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Which Insulin Is Used To Treat Diabetic Ketoacidosis?

Care Of Diabetic And Diabetic Ketoacidotic Patients (proceedings)

Care Of Diabetic And Diabetic Ketoacidotic Patients (proceedings)

Diabetes mellitus is the condition of hyperglycemia (high blood glucose) and glucosuria (glucose in the urine) caused by absence of the hormone insulin, or failure of the cells of the body to be able to respond to insulin. Diabetes mellitus is the condition of hyperglycemia (high blood glucose) and glucosuria (glucose in the urine) caused by absence of the hormone insulin, or failure of the cells of the body to be able to respond to insulin. Diabetes mellitus in veterinary patients can most often be compared to human adult onset diabetes (type 2), and juvenile onset diabetes is rare in veterinary patients. Patients may present with few clinical signs, in relatively good health (uncomplicated diabetes mellitus), or may be weak and dehydrated with severe electrolyte abnormalities (ketoacidotic diabetes mellitus). The most common clinical signs include weight loss, polyuria/polydipsia, increased or decreased appetite, unkempt hair coat, dandruff, sudden onset blindness (in dogs from cataract formation secondary to diabetes), and hind limb weakness (from diabetic neuropathy in cats) . In dogs and cats that have progressed to diabetic ketoacidosis, vomiting, anorexia, and lethargy are common complaints. Physical examination findings can reveal thin body condition, cataracts (dogs), dehydration, and mental dullness. Animals with recent onset diabetes mellitus can have a relatively normal examination. Laboratory testing to diagnose diabetes mellitus is relatively straightforward, and diagnosis can be confirmed at the time of evaluation in some cases with in-house testing. Elevated blood glucose is the mainstay of diagnosis; however keep in mind that hyperglycemia may be from diabetes, or secondary to a stress response, especially in cat. Handheld glucometers that are used by h Continue reading >>

Can Diabetes Kill You?

Can Diabetes Kill You?

Here’s what you need to know about the life-threatening diabetes complication called diabetic ketoacidosis. Diabetic ketoacidosis is one of the most serious complications of diabetes. Symptoms can take you by surprise, coming on in just 24 hours or less. Without diabetic ketoacidosis treatment, you will fall into a coma and die. “Every minute that the person is not treated is [another] minute closer to death,” says Joel Zonszein, MD, professor of medicine at Albert Einstein College of Medicine in New York City. Diabetic ketoacidosis occurs when your body doesn’t produce enough insulin. (Diabetic ketoacidosis most often affects people with type 1 diabetes, but there is also type 2 diabetes ketoacidosis.) Without insulin, sugar can’t be stored in your cells to be used as energy and builds up in your blood instead. Your body has to go to a back-up energy system: fat. In the process of breaking down fat for energy, your body releases fatty acids and acids called ketones. Ketones are an alternative form of energy for the body, and just having them in your blood isn’t necessarily harmful. That’s called ketosis, and it can happen when you go on a low-carb diet or even after fasting overnight. “When I put people on a restricted diet, I can get an estimate of how vigorously they’re pursuing it by the presence of ketones in the urine,” says Gerald Bernstein, MD, an endocrinologist and coordinator of the Friedman Diabetes Program at Lenox Hill Hospital in New York City. RELATED: The Ketogenic Diet Might Be the Next Big Weight Loss Trend, But Should You Try It? But too many ketones are a problem. “In individuals with diabetes who have no or low insulin production, there is an overproduction of ketones, and the kidneys can’t get rid of them fast enough,” sa Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Definition: Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes . It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat breaks down, waste products called ketones build up in the body. Causes: As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes. People with type 2 diabetes can also develop ketoacidosis, but it is less common. It is usually triggered by uncontrolled blood sugar or a severe illness. Symptoms: Common symptoms can include: Decreased alertness Dry skin and mouth Flushed face Frequent urination or thirst that lasts for a day or more Fruity-smelling breath Headache Muscle stiffness or aches Nausea and vomiting Stomach pain Exams and Tests: Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample. Ketone testing is usually done: When the blood sugar is higher than 240 mg/dL During an illness such as pneumonia, heart attack, or stroke When nausea or vomiting occur During pregnancy Other tests for ketoacidosis include: This disease may also affect the results of the following tests: Treatment: The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace flu Continue reading >>

