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Can Ketoacidosis Cause Chest Pains?

Type 1 Diabetes Complications

Type 1 Diabetes Complications

Type 1 diabetes is complicated—and if you don’t manage it properly, there are complications, both short-term and long-term. “If you don’t manage it properly” is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if you’ve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage. Diabetes complications are all related to poor blood glucose control, so you must work carefully with your doctor and diabetes team to correctly manage your blood sugar (or your child’s blood sugar). Short-term Diabetes Complications Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar). It develops when there’s too much insulin—meaning that you’ve taken (or given your child) too much insulin or that you haven’t properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose). There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when it’s in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely). The signs and symptoms of low blood glucose are usually easy to recognize: Rapid heartbeat Sweating Paleness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech For more information about hypoglycemia and how to treat it, please read our article on hy Continue reading >>

Ketoacidosis: A Complication Of Diabetes

Ketoacidosis: A Complication Of Diabetes

Diabetic ketoacidosis is a serious condition that can occur as a complication of diabetes. People with diabetic ketoacidosis (DKA) have high blood sugar levels and a build-up of chemicals called ketones in the body that makes the blood more acidic than usual. Diabetic ketoacidosis can develop when there isn’t enough insulin in the body for it to use sugars for energy, so it starts to use fat as a fuel instead. When fat is broken down to make energy, ketones are made in the body as a by-product. Ketones are harmful to the body, and diabetic ketoacidosis can be life-threatening. Fortunately, treatment is available and is usually successful. Symptoms Ketoacidosis usually develops gradually over hours or days. Symptoms of diabetic ketoacidosis may include: excessive thirst; increased urination; tiredness or weakness; a flushed appearance, with hot dry skin; nausea and vomiting; dehydration; restlessness, discomfort and agitation; fruity or acetone smelling breath (like nail polish remover); abdominal pain; deep or rapid breathing; low blood pressure (hypotension) due to dehydration; and confusion and coma. See your doctor as soon as possible or seek emergency treatment if you develop symptoms of ketoacidosis. Who is at risk of diabetic ketoacidosis? Diabetic ketoacidosis usually occurs in people with type 1 diabetes. It rarely affects people with type 2 diabetes. DKA may be the first indication that a person has type 1 diabetes. It can also affect people with known diabetes who are not getting enough insulin to meet their needs, either due to insufficient insulin or increased needs. Ketoacidosis most often happens when people with diabetes: do not get enough insulin due to missed or incorrect doses of insulin or problems with their insulin pump; have an infection or illne Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What is diabetic ketoacidosis? Diabetic ketoacidosis, or DKA, is a serious health problem that can happen to a person with diabetes. It happens when chemicals called ketones build up in the blood. Normally, the cells of your body take in and use glucose as a source of energy. Glucose moves through the body in the bloodstream. Insulin is a hormone that helps your cells take in the glucose from the blood. If you have diabetes, your cells can’t take in and use this glucose in a normal way. This may be because your body doesn’t make enough insulin. Or it may be because your cells don’t respond to it normally. As a result, glucose builds up in your bloodstream and doesn’t reach your cells. Without glucose to use, the cells in your body burn fat instead of glucose for energy. When cells burn fat, they make ketones. High levels of ketones can poison the body. High levels of glucose can also build up in your blood and cause other symptoms. Ketoacidosis also changes the amount of other substances in your blood. These include electrolytes, such as sodium, potassium, and bicarbonate. This can lead to other problems. Ketoacidosis happens most often in a person with type 1 diabetes. This is a condition where the body does not make enough insulin. In rare cases, ketoacidosis can happen in a person with type 2 diabetes. It can happen when they are under stress, like when they are sick, or when they have taken certain medicines that change how their bodies handle glucose. Diabetic ketoacidosis is pretty common. It is more common in younger people. Women have it more often than men do. What causes diabetic ketoacidosis? High levels of ketones and glucose in your blood can cause ketoacidosis. This might happen if you: Don’t know you have diabetes, and your body is breaking down Continue reading >>

