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Can Ketoacidosis Be Reversed

The Starvation Diet That Can Reverse Type Two Diabetes: How Dramatic Weight-loss Could Lower Blood-sugar Levels

The Starvation Diet That Can Reverse Type Two Diabetes: How Dramatic Weight-loss Could Lower Blood-sugar Levels

One of the most effective ways to tackle type 2 diabetes is to lose weight, and it seems that dramatic weight loss may be particularly beneficial for blood-sugar levels. This surprising effect was first seen in patients who had undergone weight-loss (bariatric) surgery. As well as losing weight, many also reversed their diabetes. We will look at surgery on the next page, but there may be ways to replicate these benefits without major surgery — the answer may be as simple as a drastic, short-term diet. This is very much cutting-edge thinking and is the brainchild of Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University. Inspired by the diabetes-reversing effects of bariatric surgery, he decided to investigate the impact of a short-term, low-calorie diet on type 2 diabetes, using regular MRI scans to record exactly what was going on in the body. What he found could help to transform the health of many people with type 2 diabetes, even those who have had it for years. In a study published in 2011, he took 11 people with newly diagnosed type 2 (defined as being diagnosed in the previous four years) and gave them liquid diet formula. This provided 600 calories and was formulated so they received the right amount of nutrients. They also had around 200 calories of non-starchy vegetables such as broccoli and spinach — these provided fibre usually obtained from carbs, which were excluded from the diet. After a week, MRI scans showed the fat around their livers had dropped by 30 per cent; furthermore, their blood-sugar levels were normal. At the end of the eight-week trial, fat levels in the pancreas had also plummeted and they were producing insulin again. Participants also lost an average of 2st 5lb (15kg). At a follow-up scan three m Continue reading >>

Emergent Treatment Of Alcoholic Ketoacidosis

Emergent Treatment Of Alcoholic Ketoacidosis

Exenatide extended-release causes an increased incidence in thyroid C-cell tumors at clinically relevant exposures in rats compared to controls. It is unknown whether BYDUREON BCise causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of exenatide extended-release-induced rodent thyroid C-cell tumors has not been determined BYDUREON BCise is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with the use of BYDUREON BCise and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for detection of MTC in patients treated with BYDUREON BCise Acute Pancreatitis including fatal and non-fatal hemorrhagic or necrotizing pancreatitis has been reported. After initiation, observe patients carefully for symptoms of pancreatitis. If suspected, discontinue promptly and do not restart if confirmed. Consider other antidiabetic therapies in patients with a history of pancreatitis Acute Kidney Injury and Impairment of Renal Function Altered renal function, including increased serum creatinine, renal impairment, worsened chronic renal failure, and acute renal failure, sometimes requiring hemodialysis and kidney transplantation have been reported. Not recommended in patients with severe renal impairment or end-stage renal disease. Use caution in patients with renal transplantation or moderate renal impairment Gastrointestinal Disease Because exenatide is commonly associated with gastrointestinal adverse reactions, not recommended in patients with sev Continue reading >>

Ketoacidosis

Ketoacidosis

GENERAL ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions). ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. a relative or absolute insulin deficiency is present in all cases. CAUSES The three major types of ketosis are: (i) Starvation ketosis (ii) Alcoholic ketoacidosis (iii) Diabetic ketoacidosis STARVATION KETOSIS when hepatic glycogen stores are exhausted (eg after 12-24 hours of total fasting), the liver produces ketones to provide an energy substrate for peripheral tissues. ketoacidosis can appear after an overnight fast but it typically requires 3 to 14 days of starvation to reach maximal severity. typical keto-anion levels are only 1 to 2 mmol/l and this will usually not alter the anion gap. the acidosis even with quite prolonged fasting is only ever of mild to moderate severity with keto-anion levels up to a maximum of 3 to 5 mmol/l and plasma pH down to 7.3. ketone bodies also stimulate some insulin release from the islets. patients are usually not diabetic. ALCOHOLIC KETOSIS Presentation a chronic alcoholic who has a binge, then stops drinking and has little or no oral food intake for a few days (ethanol and fasting) volume depletion is common and this can result in increased levels of counter regulatory hormones (eg glucagon) levels of free fatty acids (FFA) can be high (eg up to 3.5mM) providing plenty of substrate for the altered hepatic lipid metabolism to produce plenty of ketoanions GI symptoms are common (eg nausea, vomiting, abdominal pain, haematemesis, melaena) acidaemia may be severe (eg pH down to 7.0) plasma glucose may be depressed or normal or Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