Treatment Of Insulin-resistant Diabetic Ketoacidosis With Insulin-like Growth Factor I In An Adolescent With Insulin-dependent Diabetes

Treatment Of Insulin-resistant Diabetic Ketoacidosis With Insulin-like Growth Factor I In An Adolescent With Insulin-dependent Diabetes

INSULIN plays a central part in the regulation of carbohydrate, fat, and protein metabolism. Severe insulin resistance, in which treatment with large doses of insulin does not result in adequate metabolic control, is uncommon. Such resistance occurs in the presence of circulating insulin or insulin-receptor antibodies,1 , 2 insulin-receptor abnormalities,3 and episodically in patients with previously typical insulin-dependent diabetes mellitus (IDDM).4 The therapeutic options in patients with severe insulin resistance have been limited, since insulin has been the only available hormone with insulin-like metabolic effects. Recombinant human insulin-like growth factor I (IGF-I), which shares considerable sequence homology as well as biologic properties with insulin,5 has recently become available and has been used in treating patients with Mendenhall's syndrome.6 We describe the use of IGF-I in the treatment of a 16-year-old girl with IDDM complicated by severe episodic insulin resistance. Administration of massive doses of insulin (more than 1000 U per hour) during these episodes failed to achieve glycemic control or reverse ketoacidosis. Treatment with IGF-I rapidly reversed the hyperglycemia and ketoacidosis, and subsequent weekly intravenous infusions of IGF-I markedly improved the degree of insulin sensitivity. The patient was a 16-year-old girl who had had IDDM since the age of 3. She was treated with twice-daily injections of regular and bovine or porcine isophane insulin suspension until the age of seven, at which time she began to receive human insulin. Her glycemic control subsequently improved. At the age of 13, she began to have increasingly frequent (two to three times monthly) episodes of severe hyperglycemia, usually without ketoacidosis. Her serum glucose Continue reading >>

Which Form Of Diabetes Is Insulin Dependent? How Is It Treated?

Which Form Of Diabetes Is Insulin Dependent? How Is It Treated?

Any form of diabetes mellitus can be insulin dependent (IDDM = insulin dependent diabetes mellitus), though it is most frequently Type I diabetes (DMI). Here’s why: DMI is caused by an insulin deficiency. For whatever reason, the body becomes unable to produce insulin (either not enough or not at all) and the body then requires exogenous insulin in order to survive. Insulin is what allows your body to put sugar in your blood stream into the cell, and sugar doesn’t count unless it’s in your cells. DMII usually doesn’t require insulin becasue it is insulin resistence. Your body has such high glucose levels all the time that you no longer recognize hyperglycemia as a signal to release insulin and your cells become less inclined to pay attention to it when it’s available. Medications used to treat DMII generally work by encouraging your body to lower blood sugar levels and become more sensitive to insulin again. If that’s not working, it may be necessary to use insulin but for DMII it’s more of a last resort than a first course of action. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Treatment Approach The main goals of treatment are: Restoration of volume deficits Resolution of hyperglycemia and ketosis/acidosis Correction of electrolyte abnormalities (potassium level should be >3.3 mEq/L before initiation of insulin therapy; use of insulin in a patient with hypokalemia may lead to respiratory paralysis, cardiac arrhythmias, and death) Treatment of the precipitating events and prevention of complications. It must be emphasized that successful treatment requires frequent monitoring of clinical and laboratory parameters to achieve resolution criteria. A treatment protocol and a flow sheet for recording the treatment stages and laboratory data should be maintained. [1] [38] [39] [40] Initial and supportive treatment The majority of patients present to the emergency department, where treatment should be initiated. There are several important steps that should be followed in early management: Fluid therapy should be started immediately after initial laboratory evaluations. Infusion of isotonic solution of 0.9% sodium chloride at a rate of 1 to 1.5 L/hour should be used for the first hour of fluid therapy. Indications for admission to the intensive care unit (ICU) are hemodynamic instability or cardiogenic shock, altered mental status, respiratory insufficiency, severe acidosis, and hyperosmolar state with coma. The diagnosis of hemodynamic instability should made by observing for hypotension and clinical signs of poor tissue perfusion, including oliguria, cyanosis, cool extremities, and altered mental state. After admission to ICU, central venous and arterial lines are required, with continuous percutaneous oximetry. Oxygenation and airway protection are critical. Intubation and mechanical ventilation are commonly required, with constant monitoring of r Continue reading >>

