Diabetic Ketoacidosis becoming a growing concern in the sub-Saharan region: Its awareness, diagnosis, and treatment

Diabetic Ketoacidosis (DKA) has become a growing concern amongst the adult and children community of the Sub-Saharan region. With mortality rates growing as high as 29% in Africa, DKA is gaining momentum due to ranging factors in the continent. 

DKA happens when the cells of a person’s body do not get enough glucose to provide energy and the body starts burning fat for energy. This process produces ketones, which works as an alternative fuel for the body. Ketones are the chemicals that are created in the liver when the body breaks down fat. It happens when the body does not have sufficient insulin to use glucose which is the normal source of energy for the body. At lower concentrations, ketones are not harmful, but when they are produced at a higher concentration, they build up in the blood and make it acidic. This acid build-up makes the body dangerously dehydrated. This condition is called diabetic ketoacidosis. 

Diabetic Ketoacidosis is found to be common in people with Type 1 diabetes and less common in Type 2 diabetes. DKA can cause diabetic coma or even death of the patient, which is one of the rising factors behind mortality rates in Africa. 

Diabetic Ketoacidosis is a case of insulin deficiency in the body. The carbohydrate in the food that people eat is broken down into sugar, also called glucose. This glucose enters the bloodstream and further into the cells with the help of insulin. 

In the case of Type 1 diabetic person, insulin production is not enough that causes an uncontrolled flow of glucose in the bloodstream. Hence, Type 1 diabetic daily insulin injections become vital. In case a person’s body does not have enough insulin, the body cells cannot use the glucose for energy. To make up for the loss of energy, the liver produces ketones. These ketones give energy to the body for some time, but for a long time and at higher concentrations, ketones can be dangerous to health.

DKA is now considered to be encompassing many risk factors in Africa which makes the people become more vigilant about the issue. These factors include a former diagnosis with diabetes, or the patient tends to miss the insulin dose frequently. It can also be associated with the patient is taking a dosage that is different as prescribed by the doctor, a chronic illness, the recent case of stroke, trauma, surgery or pregnancy, use of immunosuppressants like steroids, a history of drug abuse, or suffering from any infections.

Diabetic ketoacidosis symptoms usually start with a change in the patient’s breathing patterns. As the ketone level in the blood rises, the breathing becomes slow and deep. It is accompanied by a lot of other alarming signs such as excessive and unusual thirst, frequent need to urinate, the mouth becoming dry showing signs of dehydration, skin getting pale or becomes unusually cool, blood sugar level spikes, feeling of Nausea or Vomiting, concentration power gets blurred and, the patient develops confusion, abdominal pain, headache, high fever, muscle pain, shortness of breath along with fruity odour and excessive fatigue

DKA treatment to the patient must be quick and should be allowed only by a licenced medical doctor. The patient with diabetic ketoacidosis would require some emergency Ketoacidosis treatment or in some cases would be shifted to the intensive care unit (ICU). The emergency treatment in the hospital includes Intravenous fluids (IV) for dehydration and insulin that lowers the patient’s blood sugar level and ketones. Once the patient’s condition improves, the fluids are given orally. The treatment also incorporates regular monitoring by a medical professional who checks the patient’s blood sugar and acid levels for any fluctuations, electrolyte treatment to ensure the vital organs of the patient starts functioning normally. In this treatment, potassium, sodium, chloride is given to the patient through IV which makes sure the body receives a normal supply of minerals. Further evaluation by the doctor in case there is some infection or any other risk.

The patient is likely to develop serious complications if there is a delay in diabetic ketoacidosis treatment. The decision of discharging the patient with DKA is solely on the doctor upon thoroughly investigating the patient’s vitals.

How Can the people of Africa prevent diabetic ketoacidosis as their increasing health hazard?

Type 1 diabetes patients should consider their health a priority and must adopt some measures to prevent DKA. A diabetic patient must always take their diabetes medications including insulin on time and as prescribed by the licenced medical doctor. Patients should never skip a meal. They should plan small meals in a gap of 2-3 hours instead of three heavy meals. Keeping full ensures controlled blood sugar level and protects from the risk of DKA. Diabetic people should test their blood sugar levels regularly. If possible, they can maintain a chart that will identify fluctuations in their blood sugar level. In case of regular blood sugar level fluctuations, they must visit a doctor. They should stay hydrated with water since diabetic ketoacidosis is followed by dehydration. They should keep away from canned drinks and alcohol.

Diabetic people should stay active by engaging themselves in physical exercises which includes walking, playing sports or yoga, must check their insulin for any leakage or expiry. It is vital for diabetic people to keep themselves stress-free. Stress is a leading cause of health disorders, and it can trigger blood sugar levels to rise. A diabetic person must maintain a healthy diet. They can consult a dietician who can lay down a diet plan according to their health condition.

Diabetic ketoacidosis is increasingly becoming a fatal health condition in Africa but, when treated on time with the right medication, it can be prevented.