My First Encounter With Diabetic Ketoacidosis

My First Encounter With Diabetic Ketoacidosis

I saw a post last night that a friend shared about a young girl with type 1 diabetes that had passed away. Her pump site apparently kinked and she went into DKA and then had brain damage, so her parents had to make the heartwrenching decision to remove her from life support. This led to a conversation with a couple of friends as I recounted my story of my first time in DKA. It will be forever ingrained in my head, so I thought I’d share it here as well. I was in college 3+ hours away from home. And about 4 1/2 years post dx. I was visiting my boyfriend’s house and started feeling really sick. Started vomiting. To the point of not being able to get up off of the bathroom floor. I called the campus nurse and she told me to drink some Diet Sprite. Couldn’t hold it down. Water? Couldn’t hold it down. Anything I put in, came right back up. This is not a good combination for anyone, but especially for a diabetic. At the time I had no idea how serious this was, but I was about to find out. After several hours of this cycle… my boyfriend needed to go to work but didn’t want to leave me alone. My mom was coincidentally going to be visiting me that weekend so he called the hotel to leave a message for her, not expecting her for another hour or so (this part gives me chills.) When the hotel front desk answered and he asked to leave a message for her, the receptionist said, “Oh, she is standing right here checking in.” She had gotten on the road earlier than expected. He told her I was very sick and he thought she should come stay with me, because I was too sick to drive back to my dorm. She immediately heads over there (a 20-min drive that maybe took her 10 min) and saw it was bad. I was soo soo incredibly sick. She said I needed to go to the ER, but I couldn’t w Continue reading >>

Chest Pain In Emergency Department: A Diagnosis Of Diabetic Ketoacidosis Must Be Ruled Out

Chest Pain In Emergency Department: A Diagnosis Of Diabetic Ketoacidosis Must Be Ruled Out

CASE REPORT Chest pain in emergency department: A diagnosis of diabetic ketoacidosis must be ruled out Nasir Mohamad1, Rashidi Ahmad2, PK Cheah2 1Senior Lecturer/ Consultant Emergency Physician, Department of Emergency Medicine, School of Medical Sciences, 16150 Kubang Kerian, Kelantan, Malaysia. 2Senior Lecture/ Emergency Physician, Department of Emergency Medicine, School of Medical Sciences, Health Campus USM, 16150 Kubang Kerian, Kelantan, Malaysia. 3Emergency Physician, Department of Emergency Medicine, School of Medical Sciences, Health Campus USM, 16150 Kubang Kerian, Kelantan, Malaysia. doi:10.5348/ijcri-2010-11-5-CR-2 Address correspondence to: Nasir Mohamad Department of Emergency Medicine School of Medical Sciences 16150 Kubang Kerian, Kelantan Malaysia Phone: +6097676978 Fax: +6097673219 Email: [email protected] [HTML Abstract] [PDF Full Text] How to cite this article: Mohamad N, Ahmad R, Cheah PK. Chest pain in emergency department: A diagnosis of diabetic ketoacidosis must be ruled out. International Journal of Case Reports and Images 2010;1(3):6-9. Introduction: Diabetic ketoacidosis (DKA) is a common diabetic complication presenting to the Emergency Department (ED). Early recognition and initial aggressive treatment of DKA decreases morbidity and mortality. Clinical presentations of DKA are non specific such as nausea, vomiting, dehydration and abdominal pain. Chest pain is unusual presentation of DKA, however, acute coronary syndrome and pericarditis that manifest with chest pain are known precipitating factors of DKA. Case Report: We report a case of a middle aged diabetic patient who was presented with severe chest pain and elevated creatine kinase that might have thrown us off the correct diagnosis of DKA. Conclusion: A description of his pr Continue reading >>

The Silent Heart Attacks That Can Strike Diabetics Without Warning

The Silent Heart Attacks That Can Strike Diabetics Without Warning

Property consultant Michael Green was adamant that his type 2 diabetes was nothing to worry about. 'It's the non-serious type,' he'd say dismissively. Michael's laid-back attitude is in some ways understandable. The father-of-one had never suffered any obvious ill-effects from the condition he'd lived with for 28 years, and he'd been diagnosed not as a result of any troubling symptoms, but by chance following a routine blood test. Compared to a family friend who had type 1 diabetes, he was lucky, he insisted. At least he didn't have to monitor his blood sugar levels every few hours, and inject insulin. Then one night, two years ago, he went to sleep and never woke up. At just 53, he'd suffered a 'silent heart attack' - a little-known complication of diabetes. A silent attack is almost symptomless and occurs without any of the chest pain normally associated with a heart attack. Yet they can be just as dangerous - if not more so - as a normal heart attack. They're also surprisingly common. It is estimated that around a quarter of the 175,000 heart attacks in the UK each year are the silent type - and people with diabetes are at greatest risk. This is because the nerve damage linked to their condition can prevent warning signals being transmitted in the usual way. This, in turn, can lead to a delay in seeking treatment and result in damage to the blood vessels and heart muscle that make the heart attack more lethal. Heart attacks occur when there is a blockage in the artery supplying blood to the heart. Normally, this is as a result of a fatty plaque breaking off from the artery wall, triggering a blood clot. When the blood supply to the heart is reduced, the body produces chemicals that affect nerves and trigger pain. Often, people describe the pain of a heart attack as a Continue reading >>

