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Diabetic Ketoacidosis
A Preventable Crisis

by Jan Chait

The treatment can be as simple as restoring fluids and insulin to the body, or as complicated as doing that plus bringing the body’s chemistry back into balance, something that can only be done in a medical setting such as an emergency room or hospital.

Not just for Type 1 diabetes
Historically, DKA was thought of as a condition experienced only by people with Type 1 diabetes, but recent research is noting that DKA can occur in people with Type 2 diabetes as well, although it is generally not as severe in people with Type 2.

“A significant proportion of DKA occurs in patients with Type 2 diabetes,” said one study, published in the September 27, 2004, issue of Archives of Internal Medicine. In that study, conducted in Dallas, Texas, nearly 22% of people with DKA who were identified as having diabetes had Type 2 diabetes.

Another study, conducted in the Bronx, New York, and published in the February 2007 issue of Metabolism, found that 32% of the subjects studied had Type 2 diabetes. This study focused on hospital admissions for DKA among ethnic minorities, primarily African-Americans and Hispanics. It concluded that African-Americans with Type 2 diabetes may be particularly susceptible to developing DKA. (For information about hyperosmolar hyperglycemic state, another condition characterized by very high blood glucose levels, click here.

How to check for ketones
Either a blood test or a urine test can check for ketones. The American Diabetes Association recommends that doctors use a blood test. Blood ketone testing equipment also is available for home use.

Why test blood rather than urine? First of all, because ketones enter the bloodstream first and then travel to the urine, ketones can be measured earlier in the blood. In addition, there are three types of ketones: acetoacetic acid, acetone, and beta-hydroxybutyric (b-OHB) acid. Urine ketone strips measure only acetoacetic acid and acetone, while blood ketone tests measure b-OHB, “the strongest and most prevalent acid in DKA,” according to the 2004 ADA position paper “Hyperglycemic Crises in Diabetes.”

Among people who are accustomed to checking their blood glucose, measuring blood ketones is widely accepted, according to a study published in the March 2006 issue of the British journal, Diabetic Medicine. In the study, 123 people 3 to 22 years old and their families were educated on sick-day care. Some were then given a meter that can measure blood ketones, and others were given urine ketone strips. While more than 90% of the subjects reported checking for blood ketones during illnesses, stress, or when blood glucose was elevated, only slightly more than 61% measured ketones in their urine. Hospital visits among those who checked for blood ketones were nearly half that of those who checked for urine ketones.

Two home meters are available to measure ketones in the blood: Abbott Diabetes Care’s Precision Xtra and CardioChek, which is made by Polymer Technology Systems, Inc. The Precision Xtra can also be used to check blood glucose levels, and CardioChek can also measure glucose, lipid, and creatinine levels.

While testing blood for ketones is the preferred method, the test strips are more costly than urine ketone strips, and it requires a meter that can check for blood ketones.

Urine ketone testing is done by dipping a reagent strip in urine, urinating on the strip, or, in the case of very young children, pressing the strip against a wet diaper. After a specified amount of time, the color on the strip is compared to a color chart on the container to determine the amount — if any — of ketones present. Ketones in the urine are measured in terms of the amount present: negative (no ketones), trace, small, moderate, or large.

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Also in this article:
Hyperosmolar Hyperglycemic State
Signs and Symptoms



More articles on High Blood Glucose



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