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What Is Diabetes Sickness?

Intractable Nausea And Vomiting Associated With Poor Glycaemic Control In A Patient With Type 1 Diabetes

Intractable Nausea And Vomiting Associated With Poor Glycaemic Control In A Patient With Type 1 Diabetes

A 54 year old woman with type 1 diabetes was referred to the diabetes clinic with a four year history of nausea, early satiety, abdominal pain, and intermittent vomiting. In recent months she had experienced intractable nausea and vomiting, requiring frequent admission to hospital. Her glycaemic control was poor, with blood glucose readings in the high teens and frequent severe hypoglycaemic episodes after meals, when she needed help. She has had diabetes for 45 years, complicated by diabetic retinopathy, peripheral neuropathy, and nephropathy. She has had chronic back pain and depression. She was taking insulin glulisine (quick acting insulin) 15 units with meals and insulin glargine (long acting insulin) 26 units at bedtime. Her other drugs included lansoprazole, atorvastatin, zopiclone, gabapentin, metoclopramide (short term), zomorph, and lactulose. She weighed 68.6 kg and her body mass index was 28 kg/m2. Her blood pressure was 129/78 mm Hg, with no postural drop. Her injection sites were normal and systemic examination unremarkable. Her glycated haemoglobin (HbA1c) was 11.6% (103 mmol/mol), sodium 133 mmol/L (reference range 133-146), potassium 4.9 mmol/L (3.5-5.3), urea 12.3 mmol/L (2.5-7.8), creatinine 113 µmol/L (60-120), estimated glomerular filtration rate 65 mL/min/1.73 m2 (90-120), and blood glucose 19.3 mmol/L (3.3-6.0). Haemoglobin was 145 g/L (115-165), white cell count 12.1×109/L (4.0-11.0), and platelets 251×109/L (140-400). An upper gastrointestinal endoscopy six months ago found no obstruction or ulceration but showed residual food in the stomach after an eight hour fast (fig 1⇓). An ultrasound scan of the abdomen was normal. Continue reading >>

Diabetes Safety First! Recognizing And Preventing Low Blood Sugar

Diabetes Safety First! Recognizing And Preventing Low Blood Sugar

Blood glucose (sugar) goes up and down in a small range throughout the day. In people with diabetes, the range can be much wider. It is important to understand the fine balance between treating the high sugars and avoiding the low sugars. If you have diabetes and take certain diabetes drugs or insulin, you may experience low blood sugar (hypoglycemia [hy-po-gly-SEE-me-uh]) from time to time. Hypoglycemia is a blood sugar of less than 70 mg/dL. However, some people have symptoms of low blood sugar even at higher blood sugar levels. This can happen when blood sugar is dropping too quickly or if the person has had very high blood sugars for a long time. Severe hypoglycemia means the person needs someone to treat them, which is a very serious condition! Even mild hypoglycemia symptoms are hard on your body and on your emotions. By learning more about the signs and causes of low blood sugar, you can take steps to keep it from happening again. Frequent low blood sugars are serious because the body becomes less able to show the warning signals of a low blood sugar. The blood sugar can then fall to dangerously low levels. What causes low blood sugar and what are the symptoms? Low blood sugar is usually caused by eating less or later than usual, changing your physical activity or taking a diabetes medicine that is not right for your needs. Even mistakes in dosing can lead to hypoglycemia. For example, you could mistake one insulin for another or forget that you had already taken your diabetes pills! A recent large study showed that the most common causes of hypoglycemia were smaller than usual food intake, delay in eating, or skipping a meal. Common symptoms of low blood sugar are: Feeling dizzy, shaky, or lightheaded Feeling nervous or anxious Having a fast heart beat Sweating Continue reading >>