Chest Pains | Diabetes Forum The Global Diabetes Community

Chest Pains | Diabetes Forum The Global Diabetes Community

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Does anyone else experience or know the cause of chest pains, it feels like somebody is pressing on my chest where my heart is alot of the time, it's not so much painful just very uncomfortable, thanks. Think maybe you need to get yourself checked out pronto. It could be nothing - anxiety or excessive exercise, but its best to see someone. Thanks I will I was just wondering if any other type 1s have had this due to high glucose I would see a GP urgently, or better A&E or a walk in center if its bad. Chest pains are better not to be avoided. Get checked out ASAP could just be indigestion who knows, time is always important so dont delay. Go NOW. Enclave Type 2 (in remission!) Moderator Don't ignore chest pains ... Get someone to take you to A & E ..or phone Tripple 9 for an ambulance.. if your still getting the pain you can take half an aspirin as you go to hospital. If the pain has stopped and you feel ok now, then make an appointment to see your Dr as soon as possible. As you are 18 it's most likely to be anxiety or indigestion, but don't take any risks I guess. Chest pains are not really a known side effect of anything except for DKA. Do you have really high blood sugar? Do you know the other symptoms of DKA? Difficulty breathing, tired, nausea. Do a ketone test. There is a higher risk of heart disease amongst diabetics but at 18 years old it's very unlikely. Enclave Type 2 (in remission!) Moderator As you are 18 it's most likely to be anxiety or indigestion, but don't take any risks I guess. Chest pains are not really a known side effect of anything except for DKA. Do you have really high blood sugar? Do you know the other symptoms of DKA? Difficul Continue reading >>

Diabetic Ketoacidosis: “sneaky” Triggers And Clinical Pearls

Diabetic Ketoacidosis: “sneaky” Triggers And Clinical Pearls

Authors: Catherine Reynolds, MD (EM Resident Physician, UT Houston), Kathryn Fisher, MD (EM Resident Physician, UT Houston), and Hilary Fairbrother, MD (EM Attending Physician, UT Houston) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Clinical Case #1: The patient is a 45-year-old male with history of type 2 DM and HTN who presents to the emergency department with diffuse abdominal pain, nausea, and vomiting for two days. The patient reports that he was recently started on Invokana (canagliflozin) about two weeks ago for his diabetes, and prior to that he was managing his sugars with diet and exercise alone. The patient has had difficulty keeping any food down over the last two days, but denies shortness of breath, chest pain, or fever. He reports his vomit is non-bilious and non-bloody. His initial finger stick is 84 mg/dL, and your intern states that he “knows that this is not DKA” as the serum glucose is normal. Vital signs showed RR 28, HR 110, BP 152/86, SpO2 98% on room air, T 98.4 F. Labs on presentation reveal a Na of 132 mmol/L, K of 5 mmol/L, Cl of 98 mmol/L, bicarbonate of 10 mmol/L, glucose of 84 mg/dL, and venous pH of 7.1. Venous lactate is within normal limits, and serum beta-hydroxybutyrate is positive. The patient is started on dextrose-containing fluids, an insulin drip, and admitted to the ICU for DKA. What was the cause of the patient’s euglycemic DKA? Clinical Case #2: The patient is a 62-year-old male with a history of DM, CAD, HTN, HLD, an NSTEMI, and 2 subsequent cardiac stents. He presents to the ED with diffuse abdominal pain, nausea, vomiting, and diarrhea for two days. The patient is on Humalog and Lantus but he hasn’t taken the medications over the last two days because he hasn’t been eating. He denies s Continue reading >>

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ 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 >>

What A High Blood Sugar Feels Like.

What A High Blood Sugar Feels Like.

The American Diabetes Association cites the following symptoms as indicative of high blood sugar: High blood glucose [Editor’s note: Duh] High levels of sugar in the urine Frequent urination Increased thirst And if high blood sugar goes untreated? “Hyperglycemia can be a serious problem if you don’t treat it, so it’s important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn’t have enough insulin. Without insulin, your body can’t use glucose for fuel, so your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis.” – ADA website But what does a high blood sugar feel like? Because when you see someone who is working through an elevated blood sugar, they may not look terribly out of sorts. But what is happening inside of them is real, and plays out in a myriad of ways for every person with diabetes. I’ve tried to write about it several times, but each high is different, and affects me in different ways: “It’s a thick feeling in the base of your brain, like someone’s cracked open your head and replaced your gray matter with sticky jam. I find myself zoning out and staring at things, and my eyeballs feel dry and like they’re tethered to my head by frayed ropes instead of optic nerves. Everything is slow and heavy and whipped with heavy cream.” – Oh, High! “There’s something about a high blood sugar that makes my body feel weighted down, l Continue reading >>

