It’s been a while since a young man in his 20s came to the Ebersberg intensive care unit. He was very dizzy, and at the beginning he sometimes couldn’t speak at all. One of the first tests we do in such cases is a blood gas analysis. Among other things, blood sugar is measured. With this patient it was clear: his was way too high and the pH of the blood was acidic. Actually, he was supposed to be slightly alkaline – that’s why the man had fallen into a state of so-called ketoacidosis.
Ketoacidosis means that the blood is too acidic due to high blood sugar levels. If nothing is done about it, it can lead to death. Typically, ketoacidosis occurs with type 1 diabetes – when the body no longer produces any insulin at all. If those affected then forget to inject insulin, the blood sugar level rises. Because only with the help of insulin can sugar, which is obtained from food or fat reserves, be directed into body cells and utilized there. Incidentally, the situation is different with type 2 diabetes: although the body produces insulin, it has become resistant to it, meaning that less sugar is used than is necessary. However, ketoacidosis is very rare in this type.
Every one to two months we have a case of ketoacidosis in the Ebersberger district clinic, which is not that rare. It is often the case that those affected previously knew nothing about their diabetes. It was the same with our young patient. His ketoacidosis led to the initial diagnosis of diabetes.
Intensive care specialist Pola Gülberg from the Ebersberger district clinic.
(Photo: Peter Hinz-Rosin)
But even if the diabetes is known, ketoacidosis occurs from time to time. Typically, for example, when a party weekend with a lot of alcohol or other drugs is behind the person concerned: In the intoxication, the insulin injection is simply forgotten.
What many do not know: there are signs long before unconsciousness that indicate rising blood sugar, such as an immense feeling of thirst. It is not a problem for those affected to drink up to 15 liters a day. For comparison: A quantity of two to three liters is usually recommended – and most people can’t even manage that. So if you’re suddenly drinking two, three, or four times your normal amount of fluids, stop and ask yourself, “Huh, what’s going on here?” – and then quickly off to the family doctor.
When ketoacidosis is more advanced, the intensive care unit comes into play. In these cases, we closely monitor the blood sugar level while slowly administering insulin – under no circumstances should this be done too quickly, the body would not be able to do it. It usually takes at least 24 hours for everything to be back on track. It was the same with the young man: after a good day and after being informed about his diabetes, he was able to leave the clinic again.
Pola Gülberg is an intensive care nurse. In this column, the 38-year-old talks about her work at the district clinic in Ebersberg every week. The collected texts are below sueddeutsche.de/thema/Auf Station to find.