Altitude And Type 1 Diabetes

Altitude And Type 1 Diabetes

As you may already know, travel in general can have a big impact on Type 1 diabetes management. This is typically due to elements such as stress hormones, time change and other shifts in routine that can cause blood sugar levels to behave differently. However, there are other things to consider when taking trips or exploring the outdoors that might not occur to us right away – such as changes in altitude. The most important thing to remember when planning to journey some place at a higher altitude is that nobody is affected the same way, so it is best to be prepared for multiple outcomes. Altitude sickness By far the most common side effect of being at high altitudes is altitude sickness, which can then lead to (or simulate) other symptoms that can affect T1D management. Common symptoms of altitude sickness include: shortness of breath rapid heartbeat nausea exhaustion All of this is due to the decrease in oxygen, but these symptoms are also common when suffering from hypoglycemia (low blood sugar!). So it is important to test blood sugar levels often to distinguish between the two. Blood sugar levels Hypoglycemia – There is no direct evidence that altitude causes low blood sugar, but as previously mentioned, altitude symptoms can feel quite similar. Also, increased exercise (if hiking or walking a lot while in high altitudes), can definitely lead to lows. Hyperglycemia – Traveling, exercising and managing T1D when out in the elements can cause a good deal of stress. Stress hormones lead to high blood sugar. Insulin resistance There have been studies that suggest that higher altitudes can cause insulin resistance due to carbohydrates not being metabolized as effectively. This can be another cause of high blood sugar and it can also lead to ketones/ketoacidosis in Continue reading >>

Diabetes: Symptoms, Causes And Treatments

Diabetes: Symptoms, Causes And Treatments

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Here are some key points about diabetes. More detail and supporting information is in the main article. Diabetes is a long-term condition that causes high blood sugar levels. In 2013 it was estimated that over 382 million people throughout the world had diabetes (Williams textbook of endocrinology). Type 1 Diabetes - the body does not produce insulin. Approximately 10% of all diabetes cases are type 1. Type 2 Diabetes - the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type. Gestational Diabetes - this type affects females during pregnancy. The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet. If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life. Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels. As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly. As smoking might have a serious effect on c Continue reading >>

What Is

What Is "diabetic Stomach"?

My niece takes an oral medicine for diabetes. At least once a week, she throws up at night. The doctor calls it "diabetic stomach." I have never heard of this, and I have had diabetes for 36 years. What could be the cause of her stomach problems, and what foods may be causing flare-ups? Continue reading >>

Sickness

Sickness

You might need to manage your type 1 diabetes a bit differently when you're sick If you are ill with the flu or a serious bacterial infection, your body will make and release stress hormones. These hormones can trigger a release of stored glucose from your liver. On these days your body will need significantly more insulin. It’s really important that your checking your blood glucose levels more when you’re sick, so you have the right amount on insulin. Too little insulin and your body will start to burn fat as an alternative energy source, producing ketones which can build up and make you even more unwell. In fact, this situation can be life-threatening. You are less likely to produce stress hormones if you have a gastro-type bug. In this case your blood glucose levels are more likely to be low because you’re not eating or not absorbing the food that you are eating – the food is going straight through you. There are other illnesses, such as chicken pox, that seem to have little or no effect on your blood glucose. The impact of illness is very much dependent on the illness you have, and can differ each time. If your blood glucose levels rise, you are more at risk of producing ketones. Ketones are acids and, as the levels of ketones rise, you may feel very unwell and could lead to vomiting, abdominal pain and shortness of breath. The build up of ketones could also prevent other areas of your body from working properly, especially if the condition is left untreated, and could lead to a coma in extreme cases. What to do when you’re unwell You therefore need to monitor your blood glucose and ketone levels to decide if you need more insulin. It’s the absence or presence, and level, of ketones which should determine how you manage your sickness and type 1 diabetes, Continue reading >>

