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Diabetic Ketoacidosis
DKA, as described previously results from an insulin deficiency. The decreased use of insulin prompts the release of fatty acids and the production of ketones by the liver.
DKA may be the presenting symptom in individuals previously undiagnosed with Type 1. DKA is likely seen in Type 1 diabetics if they have not received enough insulin during times of illness. Type 2 diabetics may experience DKA if they are very ill and not able to eat sufficient calories. Other factors include overeating and physical inactivity. Annual incidence rates rage from 3 to 8 persons per 1,000. It is more common in Type 1 diabetics than in individuals diagnosed with Type 2. Mortality rates range from less than 5% to 14%. (19)
Prevention of DKA is possible by following prescribed daily therapeutic regimen. Frequent blood glucose monitoring can alert the diabetic to changes in blood glucose level.
DKA usually occurs when blood glucose levels are over 240mg/dL. When the blood glucose is at this level, type 1 diabetics should consult their physician. Dental treatment should be deferred until the individual's hyperglycemia is under control. In later stages, patients suffering from DKA may present with rapid, deep respiration (Kussmaul's respiration) and acetone breath. Individuals should be transported immediately to the hospital for care and treatment. If this condition continues the patient will become increasingly ill, possibly resulting in diabetic coma (3,19,35,48)
Because it may not be possible to differentiate between a hypoglycemic and hyperglycemic episode, treatment protocol should follow that of hypoglycemia. Patients with hypoglycemia decline more rapidly and the condition can become life threatening more quickly. If the diagnosis is incorrect administration of glucose will not significantly worsen an acute hyperglycemic episode. (35)
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Hyperosmolar Syndrome
