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PEP Talk

6 Tips for Preventing DKA

By: Kellie Rodriguez, M.S.N., C.D.E., C.P.T.

Diabetes Ketoacidosis, or DKA, can be a life threatening situation in type 1 diabetes and is typically a combination of:

Beyond the potential for DKA at the time of diagnosis, our number one focus must be DKA prevention and therefore being forewarned means being forearmed. Below are some key tips to help you reduce your risk for life threatening DKA.

1. Stay on top of illness

Did you know that illness is a key reason for the occurrence of DKA? Illness can place the body under enormous stress, causing release of hormones (counter-regulatory hormones) that raise blood glucose levels. Therefore during times of illness, it is essential to stay on top of your blood glucose levels, insulin administration and keep well hydrated.

Checking for ketones (via urine or blood), especially when blood glucose levels are above 300mg/dl, is an essential management need. Also, if you can’t tolerate fluids due to vomiting, seek immediate urgent medical assistance. General rule: If you vomit twice, get immediate medical attention!   

2. Be prepared

Do you have ketone strips? If so, have your ketone strips expired? Many people are often unprepared to monitor ketones. Just like having your ‘hurricane preparedness kit,’ un-expired ketone strips need to be a part of your ‘diabetes preparedness kit’ if you have type 1 diabetes.    

3. Report changes in ketones early

Don’t wait for the ketone strip to change to purple, like the color of Barney (I love you, you love me!) before you seek medical help. Detect changes in ketones early (blood glucose levels  above 300mg/dl) and notify your health care team when you identify small ketones. Appropriate insulin and hydration management can stop DKA development.

4. Take your insulin!

Ketone development is a sign that the body is using fat for energy. The body will typically use fat for energy when it is unable to get its preferred source of glucose, due to a lack of insulin. Remember, insulin is needed to get glucose into the cells of the body.

Please let your health care team know if you are having problems getting your supply of insulin or have concerns or difficulties injecting your insulin. This is not a time to be fearful of your health care team, rather the time to embrace their support.

5. Don’t exercise if ketones are present
It is well known that cardio exercise tends to lower blood glucose levels for many people with diabetes. It is important however to check for ketones before exercising if you are experiencing elevated blood glucose levels.

Exercising in the presence of ketones, could actually lead to increased ketone development, due to the lack of circulating insulin in the body (high blood glucose levels). You should always wait until the ketones have gone before exercising and this could take up to 24 hours with correct management.

6. Be aware of the signs and symptoms of DKA

If you experience any of the following symptoms go to your closest Emergency Care Center and tell them the fast track letters of ‘DKA’:

•    “Fruity” smelling breath
•    Nausea
•    Vomiting
•    Stomach cramps
•    Confusion
•    Unconsciousness

Kellie says: "Don't exercise if ketones are present."


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