Medications For Diabetic Ketoacidosis

Medications For Diabetic Ketoacidosis

This medication may not be approved by the FDA for the treatment of this condition. Prescription Only / Over the Counter Rx Prescription Only OTC Over the Counter Rx/OTC Prescription or Over the Counter Pregnancy A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits. N FDA has not classified the drug. Controlled Substances Act Schedule N Is not subject to the Controlled Substances Act. 1 Has a high potential for abuse. Has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use under medical supervision. 2 Has a high potential for abuse. Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse may lead to severe psychological or physical dependence Continue reading >>

Understanding And Treating Diabetic Ketoacidosis

Understanding And Treating Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab 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 >>

Treatment Of Diabetic Ketoacidosis With Subcutaneous Insulin Lispro: A Review Of The Current Evidence From Clinical Studies

Treatment Of Diabetic Ketoacidosis With Subcutaneous Insulin Lispro: A Review Of The Current Evidence From Clinical Studies

Low-dose intravenous infusions of regular insulin, usually initiated in the emergency department and continued in the intensive care unit (ICU), are the standard care for patients with diabetic ketoacidosis (DKA) to ensure rapid resolution of hyperglycaemia and ketoacidosis. Several studies have evaluated whether subcutaneous injections of the rapid-acting analogue insulin lispro may be an alternative to intravenous insulin infusion for avoiding ICU admissions of uncomplicated DKA cases. This review summarizes the current clinical evidence for the effectiveness and safety of subcutaneous insulin lispro injections in non-severe DKA patients. Relevant studies were identified by a systematic literature search through the PubMed database. To date, four small randomized studies (156 patients overall; three studies in adults and one in paediatric patients with diabetes) have directly compared subcutaneous insulin lispro injections every 1–2h vs continuous intravenous infusions of regular insulin. Patients with severe complications were excluded. In all studies, the mean time to resolution of DKA was similar in both treatment groups [range (three studies): lispro 10–14.8h; regular insulin 11–13.2h]. The mean time to resolution of hyperglycaemia, total insulin doses required, number of hospitalization days and number of hypoglycaemic episodes were similar in both treatment groups; no severe complications or DKA recurrences were reported, and one study showed a 39% cost reduction for the insulin lispro group. In patients with mild-to-moderate DKA, subcutaneous injections of insulin lispro every 1–2h offer a feasible alternative to continuous intravenous infusions of regular insulin, and should now be evaluated in larger, more appropriately powered studies. The full text Continue reading >>

Diabetic Ketoacidosis: Should Current Management Include Subcutaneous Insulin Injections?

Diabetic Ketoacidosis: Should Current Management Include Subcutaneous Insulin Injections?

