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Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. [1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. [1] A person's breath may develop a specific "fruity" or acetone smell. [1]
In the early days of insulin treatment for type 1 diabetes there was much debate as to whether strict control of hyperglycaemia would delay or prevent the long-term complications of diabetes. The work of Pirart [ 50 ] suggested that microvascular complications of diabetes were less likely to occur in individuals with better glycaemic control.
The symptoms of ketoacidosis are variable depending on the underlying cause. The most common symptoms include nausea, vomiting, abdominal pain, and weakness. [1] [2] Breath may also develop the smell of acetone as it is a volatile ketone that can be exhaled.
Gestational diabetes, a form that arises during pregnancy in some women, normally resolves shortly after delivery. Type 1 diabetes is an autoimmune condition where the body's immune system attacks the beta cells in the pancreas, preventing the production of insulin. This condition is typically present from birth or develops early in life.
The major differential diagnosis is diabetic ketoacidosis (DKA). In contrast to DKA, serum glucose levels in HHS are extremely high, usually greater than 40-50 mmol/L (600 mg/dL). [6] Metabolic acidosis is absent or mild. [6] A temporary state of confusion (delirium) is also more common in HHS than DKA. HHS also tends to affect older people more.
People with type 1 diabetes experience diabetic ketoacidosis 1–5 times per 100 person-years, the majority of which result in hospitalization. [ 97 ] 13–19% of type 1 diabetes-related deaths are caused by ketoacidosis, [ 94 ] making ketoacidosis the leading cause of death in people with type 1 diabetes less than 58 years old.
A 2017 review found that, long term, lifestyle changes decreased the risk by 28%, while medication does not reduce risk after withdrawal. [88] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.
Type 2 diabetes is different in that it is usually caused by insulin resistance in the body in older patients leading to beta cell burnout over time, and is not prone to DKA. KPD is a condition that involves DKA like type 1, but occurs later in life and can regain beta cell function like type 2 diabetes.