The most dangerous emergency in diabetes! Let's be aware of DKA (Diabetic Ketoacidosis)

Do you have diabetes? Or does a family member or friend of yours have diabetes? Then you definitely need to know about what we are talking about today. This is called DKA (Diabetic Ketoacidosis). This is a very dangerous, even life-threatening emergency that can occur due to diabetes. But don't worry, if we are properly informed about this, we can protect ourselves from it and act quickly if it suddenly occurs.

Simply put, what is DKA?

Think of the cells in our body as little houses. These houses need energy to work. That energy comes from glucose, or sugar, which comes from the food we eat. But in order for this sugar to get into the houses called cells, it needs a key to open the door. That key is the hormone insulin .

Now, what happens in the body of a person with diabetes is that there is not enough of this key called insulin. What happens then? Sugar cannot enter the cells and is filled with blood. But the cells have no energy, they "starve".

When this happens, our body thinks that we are actually starving without food. So the body starts looking for energy in another way. That is, by burning fat stored in the body to produce energy. When fat is burned in this way, a chemical called ketones is produced as a byproduct.

Having a few ketones in the blood is not a problem. But when fat is continuously burned without insulin, these ketones accumulate in the blood in excess. These ketones are a type of acid. So when they increase in the blood, our blood gradually becomes more acidic. It's like adding vinegar to a glass of water. That acidosis of the blood and the accompanying dehydration are what we call DKA (Diabetic Ketoacidosis).

Who is most at risk of developing DKA?

Although DKA can occur in any diabetic, some people are at higher risk.

• People with Type 1 Diabetes: These people are most likely to develop DKA because their body has almost completely stopped producing insulin.
• For those who don't know they have diabetes: Surprisingly, some people only find out they have type 1 diabetes after they develop DKA and are hospitalized. This accounts for between 20% and 40% of DKA patients.
• For people with Type 2 Diabetes:Although it is less common, some people with type 2 diabetes can develop DKA, especially in situations such as severe infections.

What are the symptoms of this dangerous condition? How do we recognize it?

DKA does not develop suddenly. It can start with mild symptoms and then become severe within as little as 24 hours. If you are vomiting, this time frame may be even shorter. So it is important to be aware of these symptoms.

If you have any of these serious symptoms, call your doctor immediately. Or, if possible, go to the nearest hospital's Emergency Department (ETU) as soon as possible.

Why does this DKA condition occur? What are the main causes?

The main cause of DKA is not getting enough insulin to the body. These things can contribute to it:

• Missing insulin injections: If a person taking insulin for diabetes misses one or two injections, DKA can occur.
• Insulin pump problems: If someone uses a pump, the body may not receive insulin due to reasons such as a clogged tube or a loose connection to the body.
• Using expired or spoiled insulin: Insulin is a medicine that is not resistant to extreme heat or cold. For example, if it is not refrigerated or has expired, it can lose its effectiveness.
• Illnesses and infections: Any illness, such as fever, pneumonia, urinary tract infections (UTIs), is a major cause of DKA. This is because when we are sick, our body becomes stressed and produces hormones that work against insulin. Then we need more insulin than usual.
• Other causes: Severe physical injury, trauma, surgery, heart attack, pregnancy, excessive alcohol consumption, and certain medications also increase the risk of DKA.

What happens if DKA is not treated quickly?

This is the most dangerous part that we all need to be aware of. DKA can lead to very serious complications if not treated quickly and properly.

• Very low potassium levels in the blood.
• Brain swelling.
• Filling the lungs with water.
• Cardiac arrest.
• Damage to the kidneys and other organs.
• Coma.
• Ultimately, even death can occur.

How is it treated?

Treatment for DKA should always be done in a hospital. If you have symptoms of DKA, go to a hospital immediately.

Treatment given in the hospital

1. IV fluids: The first step is to give saline. This helps prevent dehydration, flush out excess sugar and ketones in the blood, and cleanse the body.

2. Insulin: Insulin is given intravenously. This controls blood sugar levels and causes the body to start using sugar for energy again. This also stops the formation of ketones.

3. Providing Electrolytes: DKA causes the body to lose essential minerals like potassium. These are given intravenously to restore balance to the body.

Home treatment (only on doctor's advice)

If DKA is detected early, your doctor may recommend home treatment. However, these should only be done under your doctor's supervision.

• Checking blood sugar levels frequently (perhaps once an hour).
• Checking ketone levels.
• Drink plenty of water and sugar-free liquids to prevent dehydration.
• Avoiding exercise.

What can we do to prevent DKA from developing?

DKA is a condition that we can often prevent. These things can help.

• Check your blood sugar levels regularly: Check your blood sugar several times a day, especially before and after meals, and before going to bed. If your blood sugar levels are high, take action immediately.
• Take your insulin and medication on time: Never skip a dose of insulin prescribed by your doctor.
• Check for ketones: If your blood sugar level is consistently higher than 250 mg/dL, or if you have an illness such as fever or vomiting, check your urine or blood for ketones.
• Make a "sick day plan": Talk to your doctor and make a plan in advance about how to adjust your insulin dose and how to eat if you develop a fever or vomit.
• Be aware: The more you know about DKA, the better your chances of surviving it. Ask your doctor for more information about this.

Sometimes, no matter how careful we are, DKA can occur for reasons beyond our control. If that happens, don't feel bad about it and think it's your fault. The most important thing is to recognize the symptoms and seek medical advice as soon as possible.