What are Hyperglycaemia & Diabetic Ketoacidosis (DKA) by Debbie Hicks
Living with diabetes presents many challenges. One such challenge is hyperglycaemia resulting in diabetic ketoacidosis (DKA), which can result in earlier development of common diabetes complications and can even be life-threatening. Our series covers hyperglycaemia, DKA, diabulimia and the related complications.
Roche Diabetes Care would like to thank Debbie Hicks, Nurse Consultant – Diabetes, for her support with this article series.
Debbie has worked in diabetes nursing for 28 years and has been a nurse consultant for 13. She has been involved in various national groups and had more than 120 papers published. Debbie was the Editor in Chief of the Journal of Diabetes Nursing from 2007 until the end of 2017 and is Co-Chair of TREND-UK (Training, Research and Education for Nurses in Diabetes – UK www.trend-uk.org ).
Debbie leads the Enfield Community Services Diabetes Nursing team, providing patient-centred diabetes care within the community.
Hyperglycaemia in diabetes
Hyperglycaemia is the term used when your blood glucose levels are too high – usually this is considered as above 7 mmol/L before a meal and above 8.5 mmol/L two hours after a meal.1 Hyperglycaemia can be caused by a wide variety of issues, including2:
- Missing doses of insulin or other diabetes medication
- Eating more carbohydrates than the body and/or medication can manage
Signs and symptoms of hyperglycaemia can include1:
- Urinating more frequently than normal (especially at night)
- Feeling very thirsty
Occasional mild episodes of hyperglycaemia can usually be treated fairly easily, or may even return to normal on their own. However, if blood glucose levels become very high or stay high for long periods of time, hyperglycaemia can result in complications.3 Prolonged hyperglycaemia can cause long term problems such as:
- Poor vision and eye problems
- Reduced kidney function
- An increased risk of heart attacks and stroke
- Poor circulation and nerve damage resulting in foot problems
It can also cause acute problems such as Diabetic Ketoacidosis (DKA).
What is DKA?
Persistent hyperglycaemia (high blood glucose levels) coupled with not enough insulin in type 1 diabetes can lead to a condition called Diabetic Ketoacidosis (DKA). This common complication of diabetes is caused when you don’t have enough insulin, so that your body can’t use glucose (sugar) as a source of energy. Instead, the body starts to break down fat as an alternative source of energy. Although this could sound like a good thing, ketones are a by-product of the breakdown of fats. Ketones are acidic, and as more and more fat is broken down, larger amounts of ketones are released into the body. If left unchecked these ketones can build up and cause the body to become acidic. This is why the term 'ketoacidosis' is used.4,5
How common is DKA?
DKA is most common in people with type 1 diabetes, but it can also occur in people with other types of diabetes.3,4 DKA can be life-threatening and is seen as an emergency that needs urgent treatment. In some cases, DKA may be the first sign of diabetes2,5 and may even be how some people are diagnosed.
What causes DKA?
DKA is not always obvious and you should always consider it as a possibility if you are unwell. DKA can occur when people with diabetes have an infection, or suffer from an acute cardiovascular event (e.g. stroke or heart attack), and even with certain drug treatments (e.g. steroids).5
DKA can also occur if you limit or discontinue your insulin for any reason (whether unintentionally or deliberately). People may reduce or stop their insulin injections for a range of reasons5:
- Fear of hypoglycaemia
- Fear of weight gain (leading to diabulimia)
- Psychological factors, such as a needle phobia and stress
- Diabetes UK https://www.diabetes.org.uk/Guide-to-diabetes/Complications/hypers (last accessed February 2018)
- NHS Choices https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/ (last accessed February 2018)
- Diabetes.co.uk https://www.diabetes.co.uk/Diabetes-and-hyperglycaemia.html (last accessed February 2018)
- Diabetes UK. https://www.diabetes.org.uk/Guide-to-diabetes/Complications/Diabetic_Ketoacidosis/?gclid=Cj0KCQiA84rQBRDCARIsAPO8RFyoNLMFYsBivtiTZqbHYrcXOCez0zVCQmadETyZmUFm-5OeE62RkV4aAitSEALw_wcB (last accessed February 2018).
- Misra S, Oliver NS. Diabetic ketoacidosis in adults. British Medical Journal 2015;351:h5660.
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