Treatment for DKA must be done in consultation with a doctor or medical team, most often in a hospital setting. For mild cases, fluid supplementations and extra insulin injections are needed approximately every 3 hours until ketones in the urine have either disappeared or fallen to low levels. Blood glucose and ketone levels should also be closely monitored during this period.
Dehydration will only make the progression of DKA worse, so it's important to maintain a steady intake of fluids.
For moderate to severe cases of DKA, hospitalization with fluid and electrolyte replacement is required. Blood glucose and acid levels will be monitored frequently and electrolytes such as potassium brought back into balance. Urine output will be monitored until your vital signs (temperature, pulse, breathing, blood pressure) are normal. Appropriate medications will be used if it was an infection that triggered the episode of DKA.
Even with careful attention to insulin treatment, ketone levels may still go up once in a while. Missing even a single insulin injection can also lead to tissue "starvation," fat metabolism, and ketone accumulation. People are especially susceptible when they're ill.
Rarely, with over-rapid rehydration, swelling of the brain can occur. This is called cerebral edema, and is often fatal.
The most important prevention strategies are to monitor blood glucose levels routinely, keep blood glucose levels controlled (e.g., following a treatment plan as recommended by your health care provider), and to detect ketones early on. When blood glucose levels exceed 14 mmol/L, or during a bout of illness, people with diabetes should test their urine or blood at least twice a day for ketones. This way, excess ketones can be dealt with quickly, before the symptoms of DKA progress and worsen.
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