The condition develops when the body can't produce enough insulin. Insulin plays a key role in helping sugar — a major source of energy for muscles and other tissues — enter cells in the body.
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.
If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care.
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Symptoms
Diabetic ketoacidosis symptoms often come on quickly, sometimes within 24 hours. For some, these symptoms may be the first sign of having diabetes. Symptoms might include:
- Being very thirsty
- Urinating often
- Feeling a need to throw up and throwing up
- Having stomach pain
- Being weak or tired
- Being short of breath
- Having fruity-scented breath
- Being confused
More-certain signs of diabetic ketoacidosis — which can show up in home blood and urine test kits — include:
- High blood sugar level
- High ketone levels in urine
When to see a doctor
If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try a urine ketone test kit you can get at a drugstore.
Contact your health care provider right away if:
- You're throwing up and can't keep down food or liquid
- Your blood sugar level is higher than your target range and doesn't respond to home treatment
- Your urine ketone level is moderate or high
Seek emergency care if:
- Your blood sugar level is higher than 300 milligrams per deciliter [mg/dL], or 16.7 millimoles per liter [mmol/L] for more than one test.
- You have ketones in your urine and can't reach your health care provider for advice.
- You have many symptoms of diabetic ketoacidosis. These include excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion.
Remember, untreated diabetic ketoacidosis can lead to death.
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OBJECTIVE—In this prospective, randomized, open trial, we compared the efficacy and safety of aspart insulin given subcutaneously at different time intervals to a standard low-dose intravenous [IV] infusion protocol of regular insulin in patients with uncomplicated diabetic ketoacidosis [DKA].
RESEARCH DESIGN AND METHODS—A total of 45 consecutive patients admitted with DKA were randomly assigned to receive subcutaneous [SC] aspart insulin every hour [SC-1h, n = 15] or every 2 h [SC-2h, n = 15] or to receive IV infusion of regular insulin [n = 15]. Response to medical therapy was evaluated by assessing the duration of treatment until resolution of hyperglycemia and ketoacidosis. Additional end points included total length of hospitalization, amount of insulin administration until resolution of hyperglycemia and ketoacidosis, and number of hypoglycemic events.
RESULTS—Admission biochemical parameters in patients treated with SC-1h [glucose: 44 ± 21 mmol/l [means ± SD], bicarbonate: 7.1 ± 3 mmol/l, pH: 7.14 ± 0.09] were similar to those treated with SC-2h [glucose: 42 ± 21 mmol/l, bicarbonate: 7.6 ± 4 mmol/l, pH: 7.15 ± 0.12] and IV regular insulin [glucose: 40 ± 13 mmol/l, bicarbonate 7.1 ± 4 mmol/l, pH: 7.11 ± 0.17]. There were no statistical differences in the mean duration of treatment until correction of hyperglycemia [6.9 ± 4, 6.1 ± 4, and 7.1 ± 5 h] or until resolution of ketoacidosis [10 ± 3, 10.7 ± 3, and 11 ± 3 h] among patients treated with SC-1h and SC-2h or with IV insulin, respectively [NS]. There was no mortality and no differences in the length of hospital stay, total amount of insulin administration until resolution of hyperglycemia or ketoacidosis, or the number of hypoglycemic events among treatment groups.
CONCLUSIONS—Our results indicate that the use of subcutaneous insulin aspart every 1 or 2 h represents a safe and effective alternative to the use of intravenous regular insulin in the management of patients with uncomplicated DKA.
Diabetic ketoacidosis [DKA] is the most common hyperglycemic emergency in patients with diabetes. DKA is the leading cause of death in children with type 1 diabetes [1,2] and accounts for a significant proportion of admissions in adult patients with type 1 or type 2 diabetes [1,3]. The mainstay in the treatment of DKA involves the administration of regular insulin via continuous intravenous [IV] infusion or by frequent subcutaneous [SC] or intramuscular [IM] injections [3,4,5]. Although several controlled studies in patients with DKA have shown that low-dose insulin therapy is effective regardless of the route of administration [4,6–8], the ideal route of insulin therapy is still a matter of debate. For most experts in the field, the administration of IV regular insulin is the preferred route because of the delayed onset of action and prolonged half-life of SC regular insulin. Fisher et al. [6] and Menzel and Jutzi [9] reported that patients with DKA treated with IV regular insulin experienced a more rapid fall in plasma glucose and ketone levels than patients treated with IM or SC insulin and that 30–40% of patients treated with IM or SC insulin did not lower their plasma glucose by 10% in the first hour of insulin therapy. Yet the cost of treating DKA with IV insulin may be higher, because in many institutions, patients are required to be admitted to an intensive care unit [ICU] or to a specialized diabetes care unit to receive IV insulin infusion [10–12].
Recently, new analogs of human insulin with a rapid onset of action—aspart insulin [Novolog; Novo Nordisk, Princeton, NJ] or lispro insulin [Humalog; Eli Lilly, Indianapolis, IN]—have become available and may represent alternatives to the use of regular insulin in the treatment of DKA. In a recent preliminary study, we reported that treatment of mild and moderate DKA with hourly injections of SC lispro insulin was as effective as the use of a standard IV regular insulin protocol [13]. The mean time of treatment to correct hyperglycemia and ketoacidosis was similar between SC lispro and IV infusion of regular insulin. Treatment with SC insulin injections on an hourly schedule, however, may be difficult in most institutions because of the intensity of treatment and the shortage of nursing staff on regular wards. Therefore, we expanded our investigation on the use of SC insulin analogs by comparing the use of aspart insulin, given at different time intervals [1 and 2 h], with a standard IV low-dose insulin protocol.
RESEARCH DESIGN AND METHODS
A total of 45 consecutive patients with DKA admitted to the University of Tennessee Regional Medical Center, Memphis, served as the study population. The diagnosis of DKA was established in the emergency department by a plasma glucose level >13.8 mmol/l [250 mg/dl], a serum bicarbonate level