Most people starting on an insulin pump do not recognize the serious danger of diabetic ketoacidosis (DKA). Even though they have been on injection therapy for years, many never experienced DKA, even on occasions when they may have forgotten to take their morning NPH. Now they are always hearing reminders from their doctors about the danger of DKA.
Diabetic Ketoacidosis is an uncommon, yet potentially life threatening complication of diabetes. The most common cause of DKA is extremely low levels of circulating insulin which will cause fat cells to break down and release poisonous or toxic substances known as ketones. Ketones are acids which can cause nausea, vomiting, abdominal pain, rapid breathing, weight loss, frequent urination and dehydration.
The amount of acid in the blood is measured by a number called the pH. The body functions properly at a pH of 7.4. Ketones in the blood stream cause the pH to drop below 7.3, which is dangerous to normal body functions. As the pH gets lower, cardiac problems may occur.
DKA can happen to anyone with diabetes, regardless of good control.
The symptoms of DKA:
- Stomach upset with or without nausea
- Nagging headache
- Muscle or joint aches
Preventing Diabetic Ketoacidosis (DKA):
- Always monitor blood glucose at least 4 times per
day.
- If blood glucose is above 13.5, take a high blood
glucose bolus via the pump and check urine for ketones. Check blood glucose
again in 2 hours and if it is still above 13.5, take an injection by syringe
and then change the infusion set.
- If you are ill, monitor blood glucose every 2-4 hours
to catch large increases in blood glucose.
- If nausea or vomiting develops with high blood glucose (above 13.5), take an injection by syringe and call your physician.
Early recognition and the administration of extra insulin when indicated will assist in preventing an unnecessary episode of DKA.
Jeffry Unger, MD
Diabetes Intervention Center
Chino, CA
Pump wearer since 1992