diabetestalk.net

How Does Diabetic Ketoacidosis Occur?

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys f Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Diabetic Coma Recovery: What You Need To Know

Diabetic Coma Recovery: What You Need To Know

In people with diabetes, a diabetic coma occurs when severe levels of either high or low uncontrolled blood sugar are not corrected. If treated quickly, a person will make a rapid recovery from a diabetic coma. However, diabetic coma can be fatal or result in brain damage. It is important for people with diabetes to control their blood sugars and know what to do when their blood sugar levels are not within their target range. The severe symptoms of uncontrolled blood sugar that can come before a diabetic coma include vomiting, difficulty breathing, confusion, weakness, and dizziness. Recovery from diabetic coma If a diabetic coma is not treated within a couple of hours of it developing, it can cause irreversible brain damage. If no treatment is received, a diabetic coma will be fatal. In addition, having blood sugar levels that continue to be too low or too high can be bad for long-term health. This remains true even if they do not develop into diabetic coma. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range. Doing so will also reduce the risk of associated complications and diabetic coma. What is diabetes? Diabetes is a long-term condition in which the body is unable to control the level of a sugar called glucose in the blood. Diabetes is caused by either a lack of insulin, the body's inability to use insulin correctly, or both. In people who don't have diabetes, insulin usually ensures that excess glucose is removed from the bloodstream. It does this by stimulating cells to absorb the glucose they need for energy from the blood. Insulin also causes any remaining glucose to be stored in the liver as a substance called glycogen. The production of insul Continue reading >>

Acute Complications Of Diabetes - Diabetic Ketoacidosis

Acute Complications Of Diabetes - Diabetic Ketoacidosis

- [Voiceover] Oftentimes we think of diabetes mellitus as a chronic disease that causes serious complications over a long period of time if it's not treated properly. However, the acute complications of diabetes mellitus are often the most serious, and can be potentially even life threatening. Let's discuss one of the acute complications of diabetes, known as diabetic ketoacidosis, or DKA for short, which can occur in individuals with type 1 diabetes. Now recall that type 1 diabetes is an autoimmune disorder. And as such, there's an autoimmune destruction of the beta cells in the pancreas, which prevents the pancreas from producing and secreting insulin. Therefore, there is an absolute insulin deficiency in type 1 diabetes. But what exactly does this mean for the body? To get a better understanding, let's think about insulin requirements as a balancing act with energy needs. Now the goal here is to keep the balance in balance. As the energy requirements of the body go up, insulin is needed to take the glucose out of the blood and store it throughout the body. Normally in individuals without type 1 diabetes, the pancreas is able to produce enough insulin to keep up with any amount of energy requirement. But how does this change is someone has type 1 diabetes? Well since their pancreas cannot produces as much insulin, they have an absolute insulin deficiency. Now for day-to-day activities, this may not actually cause any problems, because the small amount of insulin that is produced is able to compensate and keep the balance in balance. However, over time, as type 1 diabetes worsens, and less insulin is able to be produced, then the balance becomes slightly unequal. And this results in the sub-acute or mild symptoms of type 1 diabetes such as fatigue, because the body isn Continue reading >>

Diabetic Ketoacidosis In Type 2 Diabetics: A Novel Presentation Of Pancreatic Adenocarcinoma

Diabetic Ketoacidosis In Type 2 Diabetics: A Novel Presentation Of Pancreatic Adenocarcinoma

