Understanding diabetic acidosis

First of all, it is important to understand that acidosis, also known as ketoacidosis, is a life-threatening condition that occurs mostly in type 1 diabetic patients, although it can occur in type 2 diabetics as well.

It happens when there is a lack of insulin, high levels of blood sugar, the presence of certain acids (ketoacids) in the blood, and the presence of ketones in urine and blood.

If you experience symptoms of acidosis, it requires immediate hospitalization for urgent treatment with fluids and intravenous insulin.

Acidosis can be caused by a lack of insulin due to missed doses, but it can also occur with well-controlled diabetes if you get a severe infection or other serious condition, such as a heart attack or a cerebrovascular stroke.

These conditions may cause vomiting and rejection of the normal dose of injected insulin.

Insulin's main function is to lower your blood sugar level and reduce the burning of body fat. When the insulin level drops significantly, the body will start burning fat uncontrollably to raise blood sugar levels.

Glucose and ketone bodies (from fat breakdown) will then begin to show up in your urine.

The body then turns acidic and attempts to reduce the level of acid by increasing the rate and depth of breathing, thus blowing off carbon dioxide in the breath to try to correct the acidosis temporarily (acidotic breathing).

Eventually, the body will be at serious risk of dehydration because the high secretion of glucose into the urine causes large quantities of water and salts to be lost.

Symptoms of Diabetic Acidosis

The symptoms of acidosis are the same as those of diabetes but much more severe, such as increased thirst, increased urination, fatigue, confusion, and finally, diabetic coma.

In addition, symptoms of acidosis will occur, including fast breathing, a smell of acetone on your breath, nausea, vomiting, and stomach pains.

Acidosis is usually triggered by an infection, such as a urine or chest infection, and can develop in a matter of hours to a few days.

Acidosis usually requires treatment in a hospital, and sometimes in an intensive care unit. The treatment usually consists of the injection of intravenous fluids, at first with salt-containing fluids and then glucose fluids.

Injection of intravenous insulin, addition of potassium supplements to the infusion, and antibiotics if an infection is identified are also among treatment options.

You can prevent diabetic acidosis by keeping tight control of your blood sugar levels, and regular measurement with a home glucose monitor will help you do this.

To diagnose acidosis, your doctor will measure your blood glucose level, which will be in double figures and may be very high. They will also measure the level of ketones in your urine or blood. If they are present in a moderate or heavy amount, acidosis is likely to occur.

A blood sample from an artery may be taken in the hospital to measure accurately the acidity of the blood. At the same time, the doctor will examine you for the presence of an infection.

Early diagnosis and treatment of diabetic acidosis is crucial to ensure a full recovery within a few days.

It is essential to keep your blood sugar under control to avoid further diabetes complications.

Written by Dr.Albana Greca Sejdini, Md, MMedSc       

Medically reviewed by Dr.Ruden Cakoni, MD, Endocrinologist

Last reviewed 02/25/2023

References:

1. American Diabetes Association. (2021). Diabetic ketoacidosis (DKA). 
2. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Diabetic ketoacidosis. 
3. Mayo Clinic. (2021). Diabetic ketoacidosis. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551
4. American Family Physician. (2006). Diabetic Ketoacidosis. 
5. U.S. National Library of Medicine. (2021). Diabetic ketoacidosis. https://medlineplus.gov/ency/article/000320.htm
6. EndocrineWeb. (2021). Diabetic Ketoacidosis: Symptoms, Causes, and Treatment.