What are treatments for diabetic ketoacidosis

What is diabetic ketoacidosis?

High values, vomiting, abdominal pain, labored breathing - these are the signs of diabetic ketoacidosis, which is caused by a metabolic disorder in type 1 diabetes. How can ketoacidosis be prevented? What to do if you have ketoacidosis?

A diabetic ketoacidosis is caused by a severe disruption of the metabolism in type 1 diabetes and can be translated as "hyperacidity of the blood". Children and adolescents with diabetic ketoacidosis have very high blood sugar levels, and ketone can be found in the blood and acetone in the urine. The clinical presentation includes vomiting, abdominal pain, and labored breathing.

If you have ketoacidosis, you only have to go to the doctor or hospital so that insulin, fluids and salts can be supplied as quickly as possible. If the ketoacidosis is not treated in time, it can lead to a life-threatening condition for the child with a coma.

Who Will Get Diabetic Ketoacidosis?

Ketoacidosis occurs when there is not enough insulin in the body. This means that children and adolescents are primarily at risk if their diabetes manifests itself. The progressive destruction of the insulin-producing cells of the pancreas leads to an insulin deficiency, which is not necessarily recognized in the case of still unknown diabetes and can thus lead to ketoacidosis. 10 to 20 percent of all children with type 1 diabetes mellitus also have diabetic ketoacidosis at the time of diagnosis.

Values ​​too high? These questions will help you research the cause:
  • Too Many Carbohydrates?
  • Insulin too little?
  • Illness?
  • Too little movement?
  • Stress?
For insulin pump therapy:
  • Forgot your bolus or underestimated it?
  • Technical defect in the pump?
  • Air bubbles in the system?
  • Catheter defective, tube leaking?
  • Is the catheter in place for too long?
  • Insulin supply interrupted for too long?

Such insulin deficiency situations can also occur with known diabetes. If high blood sugar levels occur, the causes should therefore always be researched in order to prevent further derailment (see table on the left). If high blood sugar levels are not detected in time and their cause is not corrected, they continue to rise and can lead to ketoacidosis.

What happens in the body with ketoacidosis?

As mentioned above, diabetic ketoacidosis is characterized by the presence of high blood sugar levels and high blood ketone levels, acetone in the urine, as well as vomiting, abdominal pain and shortness of breath. The relationship and the effects of these individual components are explained here step by step:

1. High blood sugar levels

The body uses glucose to generate energy. Glucose from the blood enters the cells through insulin. If there is an insulin deficiency (e.g. when diabetes manifests or in the case of infections with known diabetes), the glucose can no longer be absorbed in sufficient quantities in the cells and remains in the blood. This leads to an increase in blood sugar.

Since glucose is no longer available to the body as an energy source, the body goes into hunger metabolism and looks for an alternative energy source: the fat cells. The breakdown of fat cells provides the body with energy on the one hand, and on the other it leads to the formation of an acid: the keto acid (alternative name: ketone body).

2. High blood ketone levels

The ketone bodies are a waste product that results from the breakdown of fat cells. They are usually excreted in the urine in the form of acetone.

If this state only lasts for a short time, it is not dangerous. The supply of insulin can lower blood sugar, and the ketone bodies can be excreted as acetone by absorbing plenty of fluids with the urine. In the situation of persistent insulin deficiency, however, more ketone is formed than acetone can be excreted, so that the blood ultimately becomes over-acidic.

3. Vomiting, abdominal pain, difficulty breathing

The over-acidification of the blood leads to malaise and nausea, later vomiting and abdominal pain. In this situation, vomiting and abdominal pain, with high blood sugar levels and evidence of ketone, should not be confused with a banal gastrointestinal infection. The cause of the complaints is the insulin deficiency, which must be compensated for as quickly as possible, since the full picture of diabetic ketoacidosis is present here. Often only hospital admission to a clinic and insulin and fluid supply via a venous access help.

Prevent diabetic ketoacidosis

Regular blood sugar measurements are the basis in the treatment of diabetes in children and adolescents. Basically, blood sugar should be measured regularly six to eight times a day. With regular measurements and corrections, the risk of developing high values ​​is already very low.

Should the values ​​turn out to be higher, parents / adolescents should follow a few basic rules: First of all, the excessively high value should be corrected by means of an additional administration of insulin via pen / syringe or insulin pump. In the next step, it is essential to investigate the cause.

Is a one-off underdosing of insulin the cause, or should a sustained increase in values ​​be expected due to an infection and the insulin dose increased significantly? Or is the insulin pump catheter kinked and has to be replaced immediately so that the insulin from the pump can get back into the body?

If the blood sugar values ​​are still too high after the first correction, the blood ketone measurement or acetone measurement in the urine is absolutely necessary. It should be able to be mastered and applied by all children and parents. By taking a drop of blood from the fingertip, the blood ketone measurement can be carried out quickly and without complications and offers very differentiated values ​​that determine the further procedure. As an alternative, an acetone test can be performed in the urine.

Every family should learn a differentiated approach to the treatment of high blood sugar levels and the prevention of diabetic ketoacidosis as part of diabetes education. The algorithm from our clinic can be found in the diagram on the left on this page ("Avoiding ketoacidosis").

Conclusion

The blood ketone measurement should be able to be used by all children and parents. Avoid ketoacidosis Diabetic ketoacidosis is an acute, life-threatening metabolic imbalance in type 1 diabetes. The characteristics are: high blood sugar, ketone in the blood or acetone in the urine. Clinical symptoms are nausea, vomiting, abdominal pain, and labored breathing.

Early treatment for high blood sugar levels can prevent ketoacidosis from developing. Families with a child with diabetes should be familiar with the Diabetic Ketoacidosis Prevention Scheme (see diagram).


by Dr. med. Nicolin Datz
Senior Physician Paediatrics III, Center for Pediatric and Adolescent Medicine "Auf der Bult", Hanover
Email: [email protected]


Published in: Diabetes-Eltern-Journal, 2016; 9 (4) pages 24-26

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