Causes
With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood.
Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 400 mg/dL (22 mmol/L) while insulin levels are very low.
Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able to function as well. A higher level of ketones also affects levels of sugar and electrolytes in the body.
DKA may occur with insulin deficiency, under the following circumstances:
- during an infection or illness (e.g., urinary tract infection or pneumonia)
- after stressful events or trauma (including heart attack, stroke, or surgery)
- inadequate insulin treatment (when someone is not yet diagnosed or someone who is diagnosed but misses a dose of insulin)