Diabetic Ketoacidosis (DKA) is preventable, why is it so common in kids with newly diagnosed diabetes?

Spot the warning signs that could save your child’s life…

Every week, paediatric endocrinologist Dr Gary Leong sees children who have been hospitalised in intensive care with diabetic ketoacidosis (DKA), a serious and life-threatening complication of diabetes. DKA can cause difficulty breathing, swelling in the brain and loss of consciousness—not to mention the stress and anxiety for parents when their child is so sick.

DKA can happen to anyone with diabetes, but it is much more common in people with type 1 diabetes, which is an autoimmune disease that attacks and destroys the insulin-producing cells in the pancreas.

Unlike type 2 diabetes, type 1 diabetes can’t be prevented—and about three-quarters of cases are diagnosed in children.

But while the disease itself can’t be prevented, DKA can.

Yet, 30-40% of children who are newly diagnosed with diabetes have DKA. These children and their families only find out they have diabetes after experiencing a medical emergency.

Dr Leong says this is far too common, particularly in children ages 2-5, and parents need to know the signs. That’s the aim of the DKA “4T” prevention program.

“During Covid we have had many children present late with new diagnosis of type 1 diabetes despite them seeing their GP many times who missed the diagnosis, especially in younger children”, he says.

What causes DKA?

DKA is metabolic problem caused by lack of insulin. Insulin is a hormone that plays a crucial role in moving blood sugar (glucose) into the cells so it can be used as fuel. If the body doesn’t produce/have insulin and can’t use glucose, it starts breaking down fat for its energy instead. This creates ketones, which are chemicals, and these build up in the blood, essentially poisoning the body. This is diabetic ketoacidosis, or DKA.

Earlier diagnosis of type 1 diabetes is the key

When diabetes is well-managed, DKA doesn’t develop. The problem is that many cases aren’t diagnosed until these potentially life-threatening symptoms of DKA occur.

If parents are aware of the subtle signs of high blood sugar, they can get help before it progresses to DKA.

What are the warning signs of Type 1 Diabetes?

Keep in mind the 4 Ts—which is a simple way to recognise early signs and symptoms of diabetes:

• Thirsty: Is your child drinking a lot, but always thirsty?
• Toilet: Is your child urinating a lot? Especially if starting to wet the bed or waking at night to go to the toilet
• Thinner: Is your child losing weight recently?
• Tired: Does your child get plenty of sleep, but is still tired?

If your child is experiencing one or more of these symptoms, see a GP immediately and request a finger-prick blood glucose test. In some cases, they may need a urine test as well.

It’s important to tell your doctor the symptoms, and request the finger prick test, since GPs sometimes miss the diagnosis, too.

If the child blood glucose level on the finger prick is high (> 11.0 mmol/L) they have diabetes.

What to expect if your child has type 1 diabetes

The good news is, once a diagnosis is made and treatment is started, children with type 1 diabetes can thrive. There’s an adjustment period where you’ll need to learn how to manage and monitor glucose levels, but new technology is now available to make this easier.

“There’s nothing diabetes could stop you from doing—playing your sports, doing your swimming, or your athletics or basketball or netball”, Dr Leong says. “You can still win an Olympic medal, you can still become the prime minister, you can still win the Nobel laureate”.

For more on the DKA Prevention Program and to hear real life stories of children living full lives with diabetes, check out this video.

Feature image by Los Muertos Crew from Pexels