Everyday Illness And Type-1 Diabetes

Everyday Illness And Type-1 Diabetes

A minor illness can result in a major rise in blood glucose levels. This will increase the amount of insulin you need to keep blood glucose levels within the target range. If the blood glucose levels remain high for several hours the body will start to produce ketones. Ketones are toxic, and if they build up to moderate to high levels, a life threatening condition called diabetic ketoacidosis (DKA) can develop (see symptoms of DKA below). Careful monitoring of blood glucose and ketone levels and adjusting your insulin accordingly should help to keep you out of hospital. At the earliest sign of any illness such as a cold or virus, it is important for you to take action. Start following a Sick Day Action Plan immediately if: You are unwell or have any signs of illness even if your blood glucose levels are normal Your blood glucose levels are greater than 15mmol/L for 6 hours or more, even if you are feeling OK There are ketones in your urine or blood You may have reasons for implementing the action plan earlier, such as how your body reacts to infections or how tightly controlled your blood glucose levels are. You should discuss this with your diabetes team. Sick Day Action Plan – What to do – Six Steps Managing your blood glucose levels when you are feeling unwell can be difficult. Phone your doctor or diabetes team early so they can help you manage the situation and assess the underlying illness. If you are not feeling well enough to be constantly testing your blood glucose levels, try to organise someone to stay with you to provide support. Check your blood glucose levels more frequently – this is the only way to monitor the effect of illness on diabetes. If your blood glucose levels are above 15mmol/L (for more than six hours or earlier if advised by your diabet Continue reading >>

Gastrointestinal Complications Of Diabetes

Gastrointestinal Complications Of Diabetes

Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications. Clinical recommendation Evidence rating References Initial work-up for gastroparesis should include a complete history and physical examination, along with pertin Continue reading >>

Diabetes Sick Or Illness

Diabetes Sick Or Illness

Ads by Google Getting sick is scary and especially when you or a loved one has diabetes. During sickness, your body tries to fight off infection, thus raise is cortisol hormone. Which in turn causes rapid and dangerously high blood glucose level. Additionally, when you are not able to keep down fluids or even eat, this causes you to go too low blood glucose level. Any illness among a diabetes individual can make their blood-glucose level to fluctuate. During illness, do not try to stop taking your diabetes pills or insulin even if you cannot eat as normal. Even your doctor recommend you to take extra insulin when you are sick. Pay close attention to your blood glucose levels - Check your blood glucose every two to four hours and record it. If your blood sugar remains high or getting too low, then consult healthcare professional at your earliest. Test for the presence of ketones - Type 1 diabetes whose blood glucose level over 250 mg/dl when left untreated leads to ketoacidosis, a dangerous condition develops due to the burning of fat for energy instead of glucose. So you should test the presence of ketones in the urine. Keep taking your diabetes medicines/insulin, even if you cannot keep food down. Don't avoid medication/insulin – It is quite natural for you to think to avoid medicine during illness, because you may have a fear of going low blood glucose due to eating less. But stress hormones are usually high during an illness that needs extra medicine than usual. An exception is if you are on metformin with dehydration that can affect kidney function. In such a case, ask your doctor whether you can discontinue metformin. You should avoid dehydration by drinking a glass of water or herbal tea every hour. If you are vomiting or diarrhea then drink broth that contains Continue reading >>

Vomiting In Diabetic Cats

Vomiting In Diabetic Cats

It’s not difficult to recognize the more common diabetes symptoms in cats. They drink a lot of water, urinate more frequently and lose weight. Treatment of diabetes involves regular injections of insulin to keep blood glucose levels within normal limits. Vomiting isn’t one of the most common feline symptoms of this disease. Having said that, if a cat is being treated for feline diabetes, vomiting is definitely something to watch out for. It can indicate that their blood glucose is not being well controlled, and they may be developing diabetic ketoacidosis. This is a potentially fatal condition that needs urgent veterinary treatment. However, if a diabetic cat starts throwing up, it doesn’t necessarily mean that their diabetes is worsening. Other symptoms of diabetic ketoacidosis to look for are increased thirst, loss of appetite and extreme lethargy. Another reason for diabetic vomiting in cats is pancreatitis. This condition can be hard to diagnose in our feline family members but should always be considered when cat vomiting in a diabetic pet becomes a problem. Some veterinarians believe that up to one half of all cases of diabetes in cats are accompanied by a low grade chronic inflammation of the pancreas. When they have a flare up, it can reduce their appetite and make them vomit. They need to be closely monitored until they recover because the change in their food intake will affect the amount of insulin they need. Don’t forget that there are many other cat vomiting causes that are totally unrelated to diabetes. Some examples include gastroenteritis, kidney disease and inflammatory bowel disease. Because a diabetic cat has an underlying chronic medical condition, any illness will need a thorough investigation including comprehensive blood tests and possibly Continue reading >>

