Ketoacidosis is a serious condition that can occur in people who have diabetes. Chemical substances known as ketones build up in the blood and urine. There is a connection between ketoacidosis and coma because, if ketoacidosis is left untreated, it can progress and lead to coma and possibly death. Ketoacidosis and coma only occur if diabetes becomes out of control, which most often occurs when patients have an infection. For this reason, diabetes patients should monitor their urine for signs of ketones when they are suffering from illnesses such as influenza.
As well as the ketoacidosis that is associated with diabetes, other types of ketoacidosis can occur. These alternative causes include alcoholism and starvation. The body becomes unable to use sugar for energy so it breaks down fat instead, and this produces ketones found in blood and urine. High levels of ketones in the blood are harmful and potentially fatal, and this is why ketoacidosis and coma are linked.
Ketoacidosis and coma are more likely to occur in people with type 1 diabetes but can also occur in those with type 2. A hormone known as insulin is needed for cells to take in sugar, and in diabetes this is lacking, meaning that high levels of sugar build up in the blood and cells are forced to use fats for fuel. The symptoms of ketoacidosis include breathing difficulties, tiredness, vomiting and confusion. Patients may also have a strange fruity smell on their breath, which is the aroma of ketones. It is important to treat patients as soon as symptoms appear to avoid progression of ketoacidosis and coma.
The treatment of ketoacidosis is usually carried out in an intensive care unit. Patients are typically dehydrated, so they are given fluids to correct this. Insulin is also given, to enable cells to take up sugar. Any underlying infections or other illnesses are treated at the same time.
When treated early enough, the outlook for many patients is positive and they are able to recover fully. Older patients who have a number of other illnesses could have a poorer prognosis. Prevention of ketoacidosis and coma is becoming more of a possibility through patient education about their increased risk when ill. Urine testing kits can be used at home to check for ketones every few hours. This can be carried out when patients have an illness such as a cold, or when blood glucose rises to a certain level, indicating that their diabetes is becoming uncontrolled.
