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Is Ketoacidosis Reversible

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Id: 64: Reversible Blindness Associated With Diabetic Ketoacidosis: A Rare Combination

Introduction A wide spectrum of ocular diseases is associated with diabetes mellitus (DM) and most of them lead to gradual loss of vision that is almost always irreversible. Sudden vision loss in severe diabetic ketoacidosis (DKA) that is reversible with treatment of the metabolic abnormality is a very rare complication that has been reported three times previously. Case Presentation A 59 year-old male with Type 1 DM presented with altered consciousness, epigastric pain, hypothermia and sudden complete bilateral vision loss for three days. He was not complaint with insulin. There was no history or laboratory evidence of ethanol, methanol, ethylene glycol ingestion, head trauma, baseline vision problem, cold or intense bright light exposure. Physical examination revealed rapid shallow breathing at 55/min, blood pressure 90/60 mm Hg, heart rate 102/min and temperature 90.2F. He was oriented only to place,pupils were dilated and non-reactive to light. No light perception in both eyes. Fundoscopy was normal without any evidence of retinal pallor, retinal detachment, retinal hemorrhages, papilledema or cataract. Labs revealed blood glucose 1100 mg/dl, pH 6.95,positive serum and urine ke Continue reading >>

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  1. Michael Simpson

    Diabetic ketoacidosis (the formal name, and the one most diabetics use, abbreviating it as DKA) can happen in Type 2 diabetics, but as you implied it is rare.
    Type 1 diabetics totally lack or have insufficient amounts of insulin. So the body produces the antagonistic hormone, glucagon, because there's no insulin, which to the body means there's low glucose. Glucagon then induces the liver to use fat as energy, producing ketone bodies while also forcing the liver to convert glycogen to glucose. Unfortunately, the blood glucose levels are high because the Type 1 Diabetic has no insulin. This causes the blood osmolarity to skyrocket, and the kidneys try to compensate by removing ketones and glucose from the blood.
    Since the kidneys have a maximum capacity to clear excess glucose from the blood, the blood becomes more acidotic and ketone bodies rise at the same time. And that leads to more serious issues like coma and death.
    The feedback systems are all broken, so the body spins out of control. It is often the first sign of Type 1 diabetes.
    So the one difference between Type 1 and Type 2 diabetics is that Type 1 has no insulin, but Type 2 generally has insulin in the blood to suppress the release of glucagon. And this is why it's rare in Type 2 diabetics.

  2. Liang-Hai Sie

    We need insulin to be able to utilize glucose, type 2 has some insulin, not enough because of the insulin resistance, type 1 don't, so in type one ketosis can develop because the lack of insulin causes the body to burn fat that forms ketones if no inslin is administered. I knew a man who every time he was arrested by intent "forgot" to inject his insulin so ended in hospital with a keto-aciditic diabetic coma, out of jail.

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