Ah, a name that just rolls off the tongue. It’s a puzzling name for a puzzling condition. For those with diabetes, ketoacidosis is perhaps a scary thought – a notion that many will have been familiar with from the beginning. Indeed, ketoacidosis often lies behind the early signs of diabetes.
Let’s fight that fear with the facts about this condition! Many with diabetes will know that it comes with ketones, which come with high blood glucose. But what is diabetic ketoacidosis exactly? What causes ketoacidosis? And what do you do about it?
Tag along as we explore ketoacidosis in its kompleteness, where you’ll find all you want to know!
Ketones are key
Ketones is where it all starts. Ketones are essentially the product of the body burning fat for a source of energy. It’s all chemicals – so brace yourselves for some keen chemistry!
More specifically, it’s about ketone bodies, which are a kind of ketone. Even more specifically, these ketone bodies have the catchy names of acetoacetate (detected in the urine), β-hydroxybutyrate (detected in the blood), and acetone (which is the same as nail polish remover and detected in the breath).
Except β-hydroxybutyrate is not technically a ketone body, even though it’s still counted as one (we’ll leave that issue to the chemists).
In this case, though, we can just call them ketones. So why do ketones appear? When the body is not getting energy from glucose, it must find an alternative energy source. The ketones can unlock that energy source. Accordingly, fat is broken down into ketones.
Because of their chemical makeup, the ketones allow a so-called citric acid cycle, which eventually results in ATP (adenosine triphosphate – you’ve gotta love chemical names). ATP is how the body mainly releases energy.
For diabetes in particular, ketones turn up as a result of high blood glucose. With high blood glucose, the body is not getting the glucose it needs because it stays in the bloodstream. And that’s because there isn’t enough insulin to transport the glucose from the blood to the cells.
That’s where the ketones come in for the alternative energy source. When there isn’t enough insulin, the body automatically produces ketones. And so, high blood glucose with diabetes means more ketones.
Knowing the Difference
So far so good. Still keeping up?
The production of ketones is not in itself a bad thing. So, the next step is figuring out why it can get dangerous and knowing the difference between ketosis and ketoacidosis. (Keep those catchy names coming, chemistry!)
You may have heard of ketosis in the context of nutrition and fitness. This is the normal process of burning fat, that we’ve just described.
Diabetic ketoacidosis, on the other hand, is the same process but too extreme. Those with diabetes have the potential for extremely high blood glucose, leading to extremely high numbers of ketones. Ketoacidosis, then, is a situation where there are too many ketones.
Remember that poetically-named citric acid cycle? Well, that’s partly to do with the fact that ketones are acidic. Too many ketones building up in the bloodstream results in acidic blood, named metabolic acidosis.
Metabolic acidosis is not ideal because it changes the chemistry of the blood and interferes with the proper functioning of the organs. The body tries to respond as it would with most emergencies: by releasing its store of glycogen from the liver, which later becomes glucose in the blood.
But, of course, without using insulin, the glucose gets stuck in the bloodstream, leading to even higher blood glucose levels, creating a vicious circle.
Meanwhile, as Harvard Health points out, the body becomes dehydrated. This is because some of the excess glucose is leaked out in the urine. Additionally, ketones in urine are present for the same reasons. But when the glucose and ketones are flushed out, the body loses its fluids.
This could all lead to a coma or worse. This may all appear dramatic but ketoacidosis is the extreme. We’re here to show you how to take steps to avoid this before it gets too extreme. Next step: looking out for the symptoms.
To avoid diabetic ketoacidosis, it’s best to know the symptoms, so as to treat yourself as soon as possible.
Diabetic ketoacidosis goes hand in hand with high blood glucose, and both situations have symptoms in common. For diabetic ketoacidosis specifically, you might experience:
- Frequent urination (that’s the glucose and ketones being flushed out)
- Feeling thirsty (that’s the dehydration)
- Nausea or vomiting (that’s the acidic blood affecting the body)
- A breath that smells fruity or like acetone (like nail polish remover, from the acetone ketone, remember?)
- Hyperventilation / deep breathing (that’s the body trying to sort out the blood’s chemical changes by lowering the levels of carbon dioxide in the blood)
- Confusion or tiredness (a lack of energy from glucose not being used)
Having these symptoms would usually indicate that it’s time to take steps to reduce blood sugar level immediately. It’s worth checking both blood glucose and ketone levels, as we shall see in the next section.
When a person first gets diabetes, their blood glucose levels become too high. As such, these symptoms are often the same as for those experiencing diabetes for the first time. This was true for Hedia’s CEO, Peter Lucas, when he was diagnosed with diabetes.
Keeping Ketoacidosis at bay
Avoiding ketoacidosis means keeping an eye on blood glucose: test blood glucose levels regularly.
It’s also important to check for ketones when the body is going through any additional pressure, such as stress or infection (like a combination of diabetes and the flu).
If your blood glucose is high before exercising, make sure to check ketones because high intensity exercise can burn fat, leading to ketone production.
A test for ketones is done with either a blood, urine, or breath testing kit. When using a blood ketone test, anything higher than a blood ketone level of 0.6 mmol/L increases the risk of ketoacidosis, according to the NHS.
If the level is between 1.6 and 2.9, you should contact a doctor as soon as possible. Higher than 2.9 and you should seek medical attention immediately.
If you measure your blood ketone level in mg/dL, you can use this converter. Converting 0.6 mmol/L indicates that anything higher than a blood ketone level of 3.49 mg/dL increases the risk of ketoacidosis.
Keen on Hedia
Do you want help with remembering when to check for ketones? Hedia will recommend checking your blood ketones in certain situations. If your blood glucose is recorded as being above 15 mmol/L or 270 mg/dL more than twice in six hours, Hedia is set to give you a warning recommendation to check your blood ketone levels.
When you do check your blood ketones, you can add the numbers at the same time you make a calculation with Hedia. These can also be added via Bluetooth with Keto-Mojo GKI, in a similar way to how you would add readings from an NFC or Bluetooth Glucose Meter.
Alternatively, you can go directly to Hedia’s diabetes logbook and add the numbers there. Note: only blood ketone (not urine ketone) levels can be added.
What’s more: you can use Hedia to help you avoid ketones in the first place by trying to avoid hyperglycemia. Log your blood glucose, exercise, and carbs (with the help of Hedia’s food database), and use Hedia’s insulin calculator for a personalised recommendation.
Get Hedia for free from Google Play and the App Store!
Kicking Ketoacidosis’ butt
This all leads to the final point: what do you do when you have too many ketones?
Treating ketoacidosis involves replacing the fluids, electrolytes, and nutrients lost from urinating. This will also help to water down the high glucose in the system. If in hospital, this can be done via a drip.
If not in hospital, medical advice should be sought for how to proceed. Generally, rehydrating is important. So, drinking water will definitely help.
The most immediate solution, though, is to use insulin in order to lower the blood glucose back to safe levels. In hospital, this can be done intravenously.
If you have a high number of ketones without having ketoacidosis itself, the first step is still to lower your blood glucose most likely with the help of insulin.
At the end of the day, it all boils down to not letting the blood glucose get too high. To put ketoacidosis into perspective: only 4% of people with type 1 diabetes in the UK experience ketoacidosis a year (according to this study).
And so, don’t worry too much about it. Just be aware of what causes it. In the meantime, keep owning your control of your blood glucose, and you’ll automatically be kicking ketoacidosis’ butt in the process!