Uncontrolled diabetes – whether due to circumstance or lack of diagnosis – can lead to a dangerous condition known as diabetic ketoacidosis (DKA). Because of a lack of glucose entering cells (regardless of whether it is due to lack of insulin or insensitivity to insulin), cells increasingly rely on fat stores for fuel. This happens despite the high amounts of circulating glucose (hyperglycemia). As a result, there is an increased production of ketones which are a byproduct of fat metabolism. Ketones are acidic and once accumulated in the blood they alter pH of the entire body causing an acidic environment in all tissues (ketoacidosis). The acidic environment forces electrolytes to be redistributed between the inside and outside of cells (i.e. blood) causing an electrolyte imbalance and disturbances. For example, DKA causes hyperkalemia  because potassium (K+) – normally in high levels within the cells – is forced out of the cell and into blood. Exiting K+ is exchanged for incoming H+ (acid) as the body tries to deal with the growing acidosis by storing H+ into cells. The hyperglycemia will also cause polyuria which can quickly lead to dehydration, thus complicating the electrolyte disturbances. DKA is a serious medical condition as there are concurrent stresses on the body: electrolyte disturbances, acidic environment, and hyperglycemia with no glucose entering the cells. If DKA is left untreated, it may progress to a life-threatening “diabetic coma” as the tissues starve and continue to acidify.

DKA can occur in all the different types of diabetes – but it is more common in T1DM due to the lack of insulin.

DKA can be caused by:

Clinical manifestations of DKA are similar to diabetes (3P’s of diabetes, fatigue, dehydration) WITH the addition of: