When Should You Call A Doctor For Diabetic Ketoacidosis
When to call the doctor
- If you have any form of diabetes, contact your doctor when you have very high blood sugars or moderate elevations that do not respond to home treatment. At initial diagnosis your doctor should have provided you with specific rules for dosing your medication and for checking your urinary ketone level whenever you become ill. If not, ask your health care practitioner to provide such “sick day rules.”
- If you have diabetes and start vomiting, seek immediate medical attention.
- If you have diabetes and develop a fever, contact your health care practitioner.
- If you feel sick, check your urinary ketone levels with home test strips. If your urinary ketones are moderate or higher, contact your health care practitioner.
When to go to the hospital
A person with diabetes should be taken to a hospital’s emergency department if they appear significantly ill, dehydrated, confused, or very weak. Other reasons to seek immediate medical treatment include shortness of breath, chest pain, severe abdominal pain with vomiting, or high fever .
Identifying Hhs Vs Dka As The Cause Of Diabetic Coma: Blood Ph
pH via arterial blood gas assessment will distinguish between HHS vs. DKA, as DKA is an acidosis due to excess ketoacids in the blood. Blood gases from an arterial blood sample is used to determine the pH.
The diabetic lack of insulin prevents glucose from entering cells, invoking a compensatory, alternate method for manufacturing; glucose for energy that produces ketones as a by-product.
Treatment For Diabetic Coma
Treatment options for diabetic coma include:
- ketoacidotic coma intravenous fluids, insulin and administration of potassium
- hyperosmolar coma intravenous fluids, insulin, potassium and sodium given as soon as possible
- hypoglycaemic coma an injection of glucagon to reverse the effects of insulin or administration of intravenous glucose.
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Low Blood Sugar Or Hypoglycemia Signs And Symptoms Of Diabetic Coma
People suffering from low levels of blood sugar may experience before a diabetic coma:
- Nervousness or weakness
- Increased production of body sweat
- Trouble in normal speaking
- Ambiguity/ confusion
Hypoglycemia unawareness is one syndrome which happens to people with prolonged diabetic conditions. People under such syndrome cannot understand the signals of dropped blood sugar in them.
All the diabetic patients should check our sugar level in the blood at regular intervals. If possible it is suggested to buy diabetes device which can give you correct information on your blood sugar levels. Thus you would be able to remain alert about the growth of diabetes in the body and get immediate medical treatment. You can remain aware of the conditions of diabetes and can support yourselves better during emergencies.
Diabetic coma is a severe medical emergency that needs immediate support. Dial 911 immediately for support if you start feeling like somebody with you who has diabetes is about to faint or has already fainted.
Living With Diabetic Ketoacidosis
Keeping the balance between blood sugar and insulin is the key to controlling diabetic ketoacidosis. In most cases, this means sticking to your insulin schedule. But you may need to adjust the amount of insulin youre taking.
You should also try to recognize when you feel stressed or sick. Small adjustments to your eating or drinking can make a big difference.
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Diabetic Coma At Diagnosis Of Type 1 Diabetes
If the symptoms of type 1 diabetes are not spotted soon enough, ketoacidosis can develop leading to coma before a diagnosis is made.
It is possible that doctors may not correctly diagnose diabetes at first presentation. Approximately 1 in 4 patients diagnosed with type 1 diabetes are recorded as demonstrating signs of ketoacidosis.
What Are The Treatment Guidelines For Diabetic Ketoacidosis
Fluid replacement and insulin administration intravenously are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely – not at an excessive rate or total volume due to the risk of brain swelling . Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte.
Insulin must not be delayed and must be given promptly as a continuous infusion to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body’s cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia .
People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit.
Some people with mild acidosis with modest fluid and electrolyte losses, and who can reliably drink fluid and follow medical instructions can be safely treated and sent home. Follow-up must be available with a health care practitioner. Individuals with diabetes who are vomiting should be admitted to the hospital or urgent care center for further observation and treatment.
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What Should My Blood Sugar Level Be
When you’re first diagnosed with diabetes, your diabetes care team;will usually tell you what your blood;sugar level is and what you should aim to get it down to.
You may be advised to use a testing device to monitor your blood sugar level regularly at home.
Or you may have an appointment with a nurse or doctor every few months to see what your average blood sugar level is. This is known as your;HbA1c level.
