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 (excerpted from Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin by Gary Scheiner MS, CDE, DaCapo Press, 2011)

Diabetic Ketoacidosis (DKA) is a condition in which the blood becomes highly acidic as a result of dehydration and excessive ketone (acid) production. When bodily fluids become acidic, some of the body’s systems stop functioning properly. It is a serious condition that will make you violently ill and it can kill you.

The primary cause of DKA is a lack of working insulin in the body. Most of the body’s cells burn primarily sugar (glucose) for energy. Many cells also burn fat, but in much smaller amounts. Glucose happens to be a very “clean” form of energy—there are virtually no waste products left over when you burn it up. Fat, on the other hand, is a “dirty” source of energy. When fat is burned, there are waste products produced. These waste products are called “ketones.” Ketones are acid molecules that can pollute the bloodstream and affect the body’s delicate pH balance if produced in large quantities. Luckily, we don’t tend to burn huge amounts of fat at one time, and the ketones that are produced can be broken down during the process of glucose metabolism. Glucose and ketones can “jump into the fire” together.

It is important to have an ample supply of glucose in the body’s cells. That requires two things: sugar (glucose) in the bloodstream, and insulin to shuttle the sugar into the cells. A number of things would start to go wrong if you have no insulin in the bloodstream:

  1. Without insulin, glucose cannot get into the body’s cells.
  2. As a result, the cells begin burning large amounts of fat for energy.
  3. This, of course, leads to the production of large amounts of ketones.
  4. Although some of the ketones eventually spill over into the urine, the body is unable to eliminate sufficient amounts to restore a healthy pH balance in the bloodstream.

The problem is further complicated by dehydration. Without sufficient insulin to inhibit the liver’s secretion of sugar, large amounts of glucose are released into the bloodstream. Because high blood sugar causes excessive urination, dehydration ensues. Without glucose metabolism to help break down the ketones, and without ample fluids to help neutralize the ketones, the bloodstream and tissues of the body become very acidic. This is a state of ketoacidosis.

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