Diabetes In Babies

Diabetes In Babies

What is diabetes in a baby? Diabetes is a chronic disease that affects the body’s ability to process blood sugar. There are two subtypes of diabetes: type 1 and type 2. Type 1, sometimes called juvenile diabetes, is the kind that affects babies and toddlers. The exact cause of type 1 diabetes is not known, but it is believed that the body destroys the cells that normally make insulin, a hormone that keeps blood sugar levels in check. Because the body can’t make insulin (or adequate amounts of insulin), blood sugar levels can skyrocket, causing damage to the organs of the body — but only if left unchecked. If blood sugar levels are well-controlled, though, your child’s risk of organ damage is low. Today, type 1 diabetes is considered a manageable, chronic condition. “Having diabetes does not mean that your child can’t play sports or join any clubs or activities when she’s older. It doesn’t mean that she won’t be able to have babies,” says Natasha Burgert, MD, FAAP, pediatrician at Pediatric Associates in Kansas City, Missouri. “They can fully participate in all of the usual major life milestones.” What are the symptoms of diabetes in babies? Weight loss is often the first symptom of diabetes in young children. “Weight is a vital sign in infants, and kids who have type 1 diabetes will be eating regularly, perhaps even more than average, but will be unable to gain weight,” Burgert says. Unexplained vomiting may also be a symptom of diabetes. When a child’s blood sugar rises (because there’s not enough insulin in the body to keep it under control), she may throw up increasing amounts over a three- or four-day period for no apparent reason. If your child has been vomiting, but has no other symptoms of stomach illness, such as a fever or diarrh Continue reading >>

Sick Days

Sick Days

When you’re unwell, you need to take extra care. As a person with diabetes, when you are sick your body’s increased production of stress hormones will cause your blood glucose levels to rise. Make sure you keep a list of contact numbers for your doctor, Credentialled Diabetes Educator, hospital and ambulance by the phone. If possible, have a friend or relative come and regularly check on you. You can also see our information sheets on sick days with type 1 type 2 diabetes in our Publications and Resources section. When you’re sick, you should continue to take your usual dose of insulin. Never stop taking or reduce your insulin dose. Sometimes when you are sick you may need more insulin or extra doses of insulin. Contact your doctor or Credentialled Diabetes Educator if your illness lasts for more than one day, or if you vomit more than three times in a day, to discuss whether your insulin needs to be changed. Eat according to how you feel and what food you can tolerate. If you can’t eat your usual meals, make sure you have small low-fat snacks at regular intervals throughout the day (for example, toast, crackers, boiled rice, soup, low-fat custard or ice-cream). If you can’t eat food, have sips of fluid every few minutes. Include carbohydrate drinks (such as fruit juice or lemonade) if your blood glucose level is below 15 mmol/L or unsweetened fluids (such as soda water or diet lemonade) if your blood glucose level is above 15 mmol/L. High blood glucose levels, vomiting and diarrhoea can all lead to dehydration. You will need to drink more, but it is important what you should drink, based on your blood glucose levels. If your blood sugar level is more than 15 mmol/L then you should drink unsweetened fluids like water, clear soups, weak tea, or diet lemonade. I Continue reading >>

