Awareness and First Aid
A hot day, a tough workout or not drinking enough water can make you feel thirsty. But if you’re very thirsty all the time, especially accompanied by other symptoms, it could be a sign of a more serious health problem.
One possible cause of excessive thirst is diabetic ketoacidosis (DKA), a potentially life-threatening complication of diabetes that needs urgent medical treatment, says Vinny Pillay, an Emergency Care Practitioner (ECP) at ER24 Durban. Spotting the warning signs early is crucial.
What is diabetic ketoacidosis?
DKA occurs when your body doesn’t have enough insulin to move glucose from the bloodstream into the cells, where it’s used for energy. “As a result, your body begins breaking down fat for fuel, producing acidic substances called ketones," explains Pillay. "When ketones build up in your bloodstream, they cause the blood to become dangerously acidic."
At the same time, your blood sugar levels rise, and your body loses large amounts of fluid, creating a dangerous combination that can quickly become life-threatening.
“DKA is a medical emergency because it can rapidly lead to severe dehydration, electrolyte imbalances, organ dysfunction, loss of consciousness – and, if left untreated, death,” warns Pillay.
Why does DKA make you so thirsty?
Excessive thirst is one of the hallmarks of DKA.
When blood glucose levels become too high, your kidneys try to remove excess sugar through your urine. This causes you to urinate more often and lose more fluid. This can dehydrate you and make you feel thirsty all the time.
But Pillay says thirst is usually not the only warning sign. “DKA is usually associated with a combination of symptoms,” he explains.
Warning signs to look out for
DKA symptoms can develop over a relatively short time and get worse quickly without treatment. Common signs are:
- Excessive thirst
- Needing to urinate often
- Dry mouth
- Feeling tired or weak
- Nausea and vomiting
- Abdominal pain
- Unexplained weight loss
- High blood sugar levels
- Breath that smells fruity or like acetone e.g., nail polish remover
- Rapid, deep breathing
- Feeling confused, drowsy, or not like yourself.
"If excessive thirst occurs alongside these symptoms, particularly in someone with diabetes or a family history of diabetes, seek medical attention at once," advises Pillay.
Can DKA happen before a diabetes diagnosis?
Many people think DKA only affects those who already know they have diabetes, but that’s not always true.
“DKA is often the first symptom of type 1 diabetes and may sometimes occur in people with previously undiagnosed type 2 diabetes,” explains Pillay.
For some people, symptoms such as excessive thirst, frequent urination, unexplained weight loss, and fatigue may be the first signs that they have diabetes.
That’s why it’s important not to ignore ongoing symptoms, even if you’ve never been diagnosed with the condition.
Who is most at risk?
People living with type 1 diabetes face the highest risk of developing DKA.
However, some factors can make the condition more likely to occur:
- Newly diagnosed diabetes
- Missed insulin doses
- Respiratory or urinary tract infections
- Severe illness
- Physical or emotional stress
- Heart attacks or strokes
- Trauma or surgery
- Some medicines that affect glucose control.
Illnesses and infections are particularly common triggers because they place extra stress on your body and can make blood sugar levels more difficult to manage.
When should you call for emergency help?
DKA should always be treated as a serious medical condition, and any of these symptoms mean you need medical care right away, says Pillay:
- Difficulty breathing
- Severe dehydration
- Persistent vomiting
- Extreme weakness
- Confusion or disorientation
- Reduced responsiveness
- Loss of consciousness.
What should you do if you suspect DKA?
If you suspect DKA, don’t wait to see if symptoms improve before seeking medical help. If blood glucose or ketone testing equipment is available, check their levels while waiting for help. If the person is conscious and able to swallow safely, encourage them to drink fluids.
Most importantly, don’t try to manage severe symptoms at home. Seek medical help as soon as possible. “Getting help early can save a person’s life,” says Pillay.
How ER24 paramedics can help
When ER24 paramedics respond to a suspected DKA emergency, their priority is to assess the patient, stabilise them, and transport them to an appropriate medical facility, confirms Pillay.
The medics will monitor vital signs, check blood glucose levels, assess hydration status, and monitor the patient's level of consciousness.
Treatment can involve intravenous access, fluid resuscitation, possible oxygen therapy and ongoing monitoring during transport.
Reducing your risk
There are practical steps people living with diabetes can take to lower their risk of developing DKA:
- Take insulin and medication as prescribed
- Monitor your blood glucose levels regularly
- Follow your healthcare provider’s sick-day plan
- Test ketones when your blood sugar levels remain high or during illness
- Stay hydrated
- Seek medical advice early when unwell
- Attend regular follow-up appointments.
“Education, adhering to treatment and early intervention are the most effective strategies for preventing DKA,” says Pillay.
It’s easy to ignore feeling very thirsty, especially when you’re busy or the weather is hot. But if you’re also urinating often, feeling tired, feeling sick, have stomach pain, or are losing weight without trying, get medical help. These symptoms could point to a medical emergency.
Diabetic ketoacidosis can develop rapidly and become life-threatening without prompt treatment. Knowing the warning signs and acting quickly could save someone’s life.