Case Description A 75-year-old woman with a 15-year history of type 2 diabetes mellitus, hypertension, hypercholesterolemia, and gastroesophageal reflux disease was admitted with confusion and vomiting. Three days prior to admission, her family noted that she was intermittently confused, had occasional vomiting episodes, and had refused to eat. There was no history of polyuria, polydipsia or diarrhea. For two months prior to admission, she reported a 10–15 pound weight loss, suprapubic discomfort, anorexia and malaise. An upper endoscopy showed changes consistent with Barrett’s esophagus. Colonoscopy and abdominal CT were scheduled but not completed prior to admission. Her diabetes had been well controlled (HbA1c 6–7%) while taking oral hypoglycemic agents (metformin, glipizide and pioglitazone) for several years. One year prior to admission, her primary care physician noted that her blood sugar was elevated despite being adherent to her medications. Insulin (Levemir) was added 6 months later, but adequate glucose control was not achieved. She did not have a history of gallstones or pancreatitis. She was a non-smoker, non-drinker, and she lived alone. She had no family history of diabetes mellitus. On presentation to the emergency room, she was lethargic. Blood pressure was 167/98 mmHg, heart rate 97 beats per minute, respiratory rate 18 breaths per minute and oxygen saturation 97% on room air. She had dry mucous membranes and decreased skin turgor. Breath sounds were present and equal bilaterally, without crackles or wheezes. Heart sounds were normal with a systolic ejection murmur at the left sternal border. Her abdomen was soft and non-distended, with mild suprapubic tenderness, no masses, and normal bowel sounds. On neurological examination, the patient was di Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complications of untreated diabetes. In this complication, severely insufficient insulin levels in the body results into high blood sugar that leads to the production and buildup of ketones in the blood. These ketones are slightly acidic, and large amounts of them can lead to ketoacidosis. If remained untreated, the condition leads to diabetic coma and may be fatal. Diabetic ketoacidosis (DKA) gets triggered by a stressful event on the body, such as an illness or severe lack of insulin. DKA is more common in people with type 1 diabetes. In some cases, identification of DKA is the first indication that a person has diabetes. Early Sluggish and extreme tiredness Fruity smell to breath (like acetone) Extreme thirst, despite large fluid intake Constant urination/bedwetting Extreme weight loss Presence of Oral Thrush or yeast infections that fail to go away Muscle wasting Agitation / Irritation / Aggression / Confusion Late At this stage, Diabetic ketoacidosis reaches a life-threatening level: Vomiting. Although this can be a sign of hyperglycemia and isn't always a late-stage sign, it can occur with or without ketoacidosis. Confusion Abdominal pain Loss of appetite Flu-like symptoms Unconsciousness (diabetic coma) Being lethargic and apathetic Extreme weakness Kussmaul breathing (air hunger). In this condition, patients breathe more deeply and/or more rapidly The major risk factors accelerating on set of diabetic ketoacidosis include the following: Diabetes mellitus: Type 1 diabetics are at a higher risk of DKA, because they must rely on outside insulin sources for survival. DKA can occur in patients with type 2, particularly in obese children. Age: DKA may occur at any age, but younger people below 19 years of age are more susceptib Continue reading >>

Diabetic Ketoacidosis: Maintaining Glucose Control

Diabetic Ketoacidosis: Maintaining Glucose Control

The metabolic chain reaction that precedes diabetic ketoacidosis can occur rapidly, and this potentially life-threatening condition requires swift recognition and treatment. Two critical words in a diabetic’s vocabulary are “management” and “control.” When a patient with diabetes fails to manage food intake and loses control of blood sugar levels, hyperglycemia follows. In most cases, blood sugar levels elevate slightly, which prompts the individual with diabetes to take action to lower those levels. Under some conditions, blood sugar rises precipitously, which is usually caused by 1 or more of the following1-3 : • Developing or fulminant infection (especially Klebsiella pneumonia) or illness • Serious disruption of insulin treatment • New onset of diabetes • Physical or emotional stress • Adverse drug reaction (especially to corticosteroids, pentamidine, thiazides, sympathomimetics, or secondgeneration antipsychotics4 ) Acute, life-threatening diabetic ketoacidosis (DKA) can develop rapidly. Table 11,2 describes criteria usually used to define DKA. We typically associate this metabolic abnormality with type 1 diabetes, but it also occurs in some patients with type 2 diabetes, with infection or an adverse drug reaction as the primary causes. As blood sugar rises in DKA, the patient becomes dehydrated and metabolic changes produce acidosis.1,2,4,5 Pathophysiology DKA usually occurs when absolute or relative insulin deficiency leads to increased counter-regulatory hormones (ie, glucagon, cortisol, growth hormone, epinephrine). These hormones enhance hepatic glucose production (gluconeogenesis), glycogenolysis, and lipolysis, all of which increase free fatty acids (FFAs) in circulation. With insulin unavailable, the liver turns to FFAs as an alternative Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What is Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) is the hallmark of type 1 (insulin-dependent) diabetes mellitus. DKA is an emergency condition caused by a disturbance in your body’s metabolism. Extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Statistics on Diabetic Ketoacidosis Diabetic ketoacidosis can occur in between 16%-80% of children presenting with newly diagnosed diabetes. It remains the most common cause of death for young type 1 diabetes sufferers. Before the discovery of insulin, mortality rates were up to 100%. Today, the mortality has fallen to around 2% due to early identification and treatment. Death is usually caused by cerebral oedema (swelling of the brain). DKA is most common in type 1 diabetes sufferers but may also occur in those with type 2 diabetes mellitus. However, the latter group usually has at least some functioning insulin so suffer from another disorder called hyperosmolar non-ketotic coma (HONK). DKA tends to occur in individuals younger than 19 years, the more brittle of type 1 diabetic patients. However, DKA can affect diabetic patients of any age or sex. Risk Factors for Diabetic Ketoacidosis People with diabetes lack sufficient insulin, a hormone the body uses to metabolise glucose (a simple sugar) for energy. Therefore in diabetic patients glucose is not available as a fuel, so the body turns to fat stores for energy. However when fats are broken down they produce byproducts called ketones which build up in the blood and can be damaging to the body. In particular, accumulated ketones can “spill” over into the urine and make the blood become more acidic than body tissues (ketoacidosis). Blood gl Continue reading >>

