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Diabetic Ketoacidosis: Risk Factors And Management Strategies

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Diabetes Mellitus: The Increasing Burden Of Disease In Kenya.

Diabetes Mellitus: The Increasing Burden Of Disease In Kenya.

Diabetes Mellitus: the increasing burden of disease in Kenya. TLJ Medical Student, University of Birmingham, UK. [emailprotected] Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus is the 4th main contributor [1]. It is characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, action or both [2]. There are three main types: type 1 (TIDM) (10%), 2 (TIIDM) (85%) or gestational (5%)[3] affecting 347 million people [4]. There were about 1.3 million deaths in 2008 [4] predicted to increase to over 2 million by 2030 [1]. The burden of diabetes is disproportionately high in low-middle income countries [5,6]. Kenya has a heavy disease burden with an average life expectancy of 56 years [7]. The main challenge arises from communicable diseases (CDs) (e.g.malaria and HIV [7,8]) accounting for about 62% of deaths [9]. Despite successes to control CDs [8], health status has stagnated due partly to the increase of NCDs [8,10] causing 28% of all deaths in 2010; diabetes accounted for 2% of this [7,9]. The World Health Organization (WHO) estimates that the prevalence of diabetes in Kenya at 3.3% [3,8,11] and predicts a rise to 4.5% by 2025 [12]. However, two-thirds of diabetics may be undiagnosed [10,11]. The double demand from CDs and NCDs has hindered Kenyas progress towards achieving the Millennium Development Goals (MDGs) [8]. It is therefore necessary to assess the increasing burden of diabetes and provide cost-effective strategies for its prevention and control. The funding, structure and administration of a health service is key to achieving success. Kenyas healthcare system is financed predominantly through private sources [13]. Private businesse Continue reading >>

Management Of Diabetic Ketoacidosis In Adults

Management Of Diabetic Ketoacidosis In Adults

Diabetic ketoacidosis is a potentially life-threatening complication of diabetes, making it a medical emergency. Nurses need to know how to identify and manage it and how to maintain electrolyte balance Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

, Volume 2, Issue2 , pp 95108 | Cite as Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections. DKA is reported to be responsible for more than 100 000 hospital admissions per year in the US, and accounts for 49% of all hospital discharge summaries among patients with diabetes. Treatment of patients with DKA uses significant healthcare resources and accounts for 1 out of every 4 healthcare dollars spent on direct medical care for adult patients with type 1 diabetes in the US. Recent studies using standardized written guidelines for therapy have demonstrated a mortality rate of less than 5%, with higher mortality rates observed in elderly patients and those with concomitant life-threatening illnesses. Worldwide, infection is the most common precipitating cause for DKA, occurring in 3050% of cases. Urinary tract infection and pneumonia account for the majority of infections. Other precipitating causes are intercurrent illnesses (i.e., surgery, trauma, myocardial ischemia, pancreatitis), psychological stress, and non-compliance with insulin therapy. The triad of uncontrolled hyperglycemia, metabolic acidosis and increased total body ketone concentration characterizes DKA. These metabolic derangements result from the combination of absolute or relative insulin deficiency and increased levels of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). Successful treatment of DKA requires frequent monitoring of patients, correction of hypovolemia and hyperglycemia, replacement of electrolyte losses, and careful search Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management

Type 1 Diabetes In Adults: Diagnosis And Management

This guideline refers frequently to circulating glucose concentrations as 'blood glucose'. A lot of the evidence linking specific circulating glucose concentrations with particular outcomes uses 'plasma' rather than 'blood' glucose. In addition, patient‑held glucose meters and monitoring systems are all calibrated to plasma glucose equivalents. However, the term 'blood glucose monitoring' is in very common use, so in this guideline we use the term 'blood glucose', except when referring to specific concentration values. 1.1 Diagnosis and early care plan 1.1.1 Diagnose type 1 diabetes on clinical grounds in adults presenting with hyperglycaemia, bearing in mind that people with type 1 diabetes typically (but not always) have one or more of: 1.1.2 Do not discount a diagnosis of type 1 diabetes if an adult presents with a BMI of 25 kg/m2 or above or is aged 50 years or above. [new 2015] 1.1.3 Do not measure C‑peptide and/or diabetes‑specific autoantibody titres routinely to confirm type 1 diabetes in adults. [new 2015] 1.1.4 Consider further investigation in adults that involves measurement of C‑peptide and/or diabetes‑specific autoantibody titres if: type 1 diabetes is suspected but the clinical presentation includes some atypical features (for example, age 50 years or above, BMI of 25 kg/m2 or above, slow evolution of hyperglycaemia or long prodrome) or type 1 diabetes has been diagnosed and treatment started but there is a clinical suspicion that the person may have a monogenic form of diabetes, and C‑peptide and/or autoantibody testing may guide the use of genetic testing or classification is uncertain, and confirming type 1 diabetes would have implications for availability of therapy (for example, continuous subcutaneous insulin infusion [CSII or 'insulin p Continue reading >>