Target blood;sugar levels differ for everyone, but generally speaking:
- if you monitor yourself at home with a self-testing kit; a normal target is 4 to 7mmol/l before eating and under 8.5 to 9mmol/l 2 hours after a meal
- if your;HbA1c level is;tested every few months; a normal HbA1c target is below 48mmol/mol
The Diabetes UK website has more about;blood sugar levels and testing.
What Tests And Procedures Diagnose Diabetic Ketoacidosis
The diagnosis of diabetic ketoacidosis is typically made after the health care practitioner obtains a history, performs a physical examination, and reviews the laboratory tests. Blood tests will be ordered to document the levels of sugar, potassium, sodium, and other electrolytes. Ketone level and kidney function tests along with a blood gas sample are also commonly performed. Other tests may be used to check for conditions that may have triggered the diabetic ketoacidosis, based on the history and physical examination findings. These may include chest X-ray, electrocardiogram , urine analysis, and possibly a CT scan of the brain.
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What To Do If Someone Goes Into Diabetic Shock
Extreme hypoglycemia, with sugar levels under 70 mg/dl, is referred to as diabetic shock. It is a medical emergency. Persons with diabetes should be aware of the symptoms and should educate those around them on what to do in the event they are unable to act on their own behalf.
How Does It Happen?
Hypoglycemia is defined as having too little glucose in the blood. Glucose is critical to the functioning of our cells, supplying energy for their processes. Hypoglycemia is the result of an imbalance between insulin levels and glucose levels. Whether as the result of medication, diet, exercise, stress or illness, the body is not reacting as expected.
Too little glucose can cause symptoms ranging from sweating, dizziness, shakiness, rapid heartbeat and hunger in mild cases to aggression, mental confusion, unconsciousness, seizures and coma in extreme cases.
What to Do
When early symptoms of hypoglycemia appear, it is wise for the diabetic to take a blood sugar reading. Prompt attention to this can prevent an emergency situation. Remedies could include consuming glucose tablets or glucose gel, which are over-the-counter products available in drug stores. Other options include an 8-ounce glass of milk, 4 ounces of fruit juice or non-diet soda, a handful of raisins, or a tablespoon of sugar or honey.
After ingesting the remedy, wait 15 minutes and check sugar levels again. If still low, repeat the treatment.
Prevention Of A Diabetic Coma
Prevention of serious complications of diabetes, including diabetic coma, requires keeping the diabetes in strict glycemic control by vigilant and aggressive blood glucose management. Even then some things can induce a hyperglycemic state that is unavoidable.
Beginning a regimen of steroids due to a flare of an arthritic condition can raise blood sugars as a side effect of this medication. Infections affect the bodys metabolism in ways that promote hyperglycemia. When an well-controlled diabetic patient begins to develop hyperglycemia without explanation, hidden causes should be sought and identified, including infection, drugs, or drug-drug interactions.
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What To Do If Someone Goes Into A Diabetic Shock
When a person gets into a diabetic shock, there is a total panic and chaos that is caused. However, in such a situation, it is extremely important that you be aware of the steps that you need to take in order to treat the same. Following are some of the things that you need to do when you are witnessing a situation where a person has slipped into a diabetic coma.
As we see, diabetic shock can be a life-threatening condition and if there is a diabetic patient in your home, you should know how to deal with the situation without any panic.
Signs And Symptoms Of Diabetic Ketoacidosis
The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA:
Malaise, generalized weakness, and fatigability
Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia
Rapid weight loss in patients newly diagnosed with type 1 diabetes
History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump
Altered consciousness ; frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis
Signs and symptoms of DKA associated with possible intercurrent infection are as follows:
Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. .
Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32:1164-9. . .
Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?. Diabet Med. 2012 Jan. 29:32-5. .
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When To Call A Doctor
If you or someone you are with has blood sugar levels that are too high or too low and feels as if they are going faint or are extremely dizzy, it is best to call 911 and go to the hospital.
In some instances, a patient can call their healthcare professional, who can tell them the proper steps needed to help them. This is a good topic for discussion during a well visit.
When To Seek Emergency Care
Its important to measure your blood sugar if you experience any unusual symptoms so that you do not progress to a coma. Diabetic comas are considered emergencies that require prompt medical attention and are treated in a hospital setting. Like symptoms, diabetic coma treatments can vary depending on the cause.
