Causes of DKA -continued-

Dehydration: When we are not well hydrated ketones become more concentrated. Like any other acid, water dilutes. Also, we need good hydration to clear ketones in urine, and when we are dehydrated that can’t happen effectively. Finally when we are dehydrated the insulin that we put into our fat layer just sits there. It needs fluid circulation to get from the fat layer into the blood stream, and when we are dehydrated that circulation slows to a crawl--meaning that insulin is less available and DKA risk rises. And guess what, pretty much all forms of illness lead to dehydration. Vomiting, diarrhea, all lead to an obvious loss of fluid. Excess mucus production and many medications we use to treat that lead to obvious fluid loss. Fever, and our body just using more water to increase metabolic processes to fight infection. These can all mean hidden fluid losses that can be extremely dangerous.

So, maintaining good hydration anytime is important to diabetes management and good health, but on sick days it becomes extra important. For kids, this means drinking 4 ounces of fluid per waking hour, and for adults, 8 ounces. Great hydration options include: water, watered down sports drinks, herbal teas, Jello, popsicles, broths, and Pedialyte.

Be aware of dehydration and medications like diuretics. A patient not on insulin but using a diuretic could easily go into DKA when they have an infection because of dehydration and impaired renal function.

Poor insulin Circulation – increased risk of DKA, highs and lows! Poor Ketone elimination Key cause of HHS   PUSH fluids  (8oz adult, 4oz child) Watered down sports drinks Popsicles Broth Herbal tea Jello Pedialyte

Now that we’ve looked at shoring up the stool of DKA in relation to sick days, let’s build a plan for sick days!

Now let’s take a look at some of the treatment options, starting with self-care.

 

Insulin Management & Sick-Days

Insulin is our highest risk medication for the treatment of diabetes. It has the highest risk profile, and so it is no surprise that when it comes to sick day management, these patients are going to be at the highest acute risk due to the mature of illness and insulin side effect risks themselves.

Risks of Severe hypoglycemia and DKA are e higher on sick days for people using insulin than those not using insulin, but anyone with diabetes can go into DKA when faced with severe ilness.

 

One major factor is a lack of proper education on the cause of DKA, In an effort to “simplify” diabetes management most patients are told only to “check if BG is high for a prolonged time” However 30% of moderate to severe DKA cases presenting to Emergency departments present with BGs under 200! It is important to properly educate patients on the causes.

 

While these patients may typically have healthy or stable blood sugar control, sick days can quickly compromise this stability as well.

 

The nature of life with insulin is that patients often do a great deal of their own medication adjustments and self-education.

However it is rare that patients are seeking education on sick day management. So it is a key topic for patient education to prevent hospitalizations and life threatening incidents for people using insulin

 

Patients may also not perceive the risk of DKA if they’ve never experienced it. I tell all patients, that is like not wearing a seat belt because you’ve never been thrown through a windshield!!

 

So let’s take a look at DKA, it’s root causes and a good educational image to share with patients.