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis

Acute Kidney Injury In Children With Type 1 Diabetes Hospitalized For Diabetic Ketoacidosis

Questions What proportion of pediatric patients with type 1 diabetes who present in diabetic ketoacidosis develop acute kidney injury, and what are the associated risk factors? Findings In this medical record review of 165 children with type 1 diabetes who were hospitalized for diabetic ketoacidosis, 106 (64.2%) met the criteria for acute kidney injury. Serum bicarbonate level less than 10 mEq/L and an elevated heart rate were found to be associated with an increased risk of severe acute kidney injury. Meaning Children in diabetic ketoacidosis are at high risk for acute kidney injury, suggesting that clinicians should consider acute kidney injury as a frequent complication in this population. Importance Acute kidney injury (AKI) in children is associated with poor short-term and long-term health outcomes; however, the frequency of AKI in children hospitalized for diabetic ketoacidosis (DKA) has not been previously examined. Objectives To determine the proportion of children hospitalized for DKA who develop AKI and to identify the associated clinical and biochemical markers of AKI. Design, Setting, and Participants This medical record review of all DKA admissions from September 1, 2008, through December 31, 2013, was conducted at British Columbia Children’s Hospital, the tertiary pediatric hospital in British Columbia, Canada. Children aged 18 years or younger with type 1 diabetes and DKA and with complete medical records available for data analysis were included (n = 165). All data collection occurred between September 8, 2014, and June 26, 2015. Data analysis took place from August 25, 2015, to June 8, 2016. Main Outcomes and Measures Acute kidney injury was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. Multinomial logistic regress Continue reading >>

Type 1 Diabetes Mellitus Treatment & Management

Type 1 Diabetes Mellitus Treatment & Management

Approach Considerations Patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Long-term management requires a multidisciplinary approach that includes physicians, nurses, dietitians, and selected specialists. In some patients, the onset of type 1 DM is marked by an episode of diabetic ketoacidosis (DKA) but is followed by a symptom-free “honeymoon period” in which the symptoms remit and the patient requires little or no insulin. This remission is caused by a partial return of endogenous insulin secretion, and it may last for several weeks or months (sometimes for as long as 1-2 years). Ultimately, however, the disease recurs, and patients require insulin therapy. Often, the patient with new-onset type 1 DM who presents with mild manifestations and who is judged to be compliant can begin insulin therapy as an outpatient. However, this approach requires close follow-up and the ability to provide immediate and thorough education about the use of insulin; the signs, symptoms, and treatment of hypoglycemia; and the need to self-monitor blood glucose levels. The American Diabetes Association (ADA) recommends using patient age as one consideration in the establishment of glycemic goals, with targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels. [5] In 2014, the ADA released a position statement on the diagnosis and management of type 1 diabetes in all age groups. The statement includes a new pediatric glycemic control target of HbA1c of less than 7.5% across all pediatric age groups, replacing earlier guidelines that specified different glycemic control targets by age. The adult HbA1c target of les Continue reading >>

Diabetes: Preventing Complications

Diabetes: Preventing Complications

Diabetes complications can be divided into two types: acute (sudden) and chronic (long-term). This article discusses these complications and strategies to prevent the complications from occurring in the first place. Acute complications Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) Acute complications of diabetes can occur at any time in the course of the disease. Chronic complications Cardiovascular: Heart disease, peripheral vascular disease, stroke Eye: Diabetic retinopathy, cataracts, glaucoma Nerve damage: Neuropathy Kidney damage: Nephropathy Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis. Basic principles of prevention of diabetes complications: Take your medications (pills and/or insulin) as prescribed by your doctor. Monitor your blood sugars closely. Follow a sensible diet. Do not skip meals. Exercise regularly. See your doctor regularly to monitor for complications. Results from untreated hyperglycemia. Blood sugars typically range from 300 to 600. Occurs mostly in patients with Type 1 diabetes (uncommon in Type 2). Occurs due to a lack of insulin. Body breaks down its own fat for energy, and ketones appear in the urine and blood. Develops over several hours. Can cause coma and even death. Typically requires hospitalization. Nausea, vomiting Abdominal pain Drowsiness, lethargy (fatigue) Deep, rapid breathing Increased thirst Fruity-smelling breath Dehydration Inadequate insulin administration (not getting Continue reading >>

Incidence Of Diabetic Ketoacidosis Among Patients With Type 2 Diabetes Mellitus Treated With Sglt2 Inhibitors And Other Antihyperglycemic Agents

Incidence Of Diabetic Ketoacidosis Among Patients With Type 2 Diabetes Mellitus Treated With Sglt2 Inhibitors And Other Antihyperglycemic Agents

