 71 participants were included in the study. Diagnostic criteria mentioned in the International Society for Paediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018 were used as a reference for diagnosis and management of DKA [5]. According to guidelines, we diagnosed DKA through a triad of symptomatology and lab findings, i.e. hyperglycemia, ketosis, and acidemia (Figure ​(Figure11).

Is ketoacidosis a complication of diabetes?

Diabetic ketoacidosis is not an infrequent complication of diabetic mellitus. The clinical presentation is vague. Symptoms that should raise suspicion regarding DKA include nausea, vomiting, abdominal pain, and dehydration. Appropriate diagnostic tests should be done for timely diagnosis of diabetic ketoacidosis.

Can ketoacidosis cause vomiting?

In our study, diabetic ketoacidosis was more prevalent in type 2 diabetes. The most common clinical presentation was nausea and vomiting, followed by abdominal pain. Seth et al. in 2015 also reported nausea, vomiting, and pain in abdomen as the most common clinical presentations in patients with DKA [3]. Severe vomiting and abdominal pain are reported as the most common symptoms in other studies as well [2,6]. Ongoing catabolism and acidosis in DKA patients can lead to extreme vomiting [7]. In this study, dehydration was present in 30% of the participants. Osmotic diuresis caused by glycosuria is mainly responsible for dehydration and electrolyte disturbance [7].

What are the mainstays of management in diabetic ketoacidosis?

Fluid resuscitation and maintenance, insulin therapy, electrolyte replacement, and supportive care are the mainstays of management in diabetic ketoacidosis.

What is the normal anion gap for diabetic ketoacidosis?

The normal anion gap is 12 mEq/l.

What is the incidence of DKA in children?

The highest incidence rate was found in Sweden and Finland, with 41.0 and 37.4 per 100,000.[6]  In the United States, one study reported nursing home residents accounted for 0.7% of DKA. Increased mortality was associated with nursing home residence among patients with DKA.[7]  Mortality rate greater than 5% has been reported in the elderly and patients with concomitant life-threatening illnesses. Death in these conditions is rarely because of the metabolic complications of hyperglycemia or ketoacidosis alone.

Why are elderly people at risk for hyperglycemia?

Some of the causes are increased insulin resistance and a decrease in the thirst mechanism. The elderly are particularly vulnerable to hyperglycemia and dehydration, the critical components of hyperglycemic emergencies. With increased diabetes surveillance and aggressive early treatment of hyperglycemia and its complications, morbidity, and mortality from acute diabetic crises in the geriatric population can be significantly reduced. [11]

What is DKA in medical terms?

Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration. It is a life-threatening complication of diabetes and is usually seen in patients with type-1 diabetes mellitus. Rarely it may also occur in patients with type-2 diabetes mellitus. ...

How does insulin affect diabetes mellitus?

Insulin decreases hepatic glucose production by inhibiting glycogenolysis and gluconeogenesis. Glucose uptake by skeletal muscle and adipose tissue is increased by insulin. Both of these mechanisms result in the reduction of blood sugar. In diabetic ketoacidosis, insulin deficiency and increased counter-regulatory hormones can lead to increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization. This will ultimately cause worsening hyperglycemia.

Why is DKA recurrent?

One of the major causes of recurrent DKA in the inner-city population in the United States is non-compliance with insulin. Socioeconomic and educational factors play a significant role in poor adhesion to medications, including insulin.  A recent report suggests that cocaine abuse is an independent risk factor associated with DKA recurrence. [4]

What are the consequences of DKA?

Complications extend beyond the crisis. "DKA also has long-term consequences," Rewers says. "It changes brain development and brain functioning for a long time. Kids who had DKA can show memory and learning problems going on for several years.".

How to prevent DKA?

Working closely with your endocrinologist, diabetes educator, dietitian and primary care provider will help you stay in control of diabetes and prevent DKA. Monitoring blood glucose is the most proactive way to prevent DKA, says Cara Schrager, a registered dietitian and certified diabetes educator at Joslin Diabetes Center in Boston.

What is the normal blood glucose level for diabetics?

A random blood glucose level of at least 200 mg/dL indicates diabetes. With DKA, glucose usually surpasses 250 to 350. "The average blood glucose in a patient with diabetic ketoacidosis is about 600 mg/dL – or six to eight times the normal blood glucose level in a nondiabetic person," Umpierrez says.

Why do you check for ketones?

Proactively checking for ketones allows people time to determine if they need an extra insulin injection to lower blood sugar. Being sick with conditions like the flu can increase blood glucose levels and make people with diabetes more vulnerable to DKA.

What does DKA mean for diabetics?

For people who don't know they have diabetes, the first DKA episode often leads to diagnosis. For those with known diabetes, DKA means blood sugar is spiraling out of control. Blood sugar levels vary throughout the day. Fasting blood sugars, after waking and before eating, tend to be lower.

What are the symptoms of DKA?

Health care providers need to be aware of these progressing DKA symptoms and signs of dehydration: 1 Abdominal pain and cramping. 2 Vomiting. 3 Decreased perspiration. 4 Cool, dry skin. 5 Behavior changes (not acting right). 6 Vision changes. 7 Confusion. 8 Lethargy.

What happens when you have too little insulin?

When the body has too little of the hormone insulin, blood sugar rises far above normal as the body loses its ability to use sugar for energy. In ketoacidosis, the body becomes acidic as it instead uses fat for energy, causing acids called ketones to form. These ketones accumulate in the blood and spill into the urine.

What causes DKA in diabetics?

DKA is most often caused by uncontrolled type 1 diabetes. Type 2 diabetes can also lead to DKA but it is less common cause.

How to treat DKA?

Treatment. DKA is treated with insulin, fluids, and minerals. Care may need to take place in a hospital. Close monitoring, exams, and blood tests will be needed. Insulin may be given by IV or injections. The insulin will let the body use glucose for fuel again. Fat will not be needed for fuel, new ketones will not be made.

What test is done to determine if you have a DKA?

An arterial blood sample will be taken to test the amount of acid in your blood. This will determine how severe your DKA is. Tests for infection may also be done. An electrocardiogram (EKG) may also be done.

What type of diabetes is not diagnosed?

Type 1 diabetes that has not been diagnosed

How to check blood glucose levels when you are sick?

Check more often when you are sick or have had high blood glucose levels. Drink plenty of fluids throughout the day. Check for ketones in your urine if you have a high blood glucose reading or are ill. Create a sick day plan. It may include changes in insulin dose and what to do if you are having trouble eating.

Overview

Common risk factors in the development of diabetic ketoacidosis (DKA) are young age, high mean glycosylated hemoglobin A1c, infection, low physical activity, depression, lack of health insurance, poor socioeconomic status, low body mass index, improper management of diabetes and unemployment.

Factors increasing risk

The following factors are associated with an increased risk of diabetic ketoacidosis (DKA):

Factors decreasing risk

The following factors are associated with a reduced risk of diabetic ketoacidosis (DKA):

What is a diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections. ...

What causes DKA?

Worldwide, infection is the most common precipitating cause for DKA, occurring in 30-50% of cases. Urinary tract infection and pneumonia account for the majority of infections.

What is a DKA?

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections.

What are the causes of metabolic derangements?

These metabolic derangements result from the combination of absolute or relative insulin deficiency and increased levels of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone).

Can DKA be prevented?

Since the majority of DKA cases occur in patients with a known history of diabetes, this acute metabolic complication should be largely preventable through early det ection, and by the education of patients, healthcare professionals, and the general public.

Overview

Symptoms

Causes

Risk Factors

Complications

Prevention