Its also important to help instruct your loved ones on how to respond if you progress to a diabetic coma. Ideally they should be educated on the signs and symptoms of the conditions listed above so that you do not progress this far. It can be a frightening discussion, but its one you need to have. Your family and close friends need to learn how to help in case of an emergency. You wont be able to help yourself once you fall into a coma. Instruct your loved ones to call 911 if you lose consciousness. The same should be done if you experience warning symptoms of diabetic coma. Show others how to administer glucagon in the case of diabetic coma from hypoglycemia. Be sure to always wear a medical alert bracelet so that others know of your condition and can contact emergency services if youre away from home.
Once a person receives treatment, they can regain consciousness after their blood sugar level is normalized.
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Can Diabetic Ketoacidosis Be Prevented Or Avoided
If you have diabetes, there are some things you can do to watch for diabetic ketoacidosis. When youre sick, watch your blood sugar level very closely so it doesnt get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels closely when they are more than 250 mg per dL.
When youre sick or stressed, you should check your blood sugar level more often than normal . If your blood sugar reaches a critical level, check it every 1 to 2 hours. Ask your doctor if you should test your blood sugar level during the night.
You should also test your urine for ketones every few hours if youre sick, stressed, or if your blood sugar level is more than 250 mg per dL.
You should talk to your doctor to develop a plan if your blood sugar level gets too high. Make sure that you know how to reach your doctor in an emergency.
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How To Prevent Hyperglycaemia
There are simple ways to reduce your risk of;severe or prolonged hyperglycaemia:
- Be careful;what you eat be particularly aware of how snacking and eating;sugary foods;or carbohydrates can affect your blood sugar level.
- Stick to your;treatment plan remember to take your insulin;or other;diabetes medications as recommended by your care team.
- Be as active as possible ;getting regular exercise can help stop your blood sugar level rising, but you should check with your doctor first if you’re taking diabetes medication, as some medicines can lead to hypoglycaemia if you exercise too much.
- Take extra care when you’re ill;;your care team can provide you with some “sick day rules” that;outline what you can do to keep your blood sugar level under control during an illness.
- Monitor your blood sugar level your care team may suggest using a device to check your level at home so you can spot an increase early and take steps to;stop it.
Page last reviewed: 08 August 2018 Next review due: 08 August 2021
Avoiding Hyperglycemia & Preventing Diabetic Ketoacidosis
The best way to prevent diabetic ketoacidosis is to treat high blood sugar levels appropriately, which means following the diabetes management plan prescribed by the diabetes health care team.
Make sure your child:
- takes insulin and diabetes medicines as prescribed
- follows the meal plan and/or makes appropriate adjustments to diabetes medicines when changes to the meal plan are made
- monitors his or her blood sugar levels regularly and ketone levels when indicated
- follows the instructions and advice of the diabetes health care team and diabetes management plan, which should include instructions for sick days
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How Can You Care For Diabetic Ketoacidosis At Home
Home care is generally directed toward preventing diabetic ketoacidosis and treating moderately to elevated to high levels of blood sugar. If you have type 1 diabetes, you should monitor your blood sugars as instructed by your healthcare proffesional. Check these levels more often if you feel ill, if you are fighting an infection, or if you have had a recent illness or injury.
Your health care professinal may recommend treating moderate elevations in blood sugar with additional injections of a short-acting form of insulin. Working with their health care practitioner, people with diabetes should have previously arranged a regimen of extra insulin injections and more frequent blood glucose and urinary ketone monitoring for home treatment as blood sugar levels begin to rise. Be alert for signs of infection and keep yourself well hydrated by drinking sugar free fluids throughout the day.
Treatments For Diabetic Ketoacidosis
DKA;is usually treated in hospital.
Treatments for DKA include:
- insulin, usually;given;into a vein
- fluids given into a vein to rehydrate your body
- nutrients;given into a vein to replace any you’ve lost
You’ll also be closely monitored for any life-threatening problems that can happen, such as problems with your brain, kidneys or lungs.
You can leave hospital when you’re well enough to eat and drink and tests show a safe level of ketones in your body.;It’s common to stay in hospital for around 2 days.
Before leaving hospital, ask to speak to a diabetes nurse about why you got DKA and what you can do to stop it happening again.
Page last reviewed: 01 May 2020 Next review due: 01 May 2023
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