Jump to Section 1. Introduction Diabetic ketoacidosis (DKA) is a serious, acute metabolic complication of diabetes characterized by absolute or relative insulin deficiency [[1], [2]], with an overall mortality rate of up to 5% in experienced healthcare centers [3]. Insulin deficiency, increased insulin counter-regulatory hormones (cortisol, glucagon, growth hormone, and catecholamines) and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance, which underlie the pathophysiology of DKA [2]. While DKA is a commonly recognized vulnerability in autoimmune diabetes, stressful conditions such as trauma, surgery, or infection also increase DKA risk in patients with type 2 diabetes mellitus [4]. In fact, studies have reported that patients with type 2 diabetes accounted for 12–56% of the DKA cases, had longer hospital stays, and higher mortality (which possibly was due to advanced age and comorbidities) than patients with type 1 diabetes [[3], [5]]. Sodium glucose co-transporter 2 inhibitors (SGLT2i’s) are a new class of oral antihyperglycemic agents (AHA) that lower blood glucose through an insulin-independent mechanism, by suppressing renal glucose reabsorption and increasing urinary glucose excretion [6]. Currently, 3 SGLT2i’s have been approved in the US and Europe for the treatment of type 2diabetes: canagliflozin, dapagliflozin, and empagliflozin (initial approval March 29, 2013, January 8, 2014, August 1, 2014 in the US, November 15, 2013, November 12, 2012, May 22, 2014 in Europe, respectively). By mid-2015, based on spontaneous adverse event reports, the US Food and Drug Administration and the European Medicines Agency [7] had both issued statements that medicines in the SGLT2i class of drugs may be associated with a Continue reading >>

Comparison Of Diabetic Ketoacidosis In Patients With Type-1 And Type-2 Diabetes Mellitus

Comparison Of Diabetic Ketoacidosis In Patients With Type-1 And Type-2 Diabetes Mellitus

Background Diabetic ketoacidosis (DKA) occurs most often in patients with type 1 diabetes, however patients with type 2 diabetes are also susceptible to DKA under stressful conditions. The aims of our study were to evaluate and compare the clinical and biochemical characteristics and outcomes of type 1 versus type 2 diabetes mellitus (DM) patients with DKA. Methods A retrospective cohort study of adult patients hospitalized with DKA between January 1, 2003, and January 1, 2010. The clinical and biochemical characteristics of DKA patients with type-1 DM were compared with those of patients with type-2 DM. The primary outcome was in-hospital all-cause mortality. Results The study cohort included 201 consecutive patients for whom the admission diagnosis was DKA: 166 patients (82.6%) with type-1 DM and 35 patients (17.4%) with type-2 DM. The patients with DKA and type-2 DM were significantly older than patients with type-1 DM (64.3 versus 37.3, P < 0.001). Significantly more patients with severe forms of DKA were seen in the group with type-2 DM (25.7% versus 9.0%, P=0.018). The total in-hospital mortality rate of patients with DKA was 4.5%. The primary outcome was significantly worse in the group of patients with type-2 DM. Conclusions DKA in patients with type-2 DM is a more severe disease with worse outcomes compared with type-1 DM. Advanced age, mechanical ventilation and bed-ridden state were independent predictors of 30-day mortality. Continue reading >>

Precipitating Factors, Outcomes, And Recurrence Of Diabetic Ketoacidosis At A University Hospital In Damascus Alourfi Z, Homsi H - Avicenna J Med

Precipitating Factors, Outcomes, And Recurrence Of Diabetic Ketoacidosis At A University Hospital In Damascus Alourfi Z, Homsi H - Avicenna J Med

Diabetic ketoacidosis (DKA) is one of the acute metabolic complications of diabetes mellitus (DM) which is fatal if not accurately treated. Its biochemical characteristics are hyperglycemia, ketonemia, and academia. [1] While DKA annual incidence is estimated between 4.6 and 8 episodes per 1,000 patient admissions with diabetes in the US population-based studies, [2] it is unknown in developing countries. [3] According to The Center for Disease Control and Prevention (CDC) - National Diabetes Surveillance Program, hospital discharges with DKA as the first-listed diagnosis increased from about 80,000 discharges in 1988 to about 140,000 in 2009. [4] However, mortality rate of DKA have fallen significantly in the last 20 years from 7.96% to 0.67% as reported by Lin et al. [5] ; but in developing countries, it is still high. [6] DKA occurs mainly in type 1 DM patients. However, type 2 DM patients might develop DKA under severe stress or illness with metabolic decompensation. [7] Inadequate insulin therapy and infection are the most common DKA precipitating factors. Other factors, including underlying medical conditions (such as myocardial infarction, stroke, pancreatitis, and trauma), provoke the release of counter-regulatory hormones and might result in DKA. Another reason which may participate in DKA is carbohydrate metabolism affecting drugs such as corticosteroids. [8] , [9] , [10] DKA patients can be managed either in the intensive care unit (ICU) or in the general medical ward. The decision where to manage DKA patients should be based on the local availability of hospital resources, the severity of DKA, and patients' comorbidities. [11] The aim of this work was to study precipitating factors, outcome, and recurrence of DKA during 7 years in one of Damascus University Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