Rocio Gavidia Quezada MD, Hawa Edriss MD Corresponding author: Rocio Gavidia Contact Information: [email protected] DOI: 10.12746/swrccc.v5i19.389 ABSTRACT Diabetic ketoacidosis is a well-known acute complication in patients with both type 1 and type 2 diabetes mellitus. Although mortality has decreased considerably, it remains an important cause for admission to intensive care units. Medical management includes intravenous fluid therapy, insulin, correction of electrolyte abnormalities, and addressing the precipitating factor which in most cases is infection or non-compliance with insulin therapy. Usually patients with diabetic ketoacidosis are admitted to the intensive care unit for continuous infusion of insulin; however, the development of rapid acting insulin analogues has made it possible to treat mild to moderate diabetic ketoacidosis with subcutaneous insulin. Although studies using subcutaneous insulin include only a small number of patients, this approach seems as effective as intravenous insulin infusions in patients with mild to moderate diabetic ketoacidosis. Diabetic education and close follow-up for patients admitted for diabetic ketoacidosis remain essential to avoid recurrence and readmissions. Keywords: Diabetic ketoacidosis, acute complication in diabetes, rapid acting insulin analogues, subcutaneous insulin in diabetic ketoacidosis INTRODUCTION Diabetic ketoacidosis (DKA) is a well-known acute complication in patients with both type 1 and type 2 diabetes. This condition results from a relative or absolute insulin deficiency combined with counter-regulatory hormone excess: glucagon, catecholamines, cortisol, and growth hormone.1 Diabetic ketoacidosis can be life threatening, but mortality rates have fallen since 1980, according to the National Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Subcutaneous Insulin In Dka: Safe — But Not Better Than Iv Insulin

Subcutaneous Insulin In Dka: Safe — But Not Better Than Iv Insulin

Diabetic ketoacidosis (DKA) remains one of the more serious complications of diabetes. DKA management usually involves the continuous infusion of intravenous regular insulin, as recommended by both the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Subcutaneous insulin may be cutting edge in the treatment of diabetics, but studies show that its benefits over old fashioned IV insulin are marginal at best. Diabetic ketoacidosis (DKA) remains one of the more serious complications of diabetes. DKA management usually involves the continuous infusion of intravenous regular insulin, as recommended by both the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Studies conducted in the 1970s and 1980s demonstrated the superiority of IV regular insulin over subcutaneous (SC) or intramuscular (IM) regular insulin, with a more rapid initial decrease in plasma glucose and ketone levels observed (Fisher 1977). These observations are likely due to the relatively prolonged half-life of SC and IM regular insulin. Newer, rapid-acting insulin analogues (aspart and lispro) offer the advantage of having much shorter half-lives than regular insulin, and their efficacy in the management of DKA, when administered subcutaneously, is worth reviewing. The main issue with IV insulin drips is that, in most institutions, their use requires admission to an ICU setting. Unfortunately, as our patient population ages and as life-prolonging treatments become more commonplace, ICU beds are getting harder to come by. As a result, DKA patients are sometimes managed in the emergency department until their anion gap closes and the insulin drip can be turned off. Management of such patients in the ED ties up pre Continue reading >>

Diagnosis

Diagnosis

Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes throu Continue reading >>

Pem Pearls: Treatment Of Pediatric Diabetic Ketoacidosis And The Two-bag Method

Pem Pearls: Treatment Of Pediatric Diabetic Ketoacidosis And The Two-bag Method

Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes mellitus (DM), all of the opposite effects occur. A lack of insulin causes the following downstream effects: Prevents glucose from being used as an energy source – Free fatty acids are used instead and produce ketoacids during metabolism. Causes a surge of stress hormones and induces gluconeogenesis – When blood glucose levels are elevated, the kidneys cannot absorb all of the glucose from the urine, and the extra glucose in the urine causes polyuria, even in the setting of dehydration. In addition, acidosis causes potassium to shift out of cells into the blood, and the combination of this with dehydration causes the body to preferentially retain sodium at the expense of potassium.1,2 When insulin homeostasis is disrupted and decompensates, patients are at risk for developing diabetic ketoacidosis (DKA). All of the following criteria are required for a diagnosis of DKA: Hyperglycemia (glucose >200 mg/dL) Acidosis (pH <7.3 or bicarb <15 mmol/L) Ketosis (by urine or blood test) Treatment is based on a simple principle: return the body’s glucose regulation to its normal state and replace all of the things the body consumed while insulin-deficient. While bolus insulin is common in the treatment of DKA in adults, it is relatively contraindicated in the pediatric patient. Dehydration and secondary sympathetic activation can interfere with local tissue perfusion and may cause irregular and unpredictable absorption. Step 1: Correction Continue reading >>

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