What is ketoacidosis?

Ketoacidosis can be a scary term, but fear not my friends as we delve into the world of this metabolic state. You might have stumbled onto this article because someone you know has diabetes or maybe you’re just really interested in biochemistry (nerd alert). Either way, no judgement here! Let’s get started.

What is ketosis and how does it relate to ketoacidosis?

Before getting into the nitty gritty of ketoacidosis (or DKA – diabetic ketoacidosis), let’s first understand what ketosis is. Ketosis occurs when our body doesn’t have enough glucose (sugar) for energy and so switches to burning stored fat instead. This happens during periods of fasting, low-carb diets like Atkins, starvation, or even in endurance athletes during long bouts of exercise.

Sounds pretty simple right? But hold your horses, there’s more!

When our body burns fats for fuel it produces substances called ketone bodies which are acidic molecules that can build up in the blood if they accumulate too fast. This increase in acidic byproducts causes changes in our blood pH levels making them more acidic which then can lead to life-threatening complications such as…you guessed it…ketoacidosis.

So why does it only cause problems sometimes?

Great question! Our bodies are pretty amazing at regulating things (cue “The More You Know” jingle) including acid-base balance through a variety of mechanisms such as exhaling CO2 through our lungs and kidney filtration systems. Typically, when we enter ketotic states our bodies compensate for these changes and keep us from reaching dangerous levels (unless something goes wrong).

I cannot stress enough that anything taken to excess can become problematic so please do not avoid carbohydrates altogether thinking that THIS WILL NEVER HAPPEN TO ME BECAUSE IT CAN AND IT’S NOT FUN!

Getting down with the DKA – Diabetic ketoacidosis

When it comes to diabetes, there are two main types: Type 1 (T1D) and Type 2 (T2D).

Type 1 diabetics have little to no insulin production within their bodies (thanks immune system) while T2D typically starts as insulin resistance where one’s body doesn’t utilize it properly before progressing to improper hormone secretion from the pancreas.

Regardless of type, both can lead to hyperglycemia (high blood sugar levels) which when severe enough or left untreated leads into a state called diabetic ketoacidosis.

Let’s break down the name for you simpletons out there:

  • Diabetic – relating or referring directly to Diabetes
  • Keto- – indicates ketones
    • Can also stand-in for ketogenic-referring more generally towards any high-fat eating approach that induces ketones.
  • -Acidosis – too much acid in your bodily fluids!

Oh snap! A series of unfortunate events…

So how does someone go from living with diabetes on a daily basis and then BAM suddenly they’re in the emergency room? Well this ain’t Hollywood folks so don’t expect Samuel L Jackson popping up right about now.

It starts when one fails to learn all components involved in insulin administration during their management course i.e incorrect bolus/timing/dosage/application method. With inadequate doses of insulin being given relative to an individual’s personalized needs, glucose begins accumulating at higher than normal levels often marked by frequent urination due tot he inability of cells utilizing insulin-mediated uptake/usage.

While insufficient movement is happening on glucose storage side-backup plans kicks off wherethe liver will start churning out excess energy molecules primarily via breaking down glycogen-stored memory banks (glucose bonds) in times where immediate fuel sources like carbohydrates aren’t present.

Great right? But watch out.

As the liver plays ketoanabolism and prep-ups at overdrive rate – ketone levels in blood stream start amassing up to toxic amounts that ultimately tips off balance primarily kicking of series of biochemical reactions such as inflammatory symptoms, electrolyte disturbance and keytones building up.

The cortisol hormone which is heightened during periods of stress-energy demand also aggravates repartitioning/preventingoverly high blood glucose expeditures so even if insulin present severe metabolic derangement will occur with cells starved for glucose.

To put it simply – this dance of multiple escalating physiologies in tandem can lead toa highly acidic state where pH being lower than normal nutrient flow/cell signaling inhibited lungs just panic breathing respiration trying desparate getting rid some CO2 instead inducing hyperventilation/breathlessness/asphyxiation-sort like forcing breathe through a tiny straw while exercising your heart out…on an empty stomach! (cue “Last Dance, Last Chance” here)

Symptoms

By now you should ‘get’ that DKA results due to prolonged elevationsofglucose along hybrid energy use induced by hepatocytes actingas substitute glucose sources when glycogen stores get too low- leads to hyperglycemia. Now let’s talk how bodies adapt/handle increasein acidic environment:

  • Hyperventilation (stretchy mouth muscles)
    • Can appear like rapid breaths or deep sighs.
  • Sweet fruity odor (not from lavender fields sorry)
    • Breath has a distinct sweet smell akin tones akin rubbing alcohol mixed with recently sliced apples/pear into slices.
  • Nausea/vomiting
    • This symptom has been known exacerbate case-fatality rates based on possibilityof choking/reflux action taking place
  • Thirst/dry mouth
  • Due excessive water loss concentrated urine becomes damaging across different body organs over long periods of time
  • Confusion/obstructive thinking (not in the sense that you ask an individual and they reply “Jenga” or anything)
  • Hyperglycemia accompanied by ketoacidosis can lead to encephalopathyand in severe cases coma

Treatment

Let’s get down to business with some facts! If someone is experiencing DKA, they will require medical attention starting with administration of fluids through intravenous pathways followed by insulin (the more the merrier) correction using algorithms created for glucose management so nutrients are regulated during treatment.

The good news? Often times once corrected it doesn’t seem many negative after-affects remain (unless complications arose) meaning no lasting issues that one must continually deal with!

Prevention

As we all know – prevention is better than cure! Here are a few quick tips on how you can prevent entering in this dangerous metabolic state:

  1. Make sure to take your medications/doses as directed when managing diabetes
  2. Stay hydrated especially during activities that may cause dehydration such as sports/games outdoors events/tropical locations.
  3. Monitor Blood/Sugar levels regularly: i.e 4-6 times per day every week cycle
  4. Keep up constant communication dialogue between doctors/nutritionists/endocrinologists(especially if changes present themselves) maintain overall healthy lifestyle keeping physical activities sufficient w.r.t body requirements.

To conclude – Don’t let fear paralyze you from seeking help- knowledge is power and catching problems early allows conditions like diabetic ketoacidosis from spiraling out into darker territories where permanent damage done whether physically/emotionally which then could result into other associated mental health realities-i.e onset depression/anxiety being common among those undergoing chronic illness-related scenarios.

Thanks for sticking around amigos, ‘til next time..Salud!

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