Ketones are produced when your body breaks down fat to use as energy. For people with diabetes, ketone production is a sign that they don't have enough insulin to remove glucose from their blood and allow it to enter their cells. Blood glucose levels are usually very high in diabetics who are producing ketones, which can be detected in the urine and in the breath. Diabetic ketoacidosis is a disorder that occurs in Type 1 diabetics, who are always insulin-dependent.
Mechanism
Insulin is essential for the absorption of glucose into cells. Cells need glucose to use as energy. People with diabetes either don't make enough insulin or don't utilize the insulin the produce efficiently. Type 1 diabetics and some type 2 diabetics don't make any insulin and must take insulin injections. Type 2 diabetics may take medications that increase their insulin output or improve their body's use of insulin. If cells can't absorb glucose for energy, they start breaking down fat and ketones are produced even though blood levels of glucose are high.
Causes
The accumulation of ketones due to lack of insulin is called diabetic ketoacidosis, or DKA. Blood glucose levels in DKA are usually over 250 mg/dL and can be as high as 400 to 800 mg/dL, compared to the normal blood fasting levels of glucose less than 100 mg/dL, according to the Gale Encyclopedia of Medicine. Causes of DKA include surgery, illness, unusual stress or strenuous exercise, all of which can increase your use of glucose and your need for insulin. Illness can also produce adrenaline, which works against insulin. Not taking enough insulin or missing an insulin injection can also cause DKA.
Symptoms
Diabetics in DKA will have high blood glucose readings in addition to other symptoms, such as nausea, vomiting, frequent urination, extreme thirst, abdominal pain, weakness, fatigue and muscle aches. The breath may have a fruity odor that, along with the accompanying poor coordination and confusion, can be misdiagnosed as alcohol intoxication. If DKA progresses, coma and deep, rapid breathing may occur.
Treatment and Prevention
Around 10 percent of people with DKA will die. Treatment consists of insulin administration, which lowers blood glucose levels; fluid replacement for fluids lost in urination; and treating the underlying cause if there is one. Low potassium levels can cause death if not treated. Report consistent blood glucose levels over 300 mg/dL to your health provider promptly. Close blood glucose monitoring, especially during periods of illness or stress helps detect signs of DKA before the condition worsens.