Diabetic Ketoacidosis Clinical Presentation

Diabetic Ketoacidosis Clinical Presentation

History Insidious increased thirst (ie, polydipsia) and urination (ie, polyuria) are the most common early symptoms of diabetic ketoacidosis (DKA). Malaise, generalized weakness, and fatigability also can present as symptoms of DKA. Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. A history of rapid weight loss is a symptom in patients who are newly diagnosed with type 1 diabetes. Patients may present with a history of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons. Decreased perspiration is another possible symptom of DKA. Altered consciousness in the form of mild disorientation or confusion can occur. Although frank coma is uncommon, it may occur when the condition is neglected or if dehydration or acidosis is severe. Among the symptoms of DKA associated with possible intercurrent infection are fever, dysuria, coughing, malaise, chills, chest pain, shortness of breath, and arthralgia. Acute chest pain or palpitation may occur in association with myocardial infarction. Painless infarction is not uncommon in patients with diabetes and should always be suspected in elderly patients. A study by Crossen et al indicated that in children with type 1 diabetes, those who have had a recent emergency department visit and have undergone a long period without visiting an endocrinologist are more likely to develop DKA. The study included 5263 pediatric patients with type 1 diabetes. [15] Continue reading >>

Am I The Heart Attack?

Am I The Heart Attack?

A few weeks ago, I woke up at 3 a.m. with excruciating chest, arm, neck, and back pain. It was the kind of pain that resembled everything I’d ever read or heard about the pain which precedes a heart attack. I don’t know what the typical response is for a man who senses that he’s experiencing a cardiac emergency, but my response was probably a textbook example of what not to do: I stayed in bed and let my thoughts run wild. This can’t be a heart attack. I’m not breaking out in a cold sweat. I’m a healthy and well-controlled type 1 diabetic. I’m not short of breath. I exercised last night and felt fine. I had carrots and celery for my nighttime snack last night. I can’t afford to have a heart attack. What does a room in the cardiac ICU cost, ten thousand dollars a day? What if I die? What will my wife and son do without me? Why did I neglect my diabetes in my 20s? I ate too much pizza in college. God, I really can’t miss work today. I wonder if I can get to the emergency room and be out in time to get to work. After about 30 minutes of panicking and waiting for things to get better, I vomited. I remembered that my father-in-law had experienced the same symptoms when he’d had a heart attack two years ago – chest pains then vomiting. I woke my wife, Theresa. “I need to get to the hospital,” I said. We dressed quickly and as we were walking out the front door, my compulsive need to know my blood glucose level at all times (which apparently persists even under threat of cardiac arrest) forced me to test. It was 180 mg/dl, quite high for the middle of the night. Before we were out of our neighborhood, my chest pain had worsened. So had my state of mind. I was trying to convince Theresa to drive faster, but she was thinking clearly and decided we shoul Continue reading >>

Can Diabetes Cause Fatigue, Body Ache?

Can Diabetes Cause Fatigue, Body Ache?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society. Asked by Mike from Tennessee Can diabetes be a (possible) cause of fatigue, leg and lower back aches? I have had bursts of energy for 10 to 15 minutes, but then need to sit for about 10 minutes, and I'm ready to go full steam again. PLEASE, Thank You, Mike Expert answer Dear Mike: Thanks for an important question, as a lot of people with diabetes complain of these symptoms. The answer is that diabetes itself probably is not the cause of your fatigue, lower back and leg aches. The things that cause type 2 diabetes (also called adult onset diabetes), such as a weight problem and lack of exercise, are commonly the cause these symptoms. Fatigue incorporates three components: 1. The inability to initiate activity. 2. Reduced ability to maintain activity. 3. Difficulty with concentration and memory. Fatigue should be distinguished from sleepiness, shortness of breath on exertion and muscle weakness, although these can also be associated with fatigue. Fatigue lasting six months or more is referred to as chronic fatigue. Chronic fatigue is not necessarily the entity known as chronic fatigue syndrome, which is a diagnosis after exclusion of all other causes. Fatigue in anyone should be evaluated by a health care provider to exclude all possible causes and to get counseling on how to treat it. Other medical causes of fatigue are the side effect of drugs, thyroid dysfunction, high calcium levels, rheumatologic illnesses, adrenal, kidney or liver problems. Some infections such as tuberculosis or hepatitis can cause fatigue, and indeed, fatigue can be their only symptom. Depression is also a major cause of fatigue. While unus Continue reading >>

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