help me clarify DKA, hyper and hypoglycemia

Published

when cells don't get glucose d/t no insulin, our body burns fat. I know that. For some reason I linked hyperglycemia and DKA together before. But, cells not getting glucose has nothing to do with hyper or hypoglycemia, right? It doesn't matter how much or how little I have glucose in my blood, if my cells ain't getting any of that glucose, my fat will start burning, right?

Up Vote Up Vote ×
Specializes in Critical Care.

Hypo/hyperglycemia refer explicitly to the serum blood state and amount of available blood glucose. It is either defined as too high (hyper), too low (hypo), or normal (euglycemia).

DKA is a state where the blood sugar becomes too high (hyper) in mostly Type 1 (IDDM) diabetics. Since their is complete failure for the pancreatic B-cells to produce any insulin.

There is no insulin to move that large amount of sugar from the blood to the cells, so the cells cannot under go their normal metabolic functions, thus they undergo anaerobic metabolism to sustain themselves which includes ketogenesis which is the break down of fatty acids into ketone bodies for cellular respiration and metabolism since there is no glucose for making ATP.

Ketones are not excreted as readily and can build up, and since they are an acid (keto-acid) they can manifest in a patient as ketone induced metabolic acidosis.

In short DKA is a manifestation of uncontrolled hyperglycemia usually presenting in IDDM patients.

Up Vote Up Vote ×

Mrmedical, thank you for your input. However, that is the way I thought before- "DKA is a state where the blood sugar becomes too high (hyper)." But here is what made me wonder about that logic... The reason body starts metabolizing fat is because the cells aren't getting sugar. But the cells aren't getting sugar in both situations; hyper (in type 1) or hypoglycemia. Why doesn't hypoglycemia cause fat metabolizing?

Up Vote Up Vote ×
Specializes in Emergency, Telemetry, Transplant.
Mrmedical, thank you for your input. However, that is the way I thought before- "DKA is a state where the blood sugar becomes too high (hyper)." But here is what made me wonder about that logic... The reason body starts metabolizing fat is because the cells aren't getting sugar. But the cells aren't getting sugar in both situations; hyper (in type 1) or hypoglycemia. Why doesn't hypoglycemia cause fat metabolizing?

Because hypoglycemia will cause death before the body has a chance to begin metabolizing fat for energy. It's pretty much impossible to write a thorough summary of DKA in an AN post.

There's a lot more that goes into a DKA dx than just blood sugar level, and its tx. is rather complex. Now, there is quite a bit I don't know about it, but it is interesting subject to learn more about.

Up Vote Up Vote ×

Your best bet is go back to your physiology book.

Up Vote Up Vote ×
Specializes in ER, progressive care.
Mrmedical, thank you for your input. However, that is the way I thought before- "DKA is a state where the blood sugar becomes too high (hyper)." But here is what made me wonder about that logic... The reason body starts metabolizing fat is because the cells aren't getting sugar. But the cells aren't getting sugar in both situations; hyper (in type 1) or hypoglycemia. Why doesn't hypoglycemia cause fat metabolizing?

Plus fat metabolism is slower than carb metabolism, yes? That's why with a hypoglycemic patient you do a rescue intervention - typically 15gm of carb then you recheck the blood sugar in 15 min. Or you may give 1/2 amp or 1 amp of D50W IV if the patient is NPO or something.

Also, as psu_213 mentioned, DKA simply isn't just a "high blood sugar."

Up Vote Up Vote ×

so what you are saying what psu_213 is saying- with hypoglycemia, DKA is not a concern because the person will die from hypoglycemia before the DKA happens. Is that correct?

Up Vote Up Vote ×
+ Join the Discussion