Generality
Diabetic ketoacidosis is a serious complication of diabetes mellitus, particularly of the insulin-dependent one (type I and more rarely type II); it is in fact caused by an absolute deficiency of insulin, in response to which the body produces significant quantities of ketone bodies.
Causes
When glucose fails to enter cells, they adapt to using mainly fatty acids, whose metabolism - in the absence of adequate intracellular glucose quantities - turns towards the synthesis of substances called ketones or ketone bodies.
At the same time, given the lack of sugar, it is absurd to witness an enhanced secretion of counterinsular hormones (glucagon, catecholamine, cortisol and GH), which stimulate the synthesis of glucose (gluconeogenesis and glycogenolysis); the newly formed zuccero is then poured into the circulation where, not being able to enter cells due to the absence of insulin, it aggravates the hyperglycemic condition.
The accumulation of ketone bodies in the blood, hyperglycemia and insulin deficiency therefore determine the characteristic symptoms and complications of diabetic ketoacidosis, which in extreme situations can even prove fatal.
Diabetic ketoacidosis is an acute complication of diabetes mellitus, which leads to hyperglycemia (high blood glucose levels), ketonemia (accumulation of ketone bodies in the blood) and metabolic acidosis.
Differences with Ketosis in Healthy People
A similar situation, but much less serious (one simply speaks of ketosis and not ketoacidosis), occurs in people who follow a diet that is particularly low in carbohydrates or have remained fasting for a long time.
The difference between these situations and the ketoacidosis of diabetics is that the latter, by not producing insulin, fail to regulate the synthesis of ketone bodies, which becomes exaggerated and without control; furthermore, due to the inability to make glucose enter cells, they find themselves in the paradox of synthesizing ketone bodies in conditions of hyperglycemia, which, as in the most vicious of circles, is further raised by the secretion of counterinsular hormones.
Symptoms
To learn more: Diabetic Ketoacidosis Symptoms
In diabetic ketoacidosis the hyperglycemia / ketosis is therefore coupled to reduce blood pH and to cause symptoms such as vomiting, dehydration, polyuria (frequent and copious urination), polydipsia (intense thirst), hypotension, arrhythmias, deep and panting breath, drowsiness and state confusing to the coma. The breath of a person suffering from diabetic ketoacidosis also takes on the typical smell of ripe fruit; it is a symptom linked to the elimination of acetone, a ketonic body deriving from the degradation of acetoacetic acid (one of the three ketone bodies together with the B-hydroxybutyrate and the aforementioned acetone).
Diagnosis
Clinically, in patients with diabetic ketoacidosis there is hyperglycemia, hypovolemia, reduction of blood bicarbonate, presence of ketone bodies in the blood (ketonemia) and urine (ketonuria), electrolytic alterations and reduction of blood pH.
Ketoacidosis can be found at onset, ie when type 1 diabetes occurs for the first time (usually at a young age), or following a deliberate abstention from insulin therapy.
Precipitating factors, which may favor its onset, are represented by concomitant infections, by the malfunctioning of the insulin pump and more generally by stresses both of a physical and psychological nature (trauma, myocardial infarction, acute cerebro-vascular episode, etc.). ).
Treatment
The treatment of diabetic ketoacidosis, to be performed in a hospital setting, involves the intravenous administration of fluids to resolve dehydration, and of insulin to stop the synthesis of ketone bodies. Also important is the monitoring and possible correction of electrolyte imbalances.
Specific treatments can also be undertaken against underlying infections (such as pneumonia or urinary infections), which often constitute an aggravating situation; in fact, stress increases the secretion of hyperglycemic hormones such as cortisol and catecholamines.
In these situations the patient may also be led to think that - due to the lack of appetite and poor food intake - it is necessary to reduce the dose of insulin; in the face of such occurrences, to prevent diabetic ketoacidosis, it is instead important to intensify the glycemic controls and adapt the therapeutic scheme as recommended by the diabetologist.