Diabetic Coma

Diabetic Coma

The three types of diabetic coma include diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. Diabetic coma is a medical emergency and needs prompt medical treatment. Uncontrolled blood glucose levels may lead to hyperglycaemia or hypoglycaemia. Low or persistently high blood glucose levels mean your diabetes treatment needs to be adjusted. Speak to your doctor or registered diabetes healthcare professional. Prevention is always the best strategy. If it is a while since you have had diabetes education, make an appointment with your diabetes educator for a review. On this page: Diabetes mellitus is a condition characterised by high blood glucose (sugar) levels. Uncontrolled diabetes may lead to a diabetic coma or unconsciousness. The three types of coma associated with diabetes are diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. Diabetic ketoacidosis coma Diabetic ketoacidosis typically occurs in people with type 1 diabetes, which was previously known as juvenile diabetes or insulin dependent diabetes mellitus (IDDM), though it can occasionally occur in type 2 diabetes. This type of coma is triggered by the build-up of chemicals called ketones. Ketones are strongly acidic and cause the blood to become too acidic. When there is not enough insulin circulating, the body cannot use glucose for energy. Instead, fat is broken down and then converted to ketones in the liver. The ketones can build up excessively when insulin levels remain too low. Common causes of ketoacidosis include a missed dose of insulin or an acute infection in a person with type 1 diabetes. Ketoacidosis may be the first sign that a person has developed type 1 diabetes. Symptoms of ketoacidosis Symptoms of ketoacidosis are: extreme thirst lethargy frequent urination ( Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

The Scary Experience Of Diabetic Ketoacidosis

The Scary Experience Of Diabetic Ketoacidosis

Today, we’re excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company’s philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it. Throughout this past year, I’ve had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much. In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.) Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. – and I thought it was 11:00 a.m. The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walke Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>

Ketones & Insulin Pumps

Ketones & Insulin Pumps

Check for ketones if you have the following: There is a higher risk for developing ketones on pump therapy. This is because long-acting insulins are not used, and rapid-acting insulin is delivered in extremely small amounts. If this basal insulin delivery is interrupted for more than an hour, check your blood sugar and ketones. If you continue to not get insulin, blood glucose and ketone levels may increase into a dangerous range. See also Acute: Diabetic ketoacidosis (DKA). Insulin pump-related ketone buildup may be caused by: Site problem Air in tubing (resulting in missed insulin) Extended pump suspension or disconnection (for more than one to two hours) Pump malfunction Insulin leakage (at insertion site or infusion set connection site) Illness or infection Vomiting or dehydration Severe emotional stress “Spoiled” insulin Ketones checklist The presence of ketones while using an insulin pump can indicate a serious medical emergency. Check for ketones if you have: An unexplained elevation in your blood sugar Persistently elevated blood sugars Symptoms of nausea or vomiting This is because you want to be sure you are not developing diabetic ketoacidosis. Remember that ketoacidosis occurs more commonly in pump users. Here’s what you should do. Use the mnemonic KISS. K – Check for Ketones I – Give Insulin by Injection (using an insulin pen or syringe – not through the pump) S – Change the infusion Set S – Check blood Sugar If ketones are positive, you need to obtain emergency medical care. Treating ketones If you have elevated ketones, insulin replacement must be delivered via an injection with an insulin pen or insulin syringe instead of the pump because the pump or infusion set may be malfunctioning and causing ketones to develop. Remember! Ketoacidosis Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin deficiency, and the action of counter-regulatory hormones, blood glucose increases leading to hyperglycemia and glucosuria. Glucosuria causes an osmotic diuresis, leading to water & Na loss. In the absence of insulin activity the body fails to utilize glucose as fuel and uses fats instead. This leads to ketosis. Pathophysiology/2 The excess of ketone bodies will cause metabolic acidosis, the later is also aggravated by Lactic acidosis caused by dehydration & poor tissue perfusion. Vomiting due to an ileus, plus increased insensible water losses due to tachypnea will worsen the state of dehydr Continue reading >>

Diabetes With Ketone Bodies In Cats

Diabetes With Ketone Bodies In Cats

Diabetes Mellitus with Ketoacidosis in Cats The term “ketoacidosis” refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies.” Meanwhile, diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. Typically, the type of condition affects older cats; in addition, female cats are more prone diabetes with ketoacidosis than males. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the cat's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your cat’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azotemia), low sodium levels Continue reading >>

More in diabetes