Even if you work hard at your diabetes management and use technology to help keep your numbers in range, you can still experience high blood glucose, which can escalate to diabetic ketoacidosis (DKA). While DKA can be scary if left untreated, it is preventable if you know what to look for and what to do. Senior District Clinical Manager, Melinda Turenne, BSN, RN, CDE, has more than 15 years of diabetes clinical experience. Today she shares some valuable DKA risk factors and prevention tips.
Living with diabetes involves a lot of duties. You are checking your blood glucose (BG), counting your carbohydrates, exercising, and keeping doctors’ appointments. I am sure you remember your doctor or diabetes educator telling you to check for ketones too, right? Checking my what? One more thing to add to my to-do list! Yes, and here is WHY.
What are ketones?
Ketones are acid molecules produced when we burn fat for energy or fuel. As fat is broken down, ketones build up in the blood and urine. In high levels, ketones are toxic and can make you very sick. When combined with dehydration, it can lead to Diabetic Ketoacidosis (DKA), a life threatening condition.
Why would DKA happen?
DKA occurs when there is not enough insulin present in the body. Without enough insulin, glucose builds up in the blood, causing high BG levels. Since the body is unable to use glucose without insulin for energy, it breaks down fat instead. This can occur for several reasons:
- Infection, injury, or serious illness
- A lack of insulin in the body due to missed injections, spoiled insulin, poor absorption
- Severe dehydration
- Combination of these things
What are the signs of DKA?
- High BG levels
- Ketones (in blood and urine)
- Nausea, vomiting, and abdominal pain (cramps)
- Tired, sluggish, or weak
- Flushed, hot, dry skin
- Blurred vision
- Rapid, deep breathing and shortness of breath
- Excessive thirst and frequent urination
- Fruity scented breath
When do I check for ketones?
Most experts recommend testing ketones:
- Anytime you have unexplained high BG, or if your glucose is over 250 mg/dL for two BG tests in a row
- If you experience nausea, vomiting, and have abdominal pain
- If you feel ill (i.e., cold, flu, stomach virus). Illness, infections, or injuries can cause BG’s to run higher than normal. Therefore, the risk of developing DKA increases when you’re ill.
How do I check for ketones?
You can check for ketones using a urine test or blood test, which are available at most pharmacies.
- A simple urine test that involves peeing on a Ketostix or dipping the Ketostix into a cup of urine, and observing the color change on the strip. Positive ketones are indicated by small or greater ketones.
- A blood test can be done with special ketone test strips. It is like testing your BG, except a ketone measurement is given. Positive ketones are indicated by a blood test that indicates the presence of Beta-Hydroxybutyrate.
What do I do if ketones are present?
- Correct high BG with insulin using a syringe
- If you use an insulin pump, change infusion site, infusion set, reservoir, and insulin, and troubleshoot pump
- Drink non-carbohydrate fluids
- Call your doctor immediately. Don’t delay!
- Seek emergency care if you can’t reach your doctor
- Follow any instructions you are given by your healthcare team
- Using an insulin pump with continuous glucose monitoring (CGM)  can help you keep an eye on your glucose trends, and you can set alerts to let you know when your sensor glucose goes above a certain threshold. Sensor glucose isn’t the same as blood glucose, so be sure to still check your BG 4-6 times a day, and before making any therapy decisions (like giving yourself more insulin).
- The risk for DKA is higher when you’re sick because illness related stress can raise your BG. DKA symptoms are similar to flu and stomach virus symptoms, so when you’re sick be sure to:
- Check your BG every two hours
- Check your urine for ketones each time you urinate during illness
- If you haven’t been given special instructions on how to manage your diabetes during illness, contact your healthcare team for advice
- Immediately check for ketones if you’re nauseous or vomiting
- Follow your doctors’ instructions for correcting high BG and testing for ketones
- Learn to recognize the signs and symptoms of DKA
Recovery can vary depending on different complications that can occur, and each person is different. The most important aspects of DKA treatment is fluids and insulin so BG levels, dehydration, and ketosis are corrected slowly. Here are a few things to keep in mind when recovering from DKA:
- Drink non-carbohydrate fluids
- Closely monitor BG by checking every one to two hours, in addition to watching your CGM graph; give correction boluses when needed
- Closely monitor ketones
- Call your doctor or seek emergency care if ketones are still positive
You and your loved ones may find this Safety Rules Quick Reference Guide  for ways to treat high blood glucose levels helpful, too.
Guest Blogger – Melinda Turenne, BSN, RN, CDE
Melinda Turenne is a Registered Nurse, Clinical Diabetes Educator, and Medtronic Senior Diabetes Clinical Manager. Melinda enjoys providing people with diabetes the information, knowledge, and support they need to improve their diabetes management. Prior to working for Medtronic, she worked as a Clinical Diabetes Educator for five years at a large hospital system.
IMPORTANT SAFETY INFORMATION
– Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems.
– Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms.
Medtronic Diabetes Insulin Infusion Pumps
– Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day.
– Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately.
Medtronic Diabetes Continuous Glucose Monitoring (CGM) Systems
– The information provided by CGM systems is intended to supplement, not replace, blood glucose information obtained using a home glucose meter. A confirmatory fingerstick is required prior to treatment.
– Insertion of a glucose sensor may cause bleeding or irritation at the insertion site. Consult a physician immediately if you experience significant pain or if you suspect that the site is infected.
For more information, please visit http://www.medtronicdiabetes.com/important-safety-information .