The Facts Diabetic ketoacidosis (DKA) is a condition that may occur in people who have diabetes, most often in those who have type 1 (insulin-dependent) diabetes. It involves the buildup of toxic substances called ketones that make the blood too acidic. High ketone levels can be readily managed, but if they aren't detected and treated in time, a person can eventually slip into a fatal coma. DKA can occur in people who are newly diagnosed with type 1 diabetes and have had ketones building up in their blood prior to the start of treatment. It can also occur in people already diagnosed with type 1 diabetes that have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. Although much less common, DKA can occasionally occur in people with type 2 diabetes under extreme physiologic stress. Causes With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL) while insulin levels are very low. Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able 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 >>

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 >>

What Is The Longest A Diabetic Can Go Without An Injection?

What Is The Longest A Diabetic Can Go Without An Injection?

Type one diabetes at the most two to three days, by that time they would be severely ketotic, risking a sometimes fatal diabetes hyperglycemic ketoacidotic coma. For type 2 diabetes mostly that can be for months, even years, like we see in those war torn areas. My erstwhile partner, when I met him already a senior physician, told me that the experience during WW II in The Netherlands, those mostly type 2 diabetics who couldn’t get insulin didn’t die from not having insulin (which at the end was air-dropped by the British into German occupied territories), in fact did quite well with their blood sugars, unfortunately for a very sad reason: the Dutch famine of 1944–45 - Wikipedia costing about 18,000 people their lives. Of course not having their diabetes well controlled would cause them to develop a lot more complications so would shorten their lifespan appreciably. Continue reading >>

Actrapid: Eight Steps For Managing Diabetic Ketoacidosis

Actrapid: Eight Steps For Managing Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) is a potentially life threatening condition that occurs when excessive amounts of ketones are released into the bloodstream as a result of the body breaking down lipids, instead of utilising glucose as the energy source. This process is known as gluconeogenesis and occurs when the body does not have sufficient insulin to allow the uptake of glucose from the bloodstream into the cells. It is observed primarily in people with type one diabetes (insulin dependent), but it can occur in type two diabetes (non-insulin dependent) under certain circumstances. To understand the symptoms of DKA and therefore how to manage it effectively, it is important to understand the pathophysiology of hyperglycaemia which is explained in the flowchart below: The further down this flowchart the patient gets, the more serious their symptoms become. For this reason, there are varying degrees of severity with DKA: Mild pH 7.25 – 7.30, bicarbonate decreased to 15–18 mmol/L, the person is alert Moderate pH 7.00 – 7.25, bicarbonate 10–15 mmol/L, drowsiness may be present Severe pH below 7.00, bicarbonate below 10 mmol/L, stupor or coma may occur A.C.T.R.A.P.I.D. To remember the principles involved in managing a patient with DKA, remember the acronym ACTRAPID. Airway, breathing, circulation Commence fluid resuscitation Treat potassium Replace insulin Acidosis management Prevent complications Information for patients Discharge Airway, Breathing, Circulation As Per Any Emergency DKA patients need to have their airway, breathing and circulation assessed immediately. A decreased level of consciousness may lead to an unprotected airway and compromised breathing. The osmotic diuresis can cause a significant loss of fluid, leading to severe dehydration and circulatory co Continue reading >>

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis in cats at a glance Ketoacidosis is a serious complication of diabetes in which ketones and blood sugar levels build up in the body due to insufficient levels of insulin which is required to move glucose into the cells for energy. As a result, the body uses fat as an alternate energy source which produces ketones causing the blood to become too acidic. Common causes include uncontrolled diabetes, missed or insufficient insulin, surgery, infection, stress and obesity. Symptoms of ketoacidosis include increased urination and thirst, dehydration, nausea, diarrhea, confusion, rapid breathing which may later change to laboured breathing. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterised by metabolic acidosis (increased acids in the blood), hyperglycemia (high blood glucose) and ketonuria (ketones in the urine). It is caused by a lack of or insufficient amounts of insulin which is required to move glucose from the bloodstream and into the cells to be used for energy. When this occurs, the body begins to search for alternate sources of energy and begins to break down fat. When fat is broken down (metabolised) into fatty acids, waste products known as ketones (acetoacetate, beta-hydroxybutyrate, acetone) are released from the liver and accumulate in the bloodstream (known as ketonemia). This causes the blood to become too acidic (metabolic acidosis). As well as metabolic acidosis, ketones also cause central nervous depression.The body will try to get rid of the ketones by excreting them out of the body via the urine, increased urine output leads to dehydration, making the problem worse. Meanwhile, the unused glucose remains in the bloodstream, resulting in hyperglycemia (high blood sugar).Insulin Continue reading >>

