Do you say ‘Sugar’ or ‘Glucose’ ? One of my attendings was a stickler regarding this. ” ‘Sugar’ is for the layman – medical professionals say ‘Glucose’ “, he often quipped.
In a way, the pathophysiology of Diabetic Ketoacidosis (DKA) has the same basis as the logic of fat-burn in Intermittent fasting. Insulin has two functions – 1. to enable glucose transport into the cells and 2. to stop lipolysis or fat-burn – Indeed, one of the common side-effects of Insulin therapy is body fat gain! If you fast longer than 14-16 hours, your insulin levels finally come down low enough to release the brakes on fat burn (lipolysis). In DKA however, the complete lack of insulin (in Type 1 diabetics and in some late Type 2 Diabetics ) and high resistance to Insulin (In type 2 diabetics), results in accelerated and unopposed fat burn with the by-products of fatty acids and ketones ( ketoacidosis ).
Just like in CHF exacerbation and Hepatic Encephalopathy, in DKA, we need to determine the triggers or the precipitating factors, to reduce the risk of recurrence.
Here is how I remember triggers of DKA: S for Sugar, ‘S’ also gives u DKA triggers! (Same triggers apply for Hyperosmolar Hyperglycemic Syndrome (HHS))
The critical triggers ( always rule these out) :
S – Sepsis (UTI,Pneumonias are common – CXR might not show an infiltrate initially due to dehydration)
S – STEMI (a way to remember AMI/ACS)
S – Stroke
S – SIRS from Trauma, Pancreatitis, burns, etc
The less critical triggers: (should be obvious from history)
S – Stopped / Skipped insulin: Most common cause, either due to unaffordability, depression, or stopping when not eating from nausea or when are starting to get an infection
S – Surgery (Never ever stop insulin in DM Type 1 completely even if NPO for surgery, give half the basal dose instead)
S – Steroids Including steroid injections in joints
S – SGLT-2 inhibitors and some other meds you can easily Google
S – Subcutaneous Insulin pump malfunction (Insulin pump device failure or the pump needle may have bent under skin, accidentally resulting in skipped insulin)
S – Substance abuse ( Alcohol, Cocaine)
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