Causes and Risk Factors of Diabetic Ketoacidosis

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Diabetic ketoacidosis is serious complication of diabetes. This problem occurs when there is low insulin level in blood, that lead to inability of body to use sugar/glucose as energy source. This in turn leads to utilization of fats as energy and breakdown of fats for energy. Breakdown of fats lead to accumulation acid (by product of fat metabolism) known as ketones (these are acidic substances), which makes blood acidic and lead to systemic acidosis and in case of diabetes it is called diabetic ketoacidosis. Excess ketones in blood spill over to urine and it can be detected in urine using simple test kit to detect ketones in urine.id-100314461

Hence, the main cause of diabetic ketoacidosis is low level of insulin in blood as is the case in type-1 diabetes where the patient is unable to produce any insulin because of lack of insulin producing beta cells in pancreas. However, diabetic ketoacidosis can also occur among patients with type-2 diabetes, who are receiving insulin for blood glucose control (because these patients are unable to produce adequate insulin even by using oral hypoglycemic drugs), if they miss one or more doses of insulin or if they receive less than required quantity of insulin (under-treatment).

Diabetic ketoacidosis is common among patients of type-1 diabetes. However, type-2 diabetes patients can also develop diabetic ketoacidosis, who are receiving insulin, especially when they miss a dose or two.

Diabetic ketoacidosis may be triggered by various factors such as,

  • Illness or infection: an illness or infection may trigger diabetic ketoacidosis. Illness lead to increased requirement of insulin and if the patient receives usual dose of insulin during illness or infection this may not be sufficient to control blood glucose level. There may be increase in blood glucose level and lead to diabetic ketoacidosis. During illness or infection (such as pneumonia, urinary tract infection) our body secretes hormones such as cortisol, adrenalin etc. Which can oppose action of insulin and lead to increased insulin requirement.
  • If the patient unable to adhere strictly to the insulin treatment regimen and misses out insulin dose frequently, it is a cause and trigger for diabetic ketoacidosis. Insulin regimen should be followed strictly as per advice of the treating doctor.
  • Insulin requirement may also go up in various medical conditions and hence may lead to diabetic ketoacidosis. These include, physical trauma, emotional problem/trauma, heart attack, drug abuse (e.g. Cocaine), excess alcohol consumption (binge drinking episode), certain medications (such as corticosteroids, cortisol etc.).

Who are at higher risk of diabetic ketoacidosis?

Patients with type-1 diabetes are at greater risk of diabetic ketoacidosis. Because type-1 diabetes patients are dependent on external insulin therapy for sugar control. Type-2 diabetes patients can also develop diabetic ketoacidosis, if they have tendency to miss insulin dose frequently. However, type-2 diabetes patients have low risk of diabetic ketoacidosis, because their pancreas can produce and secrete insulin, albeit less than required.

 

Image courtesy of [Stuart Miles] at FreeDigitalPhotos.net

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