diabetic ketoacidosis

Diabetic ketoacidosis is what happens when the body, locked out of its sugar supply by a lack of insulin, panics and starts burning fat for fuel as if it were starving — even though the blood is awash with glucose. Burning fat so frantically floods the blood with acidic byproducts called ketones, turning a fuel crisis into a chemical emergency.

DKA is an acute, life-threatening complication marked by the triad of hyperglycemia, ketosis, and metabolic acidosis. With severe insulin deficiency (and a surge of counter-regulatory hormones), the liver pours out glucose and breaks down fatty acids into ketone bodies — beta-hydroxybutyrate and acetoacetate — which acidify the blood. Heavy urination from the high glucose causes profound dehydration and loss of electrolytes such as potassium.

It is most common in type 1 diabetes and may be the first sign of the disease, but it can occur in type 2 under severe stress. Typical features are nausea, vomiting, abdominal pain, deep rapid (Kussmaul) breathing, a fruity acetone breath, and a falling level of consciousness. Treatment is urgent: intravenous fluids, insulin, and careful electrolyte replacement, while treating the trigger — often an infection or missed insulin.