Acute Reversal Of Experimental Diabetic Ketoacidosis

Acute Reversal Of Experimental Diabetic Ketoacidosis

in the Rat with (+) -Decanoylcarnitine J. DENIS McGARRYand DANIEL W. FOSTER From the Departments of Internal Medicine and Biochemistry, The University of Texas Southwestern Medical School at Dallas, Dallas, Texas 75235 A B S T R A C T The effect of (+) -decanoylcarnitine, a potent inhibitor of long-chain acylcarnitine transferase, was tested for its ability to inhibit hepatic ketogenesis both in the isolated perfused liver and in vivo in severely ketotic alloxan diabetic rats. In vitro the in- hibitor caused an almost complete block in ketone body production. In vivo (+) -decanoylcarnitine caused a rapid reversal of ketosis under conditions where large doses of insulin had little effect. A combination of the two agents produced an even more striking fall in plasma ketone levels. While (+) -decanoylcarnitine alone had no effect on plasma glucose levels it enhanced the hypoglycemic effect of insulin in anesthetized animals. Loss of this effect was noted in nonanesthetized animals, possibly as a result of increased muscle activity. Studies in the isolated perfused liver indicated that the blockade of fatty acid oxidation and ketogenesis pro- duced by (+) -decanoylcarnitine was rapidly reversible upon removal of the inhibitor. INTRODUCTION Recent studies from this laboratory have been concerned with the mechanisms by which ketogenesis is regulated (1-6). It now seems clear that maximal ketogenesis requires that two conditions be fulfilled: (a) There must be an adequate delivery of the basic ketogenic sub- strate, fatty acid, to the liver, and (b) There must be a change in the metabolic "set" of the liver such that a greater fraction of the incoming fatty acids is shunted into the oxidative sequence relative to that utilized for triglyceride and phospholipid synthesis. Failu Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What Is It? Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when you have much less insulin than your body needs. This problem causes the blood to become acidic and the body to become dangerously dehydrated. Diabetic ketoacidosis can occur when diabetes is not treated adequately, or it can occur during times of serious sickness. To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily. Your body needs a constant source of energy. When you have plenty of insulin, your body cells can get all the energy they need from glucose. If you don't have enough insulin in your blood, your liver is programmed to manufacture emergency fuels. These fuels, made from fat, are called ketones (or keto acids). In a pinch, ketones can give you energy. However, if your body stays dependent on ketones for energy for too long, you soon will become ill. Ketones are acidic chemicals that are toxic at high concentrations. In diabetic ketoacidosis, ketones build up in the blood, seriously altering the normal chemistry of the blood and interfering with the function of multiple organs. They make the blood acidic, which causes vomiting and abdominal pain. If the acid level of the blood becomes extreme, ketoacidosis can cause falling blood pressure, coma and death. Ketoacidosis is always accompanied by dehydration, which is caused by high Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

How Do You Cure Type 2 Diabetes Naturally With Diet?

How Do You Cure Type 2 Diabetes Naturally With Diet?

