Diabetic Ketoacidosis
A serious complication of diabetes involving dangerously high blood sugar, dehydration, and accumulation of ketone bodies (acids) in the blood. DKA is primarily a type 1 diabetes emergency but can occur in type 2. Glucagon may worsen DKA and is generally contraindicated in this setting.
Technical Context
DKA pathophysiology: absolute or relative insulin deficiency → unrestrained lipolysis → hepatic ketogenesis → metabolic acidosis (pH <7.3, bicarbonate <18 mmol/L) with hyperglycaemia (usually >250 mg/dL) and ketonuria/ketonaemia. Treatment: IV insulin infusion, aggressive fluid replacement, electrolyte monitoring (especially potassium), and identification/treatment of precipitating factors. Glucagon is generally contraindicated in DKA because it stimulates hepatic glucose output and ketogenesis, potentially worsening the metabolic crisis. GLP-1 RAs: there are case reports of euglycaemic DKA (DKA with near-normal glucose levels) in patients on SGLT2 inhibitors, which are sometimes used alongside GLP-1 RAs. Clinicians should be aware of this possibility in patients on combination metabolic therapy.