by Lynn Tracey

Created on: August 21, 2009

Ketoacidosis

Ketoacidosis (key-toe-ass-i-DOE-sis) is a serious condition that can lead to diabetic coma or even death. When the body cannot utilize glucose due to the lack of insulin, it breaks down fat. ketone's are the byproduct of this fat breakdown. ketone's can develop with a glucose level greater than 240.

Warning signs

Ketoacidosis usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. The first symptoms are:

-Thirst that cannot be satisfied, a very dry mouth

-Frequent urination

-High blood glucose (sugar) levels.

-High levels of ketone's in the urine

-sleepiness and weakness

-Dry or flushed skin

-Nausea, vomiting, or abdominal pain

-A hard time breathing (short, deep breaths)

-Fruity odor on breath which is often mistaken as smelling like alcohol

-A hard time paying attention, or confusion

Ketoacidosis is dangerous and serious. If you have any of the above symptoms, contact your health care provider IMMEDIATELY, or go to the emergency room.

A simple urine test can detect ketone's. Ketostix do not require a prescription, and cost about $12.00 for a vial. Just urinate on the stick and match the color to the color code on the vial. Always check your urine for ketone's when your blood glucose is sustained more than 240 mg/dl for 4 hours. It is possible to have negative urine ketone's but still have ketones in your blood, so if your glucose remains high, with any of the symptoms listed above seek medical assistance at once.

If you are on an insulin pump, with no, or low ketones, and no symtpoms such as vomiting: give yourself a correction dose with a syringe, do not bolus through the pump and change out the infusion site. Drink 1/2 to 1 litre of water over 1 hour (if you are not a dialysis patient or otherwise on a fluid restriction for other conditions such as congestive heart failure) then recheck your blood sugar. Your glucose should come down at least 50points in 1hr. If it does not, call your health care provider. If it does you may continue hourly blood sugar checks with coverage through the new infusion set. Don't drink or eat any carbohydrates until your blood sugar is below 250 and your ketones have cleared. Do NOTexercise when your urine tests show ketone's and your blood glucose is over 200.

Those not on a pump that do not know how to calculate their insulin adjustments must call their health care provider for dosing. The typical formula is BG (blood glucose) minus 100 to 125 divided by the sensitivity factor. Sensitivity factor is the number of points that 1 unit of insulin will lower your blood sugar. This is different for everyone and in many it is different at different times of the day. When your blood sugar is high, your insulin requirement is higher. If 1 unit of insulin lowers you 30points then having a glucose in the 300-400 range will probably require a 1.5 dose adjustment. Anyone not on a pump who using Novalog, Humalog, Apidra or Regular insulin must also remember to factor in the active insulin into their correction calculation.

Never just guess at how much insulin you need. Call your physician or diabetes nurse specialist. Have the following information ready when you call: your blood sugars, the amount of insulin taken, the time, last meal and # of carbohydrates eaten, and your urine ketone's.

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