I’m a specialist practitioner in obesity and diabetes. Type 2 diabetes can be reversed through diet. Absolutely. Firstly this is what is a normal insulin reaction looks like: Insulin is manufactured in the pancreas and secreted when your blood sugar levels rise. Blood sugar needs to be not too high and not too low. Insulin’s mechanism to remove sugar from blood is to put it into cells, like your muscles. If there is an excess after blood glucose has gone into cells it is then put in the liver and further excess becomes fat. What happens with type 2 When insulin is secreted the body’s cells have ‘‘receptors’ that accept the insulin’s key that then open the doors to the cell to let the glucose in. Sadly in type 2 the receptors become resistant to the insulin key. Therefore not enough energy gets into the cell. The body has a negative feedback system. Once the cells do not get enough energy a signal is sent back to the pancreas to manufacture even more insulin. This is a vicious cycle. Insulin keeps going up and resistance keeps getting worse. A drug, called metformin works by making cells receptive again but it has limitations and eventually other drugs are needed. This is not ideal; so how can we reverse this? Well quite simply really. The crux of this scenario is that it is the sugar spikes in the blood that are causing the high levels of insulin in the first place. Certain foods cause insulin to enter the system in a fast and high volume way and some foods hardly disturb insulin at all. The insulin index is similar to the GI system and by picking foods that cause little insulin response the type 2 diabetes begins to reverse. This is a snapshot. The lower the number the lower the insulin response Sadly many government guidelines are not beneficial and larg Continue reading >>

My Dog Has Acute Kidney Failure And Diabetic Ketoacidosis. Should We Put Her To Sleep?

My Dog Has Acute Kidney Failure And Diabetic Ketoacidosis. Should We Put Her To Sleep?

First of all, you have my heart felt sympathies for what you are going through. I know how painful this time must be for you and your family. That decision to put your furry kid to sleep is yours and only yours to make. I am in a position to only share my experience with my own GSD's AKD. My Dash was affected by Acute Kidney disease at the age of 9 months. Within 3-4 hours of fluid therapy, our vet told us upfront that it's not working as the creatinine level had spiked from 5 at the time of reaching the vet to 9. We were proactive in asking her what can we do to save Dash. She told us that prompt dialysis is the only chance he has, no assurances / guarantee, just a chance; and directed us to the only private facility in the city where he could be given dialysis. Unfortunately, Dash couldn't be given dialysis there due to some last minute technical glitch. During this time, his creatinine had shot up to 11. Then, as the last resort, we took him to the government Veterinary hospital (which each and every one of our contact was against) as it has the only other canine dialysis unit in the city. As our luck would have it, the dialysis unit there too got stuck at the last minute. The vet there assured us she would stabilise Dash till the next morning and then have him go through dialysis. Sure enough, Dash did pull through the night and we were back the next morning for dialysis. The unit was fixed, however, Dash was found to be unfit for dialysis as his electrolyte levels had dropped substantially as well as his blood clotting was taking longer than normal. It took us almost 2 weeks to get him fit for dialysis. During this period, his creatinine had stayed above 10, fluctuating now and then; in addition, Dash had not eaten a single morsel of food in all this time. He was b Continue reading >>

Is The Ketogenic Diet Safe For People With Diabetes?

Is The Ketogenic Diet Safe For People With Diabetes?

Is The Ketogenic Diet Safe for People with Diabetes? If you’ve been diagnosed with diabetes, chances are you’re looking for simple yet effective ways to control your blood sugar. And, if at all possible, without the use of daily shots or medications. As I’ve mentioned in earlier blog posts, exercise is one of the best natural ways to manage blood glucose. But perhaps the most obvious way to keep blood sugar at a safe and consistent level without insulin is to pay special attention to what you eat. And, in the case of diabetes, limiting your carbohydrate intake may be the key. What Is the Keto Diet? At first glance the ketogenic (keto) diet may seem like a crazy idea for type 2 diabetics. After all, many patients are put on diets to help them lose weight. The keto diet is high in fat, but it is very low in carbs, and this combination can help change the way your body stores and uses energy. With this diet your body converts fat instead of sugar into energy, which can improve blood glucose levels while reducing the need for insulin. Ketosis VS Ketoacidosis Ketosis and ketoacidosis are two very different things, which are often confused. But it’s very important you understand the difference. What is ketoacidosis? Ketoacidosis (KA) is a life-threatening condition in which your body doesn’t make enough insulin. This causes you to have dangerously high levels of ketones (substances occurring when the body uses fat stores for energy) and blood sugar. The combination of both makes your blood incredibly acidic, and this can, in turn, change the normal functioning of your internal organs such as your liver and kidneys. Patients suffering from ketoacidosis must get treatment immediately or they could slip into a coma and even die. Ketoacidosis can develop in less than 24 Continue reading >>

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