Diabetic Ketoacidosis Linked To Higher Risk For Aki In Youth

Diabetic Ketoacidosis Linked To Higher Risk For Aki In Youth

High rates of acute kidney injury (AKI) were reported among youth in the hospital for diabetic ketoacidosis (DKA), researchers reported. A low serum bicarbonate level (<10 mEq/L) among hospitalized children with type 1 diabetes and DKA was associated with a significant increase in the risk for stage 2 or 3 AKI (aOR 5.22; 95% CI; 1.35-20.22), according to Brenden E. Hursh, MD, of the University of British Columbia, and colleagues. In the study, published in JAMA Pediatrics, stage 1 acute kidney injury for children with DKA was also linked to an initial corrected sodium level of 145 mEq/L or more (aOR 3.29; 1.25-8.66). Using a multinomial logistic regression model, the researchers also reported a linear relationship between heart rate and severe AKI, with a 22% increase in risk for AKI associated with each increase of five beats per minute in initial heart rate (aOR 1.22; 1.07-1.39). In an interview with MedPage Today, the senior author, Constadina Panagiotopoulos, MD, also of the University of British Columbia, noted, "While I thought we would detect more cases of AKI than that previously represented by the two isolated case reports in the literature, I was surprised by the high proportion -- 64.2% -- of AKI in pediatric DKA documented in our study." The team explained that they predicted that the risk level of hospitalized children with DKA is actually higher than previous case studies have reported, and therefore aimed to identify a more accurate depiction of AKI rates for this high-risk population. Panagiotopoulos said that inspired by a lack of large-scale, systematic studies regarding AKI in youth with DKA when caring for patients affected, the researchers "decided to conduct this study to better understand the magnitude of the problem and any associated risk factor Continue reading >>

Frequency Of Ketoacidosis In Newly Diagnosed Type 1 Diabetic Children

Frequency Of Ketoacidosis In Newly Diagnosed Type 1 Diabetic Children

ABSTRACT Objectives:Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). Many patients with newly diagnosed type 1 diabetes present with DKA. The aim of this study is to determine the frequency and the clinical presentation of diabetic ketoacidosis at the diagnosis of type 1 diabetes mellitus in youths in hamadan, Western Province of Iran. Methods:The Clinical and laboratory data of a total of 200 patients under 19 years of age with newly diagnosed type 1 diabetes mellitus between 1995-2005 were retrospectively reviewed. Statistical analysis was performed using SPSS 11. Results:48 (24%)of the children were presented in a state of ketoacidosis. Sever form of DKA (pH≤7.2) was observed in 54.5% of patients. The mean age at diagnosis was 7.3±5.15 years in DKA group and 8.59±3.07 in non-DKA group (p=0.22). 60.4% of patient with DKA were female whereas in the non-DKA group, 53.3% of patients were female, the difference was not significant (p=0.38). The duration of symptoms before diagnosis was 14.84±8.19 days in patients with DKA and 22.39±2.27 in the non-DKA group, (p=0.11). No significant difference was found between the age, sex and duration of the symptoms and occurance of DKA. Polydipsia (85.4) polyuria (83.3%), weakness (68.8%) and abdominal pain (52.1%) were the most frequently notified symptoms among the patients. In two cases, diagnosis of DKA was preceded by as appendicitis and the patient underwent appendectomy. Conclusion: Frequency of DKA at onset of type 1 diabetes mellitus was significant in the studied region. However, it was lower than other regions in Asia. Polydipsia, polyuria, fatigue and abdominal pain were the most common symptoms on presentation. From the Department of Pediat Continue reading >>

Management Of Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar State In Adults

Management Of Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar State In Adults

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes associated with high mortality rate if not efficiently and effectively treated. Both entities are characterized by insulinopenia, hyperglycemia and dehydration. DKA and HHS are two serious complications of diabetes associated with significant mortality and a high healthcare costs. The overall DKA mortality in the US is less than 1%, but a rate higher than 5% is reported in the elderly and in patients with concomitant life-threatening illnesses. Mortality in patients with HHS is reported between 5% and 16%, which is about 10 times higher than the mortality in patients with DKA. Objectives of management include restoration circulatory volume and tissue perfusion, resolution of hyperglycemia, correction of electrolyte imbalance and increased ketogenesis. Continue reading >>

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