Q: My husband was planning a recent trip to the Eastern portion of the United States recently from Denver. We thought he was plenty well enough to make the trip but he was suddenly in the acute phase of diabetic ketoacidosis. His doctor frightened me when he indicated my husband was very seriously ill. What happened? Suffice it to say he didn’t make the trip but I’m baffled by the whole thing. Can you shed some light on this?
A: Diabetic ketoacidosis is a potentially life-threatening complication that occurs when the body of a diabetic suddenly produces high levels of ketones, blood acids. The body becomes unable to produce sufficient insulin (the substance that generally is key in helping glucose (sugar) enter a person’s cells). Without sufficient insulin, the body breaks down fat and muscle as fuel which causes toxic acids to build up in the bloodstream and eventually leads to diabetic ketoacidosis if left untreated. Signs and symptoms may develop rapidly and may include high ketone levels in the urine and hyperglycemia (high blood sugar levels).
Diabetic ketoacidosis may be triggered by stress, a heart attack, surgery, physical or emotional trauma, high fever, illness such as pneumonia, urinary tract infections, because of erratic insulin therapy such as forgetting to take insulin in a timely manner, inadequate insulin therapy or because of alcohol or drug abuse. The risk of advancing to diabetic ketoacidosis is increased for those individuals with type 1 diabetes, in individuals younger than 19 years of age, and if insulin doses are missed frequently. People with type 2 diabetes can develop the condition; however, it is far less common.
Your husband’s primary care physician or endocrinologist likely tested his blood sugar levels, arterial blood gases, ketone levels, and he may have also done a urinalysis and chest X-ray.
Treatment is with electrolytes, fluids and insulin – all through an IV. The electrolytes will help keep the nerve cells, heart and muscles function normally, the fluids will rehydrate the body and replace those fluids lost through the process of urination, and the insulin will reverse the entire process of the ketoacidosis.
My guess is twofold. First, it is possible your husband did not know he was a diabetic and this was his first encounter with the disease. Or second, he did know of his condition and may have been preoccupied with his plans to travel and neglected to take his insulin in a timely manner as he should have. He may not have eaten properly or failed to monitor his blood sugar and ketone levels. Lastly, most diabetics are trained to adjust their insulin levels as needed depending on their readings. He was lucky to have taken rapid steps to remedy the situation. In all likelihood there will be another trip to look forward to and the lesson you both learned this time will obviously put both of you on your toes so it doesn’t happen again.