By the end of this section, you will be able to:
- Explain a consequence of uncontrolled diabetes
- Identify the clinical manifestations and causes of diabetic ketoacidosis
- unknown diagnosis of Type I diabetes where lipid metabolism is needed due to the absence of insulin. As a result, ketones are made. DKA may develop and bring the patient for emergency care where the official diagnosis of both DKA and T1DM is made
- insufficient insulin is administered in a Type I diabetic. Thus, the tissues can not get glucose into the cells and, as a result, cells turn to lipid metabolism making ketones.
- insulin demand is suddenly increased (e.g. sudden illness or injury, alcohol/drug ingestion) in a Type I diabetic leading to lipid metabolism and ketone production.
- Fruity smelling breath (presence of ketones)
- Fast, deep breathing (breathing off the acid)
- GI upset (will complicate dehydration)
- Signs of Electrolyte disturbances (e.g. arrhythmia, loss of consciousness, seizures) [hyperkalemia will disrupt every tissue that is electrically excitable]
DKA is a serious condition that can result from a serious, prolonged lack of glucose intake into the cells: usually as a result of insufficient insulin. Fats need to be metabolized resulting in the production of acidic ketones. High ketones causes pH changes in the body and the as the body tries to compensate for this acidification, K+ is expelled from the cells leading to hyperkalemia and resulting electrolyte disturbances. The resulting hyperglycemia will lead to polyuria causing dehydration which further complicate the electrolyte disturbances. Electrolyte disturbances will manifest as irregular heart rhythms (arrhythmia) and neurological impairments (e.g. loss of consciousness, seizures). The high amount of circulating ketones is noticeable in a fruity breath with the acidosis causing a rapid respiratory rate. This is in conjunction with the signs of DM (i.e. polyuria, polydipsia)