Diabetes

Diabetes

Additional information on Diabetes Monitoring Approximately 3.5 million people in the UK have been diagnosed as diabetic, around 10% of whom have Type 1 diabetes. There is no conclusive proof that those travelling with diabetes are more likely to become unwell during travel than those without diabetes. However, a change in diet, activity levels and environment (temperature, altitude) during travel can all affect blood glucose levels and represent a challenge to maintaining good health. Many people with diabetes need to travel with medication and/or medical devices and be able to access medical attention when needed. Careful pre-travel education and preparation should allow travellers with diabetes to enjoy a rewarding and pleasurable trip. Preparing for Travel Ideally you should start planning your trip well in advance (i.e. 8 weeks) of your departure date. Dedicated diabetes websites (see Useful Contacts) offer excellent advice and Travel Check Lists and Travel Guides are available online. Alongside accessing information on vaccination and prevention of travel-related illness you also need to consider: Travelling with a chronic medical condition. Maintaining health and glucose control during travel. Effects of temperature and altitude. Not all people with diabetes require medication, or are on insulin, therefore some advice (where stated) will not apply to everyone. Travelling with a Chronic Medical Condition Before embarking on travel, you should ensure that your health is optimized and can be maintained throughout your trip. You should consider: Pretravel Medical Check-up A routine checkup with your Diabetic Consultant, Diabetic Nurse Specialist or General Practitioner pre-travel will include assessment of: Glucose control If you are crossing time zones, alteration o Continue reading >>

History Of Diabetes

History Of Diabetes

Frederick Banting (right) joined by Charles Best in office, 1924 Diabetes is one of the first diseases described[1] with an Egyptian manuscript from c. 1500 BCE mentioning “too great emptying of the urine.”[2] The first described cases are believed to be of type 1 diabetes.[2] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[2] The term "diabetes" or "to pass through" was first used in 250 BC by the Greek Apollonius of Memphis.[2] Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 CE with type 1 associated with youth and type 2 with obesity.[2] The term "mellitus" or "from honey" was added by Thomas Willis in the late 1600s to separate the condition from diabetes insipidus which is also associated with frequent urination.[2] Further history[edit] Plaque in Strasbourg commemorating the 1889 discovery by Minkowski and Von Mering The first complete clinical description of diabetes was given by the Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE), who also noted the excessive amount of urine which passed through the kidneys.”[3] Diabetes mellitus appears to have been a death sentence in the ancient era. Hippocrates makes no mention of it, which may indicate that he felt the disease was incurable. Aretaeus did attempt to treat it but could not give a good prognosis; he commented that "life (with diabetes) is short, disgusting and painful."[4] The disease must have been rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[2] In medieval Persia, Avicenna (980–1037) provided a detailed account on diabet Continue reading >>

Sick Day Management Tips When Your Child Has Type 1 Diabetes

Sick Day Management Tips When Your Child Has Type 1 Diabetes

Having a sick child can be challenging—getting time off work and securing a last-minute doctor's appointment isn't always easy. But when your sick child also happens to have type 1 diabetes, it presents a separate set of complications relating to insulin and blood glucose (blood sugar) management. This article covers some important considerations to keep in mind the next time your child with type 1 diabetes feels under the weather. Checking Blood Glucose and Ketones Even the most common ailments, such as a cold or flu, can cause your child's blood glucose levels to rise. Plus, some over-the-counter medications can cause blood glucose levels to increase even more. Complicating matters, your child's blood glucose levels may actually drop too low if he or she is vomiting or has stopped eating. You just can't be certain how an illness will affect your child's blood glucose—that's why it's important to check their levels more often than you normally would. A general guideline to shoot for is to check their blood glucose every 2 to 3 hours, but remember—that's a guideline. Your child may require more or fewer checks, depending on your health care professional's recommendations. In addition to checking blood glucose levels, you also need to check for the presence of ketones in the urine. In people with type 1 diabetes, common illnesses can lead to diabetic ketoacidosis, a condition characterized by acidic blood caused by the release of too many ketones. Ketones are released when your body doesn't have enough insulin, so it's important to check your child's urine regularly (usually every 4 hours) until there are no ketones detected. If ketones are still present, that's a sign that your child needs more insulin. There are 2 ways to check ketones: using urine ketone strips Continue reading >>

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