Recognizing The Danger Of DKA
Most people starting pump therapy do not recognize the serious danger of diabetic ketoacidosis (DKA). Even though they have been on injection therapy for years, many never experienced DKA, even on occasions when they may have forgotten to take their morning NPH. Now they are always hearing reminders from their doctors about the danger of DKA.
Diabetic Ketoacidosis is an uncommon, yet potentially life threatening complication of diabetes. The most common cause of DKA is extremely low levels of circulating insulin which will cause fat cells to break down and release poisonous or toxic substances known as ketones. Ketones are acids which can cause nausea, vomiting, abdominal pain, rapid breathing, weight loss, frequent urination and dehydration.
The amount of acid in the blood is measured by a number called the pH. The body functions properly at a pH of 7.4. Ketones in the blood stream cause the pH to drop below 7.3, which is dangerous to normal body functions. As the pH gets lower, cardiac problems may occur.
DKA can happen to anyone with diabetes, regardless of good control.
The three most common causes of DKA in pump users are:
- Failure to recognize an insulin delivery problem, such as an infusion set which has fallen out, or using insulin which has lost some of its potency. Note: Your Medtronic Diabetes insulin pump has a highly sensitive occlusion alarm to notify you if insulin delivery is interrupted due to blockage in the tubing or a kinked cannula.
- Underlying medical problems such as pneumonia or kidney infection which may cause insulin resistance. More insulin is needed in order to prevent DKA.
- Use of other medicines, such as prednisone, which can raise blood glucose levels.
Because pump wearers use regular insulin, the body can run out of insulin more quickly than when using NPH or long-acting insulin. With the new, short-acting insulins (e.g. Humalog®) the body will begin to develop DKA in as few as 4 hours after insulin delivery is stopped.
My advice on preventing DKA is:
- Always monitor blood glucose at least 4 times per day.
- If blood glucose is above 240, take a high blood glucose bolus via the pump and check urine for ketones. Check blood glucose again in 2 hours and if it is still above 240, take an injection by syringe and then change the infusion set.
- If you are ill, monitor blood glucose every 2-4 hours to catch large increases in blood glucose.
- If nausea or vomiting develops with high blood glucose (above 240), take an injection by syringe and call your physician.
Early recognition and the administration of extra insulin when indicated will assist in preventing an unnecessary episode of DKA.
Jeffry Unger, MD
Diabetes Intervention Center
Chino, CA
Pump wearer since 1992
