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Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible fo Continue reading >>

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Popular Questions

  1. celeste03

    Ketones and weight loss

    Good morning! I've been a type 1 since I was 8 (I am 32 now) and I've always had ups and downs with weight. I've had ketones when losing weight before - and I've never gotten good answers from my doctors. They panic or think my blood tests are wrong (usually normal numbers with ketones) or tell me to eat more. I am around 275 pounds now (after losing 15 pounds) so I need to lose weight.
    I have a pump and a CGM (average bg on the cgm is around 128). Since starting the Cgm (a couple months ago) I rarely go above 200. My worst spikes are around 180.
    Last night, my blood sugar was around 72 before bed. That is lower than I want before bedtime so I had half a pack of fruit snacks. Usually my bg is very stable overnight so I wasn't worried. Around 1am I had an alarm that there was an impending low. I suspended the pump (temp basal for an hour). After an hour, it woke me up and my bg was around 65. So this time it auto suspended. I still wasn't concerned because the rate it fell wasn't quick and I thoight ok just have the pump suspend and it will fix itself (my normal rate overnight is 1.4u/hr). I know my basal rate is fine because every other night it's a flat line. I had some xtra exersize last night which I think was the issue. Anyway I did confirm the low with a meter.
    When I woke up around 5, I felt like my sugar was high. I did not feel good. The sensor said 117. My meter said 123. I felt high. So I checked for ketones. The color was at least moderate (40mg/dl)
    I know I had ketones because my pump was off for about 3 hours. But during this time my blood sugar never rose above 125. I confirmed the sensor with a finger poke so I know my blood sugar was fine. So my guess is they were starvation ketones. However, I have beeen eating carbs through the day. Not as many as I used to - but I am not low carbing.
    Are ketones like that (with symptoms) cause for concern with normal bg? Does it put me at more of a risk if my blood sugar were to rise? I'm just really.... frustrated and don't know what to do. I need to lose weight.
    My diet right now is a modified shake diet. I have a shake (ideal shake) for breakfast and maybe one more time a day if I'm hungry instead of snacking. I mix the shake with a banana and almond milk. Lunch is usually a lean protein and 2 vegetable servings. Dinner is usually similar, but I may have a piece of bread or half a roll. I am not calorie counting. I've done that before and i get burned out. I'm basically just trying to avoid high calorie density foods and eat vegetables when I am hungry. Or shakes (which have carbs). It's working so far - so I'm planning on keeping with it. If it stops working I'll do something more rigid like weight watchers or calorie counting. I'm not interested in anything where I have to cut entire foods out. I ate 1 cheese breadstick one night when the family got pizza. I want to be able to still have small indulgences sometimes . So paleo/atkins/etc are not an option.

  2. Jennifer72

    Do you own a copy of Dr. Bernstein's Diabetes Solution and Blood Sugar 101 by Jenny Ruhl?

  3. MarkM

    Having ketones just means that you are using fat for energy. Low carbers make ketones because they get most of their calories from fat. People losing weight make ketones because stored fat is used for energy. Ketones are a by-product of the process. Blood glucose does not need to be high for this to happen.
    If blood glucose is high, ketones are most likely because there is not enough circulation insulin for glucose to be metabolised. Blood glucose goes very high and the body switches to burning fat for energy. If too many ketones are produced because of this energy crisis, the blood becomes acidic. What they call diabetic ketoacidosis (DKA).
    Don't confuse normal ketosis with DKA. Ketosis is a useful and harmless process. Especially if you need to lose weight. As long as your insulin levels are adequate, you won't go into DKA.

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