How To Lower Your Blood Sugar When It's Really High
This article is written for type 2 diabetics who need help coming down from a very high blood sugar during a single, isolated high blood sugar event. If you want to try an stabilize your baseline, consider signing up for my Baseline Blood Sugar Challenge course. THIS ARTICLE IS NOT A SUBSTITUTE FOR REAL MEDICAL ADVICE. If you're a type 2 diabetic and your blood sugar is high right now (greater than 300mg/dL for at least 6 hours), the first thing you should do is call your doctor. So, if you haven't called anyone for help yet, please stop reading this article and call your doctor. If your doctor is able to help, then you need not read on. Also, if you are having symptoms of Diabetic Ketoacidosis, stop reading this article and go to the hospital immediately. Diabetic Ketoacidosis can kill you if left untreated. But. If you're in a situation where your blood sugar has been high for an extended period of time, you could perhaps consider taking the following steps to solve your blood sugar problem. Disclaimer: This is friendly, non-medical advice from a random diabetic person you don't even know, which is a very (very) poor substitute for real, actual medical advice. Use at your own risk. First, you should try and lower your blood sugar without injectable insulin by completing the following steps: 1. Check your blood sugar. Write down the time and your blood sugar level. 2. Drink water (this doesn't actually lower blood sugar, but it helps flush sugar and ketones from your body, if you have them). Continue drinking water, but please don't make yourself sick. 3. Move. As in, walk. Walk around the block or walk in place or haul your ass up and down the stairs for 30-60 minutes. Walking helps your cells become less insulin resistant, which is what you need right now. Do N Continue reading >>
A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>
Is Ketosis Dangerous?
Duck Dodgers October 14, 2014 Peter, An article by Per Wikholm was published in this month’s LCHF Magasinet, where Per demonstrates that the Inuit could not have been in ketosis given that the scientific literature is abundantly clear, over and over again, that the Inuit consumed too much protein, and more importantly, Per debunks Stefansson’s claims for high fat with writing from his own books—Stef admitted in the pemmican recipes that Arctic caribou was too lean to make pemmican that supported ketosis. The most popular LCHF bloggers in Sweden, Andreas Eenfeldt/Diet Doctor and Annika Dahlquist have reluctantly agreed with Per’s findings—admitting that the Inuit were likely not ketogenic from their diet. I’ve put together a comprehensive review of the scientific literature regarding the Inuit, encompassing over two dozen studies, spanning 150 years, with references from explorers, including Stefansson. In the comments section of that post, Per gives a brief overview of how he was able to prove Stefansson’s observations on high fat intake were flawed. The post is a review of all the available literature that I could find (over two dozen studies). But, the literature certainly does not in any way support ketosis from the Inuit diet due to such high protein consumption. As Per (and Stefansson) points out, the caribou is too lean and as the many quotes show, the Inuit were saving their blubber and fat for the long dark Winter to power their oil lamps and heat their igloos. Again and again, we see that in the literature, as even Stefansson admits this. As far as glycogen is concerned, their glycogen intake is probably not worth scrutinizing given the well-documented high protein consumption in every published study. It really is besides the point. But, interest Continue reading >>
Beware The Perils Of Severe Hypoglycemia
Over 80 years ago, famed diabetologist Elliot Joslin said about the treatment of patients with type 1 diabetes: “Ketoacidosis may kill a patient, but frequent hypoglycemic reactions will ruin him.” Unfortunately, hypoglycemia continues to be the most difficult problem facing most patients, families, and caregivers who deal with the management of type 1 diabetes on a daily basis. Frequent hypoglycemia episodes not only can “ruin,” or adversely impact the quality of life for patients, but also, when severe, can cause seizures, coma, and even death. A Tragic Case Recently, our group published a case report in the journal Endocrine Practice describing a tragic death from hypoglycemia that occurred while the patient slept in his own bed. Our patient, a 23-year-old man with type 1 diabetes who had a history of recurrent severe hypoglycemia, was using an older model insulin pump and wearing a separate, non-real-time continuous glucose monitoring (CGM) system. He was given the CGM in 2005 for the purpose of tracking his nocturnal (nighttime) blood glucose values and making further insulin pump adjustments. After he was pronounced dead in the emergency room, our diabetes nurse removed the pump and CGM to help us understand what happened. His insulin pump was found to have been working correctly. What we learned was that after supper, he had a heavy workout at a gym, followed by a late snack. Between 8 pm and midnight, he “stacked” five boluses of insulin, totaling 7.35 units (33% of his basal dose), in an attempt to keep his glucose values in “tight” control. The downloaded sensor demonstrated that his glucose values fell from about 200 mg/dL at midnight to under 50 mg/dL by 2:00 am, and to under 30 mg/dL by 5:00 am – three hours before he was found by his pare Continue reading >>
Pumping Pitfalls Avoiding and dealing with pump-related problems For anyone who uses an insulin pump, there are bound to be occasional problems. For some, problems may be as rare as a Chicago Cubs’ World Series victory; for others they may occur as often as a Hollywood scandal. Insulin pumps, being mechanical devices, are subject to mishaps that can result in interruptions or irregularities in insulin delivery or action. When too little insulin is being infused into your body, high blood sugar will occur. When absorption is inconsistent, highs and lows can occur. And if no insulin is being delivered, diabetic ketoacidosis (DKA) can occur in just a few hours. Fending Off DKA DKA is a serious condition that will make you very ill and can kill you. The primary cause of DKA is a lack of working insulin in the body, accompanied by dehydration. When you are using an insulin pump, there is no long-acting insulin present in your body. Any interruption in insulin delivery can result in a sharp rise in blood sugar and ketone production can start as soon as three hours after the last bit of insulin was infused. The most important step in preventing ketoacidosis is early detection of the problem. You accomplish this by checking for ketones with any unusually high blood sugar levels. Everyone on a pump should be prepared to test for ketones and you can do this by way of a urine dipstick (ketostix or ketodiastix) or a fingerstick blood sample (Precion Xtra meter from Abbott). Positive ketones are indicated by either of the following: • Urine testing that indicates small, moderate or large levels of ketones (³15 mg/dl) • Blood testing that indicates the presence of b-Hydroxybutyrate (³.6 mmol/l) If your ketone test shows negative or trace amounts, your high blood sugar is prob Continue reading >>
High Alert: The Emergency Complications Of Diabetes
Diabetes has become such a chronic long-term condition that it’s easy to forget about the serious acute complications that can arise, which can lead to a coma or death if not treated. There are only two types of emergencies – having very high glucose and having a very low glucose. The warning signs of an looming coma range from a mild headache to hallucinations.. If not identified or treated both types of emergencies can lead to serious irreversible complications including brain damage, kidney failure and death. When your glucose is very very high The fundamental issue in diabetes is raised blood glucose levels. Medically this is called hyperglycaemia. When glucose rises very rapidly or to very high levels, it can result in a diabetic ketoacidotic coma or a hyperglycaemic coma. Diabetic ketoacidotic coma This happens in type 1 diabetes and the high risk people include children and teens. A person can go into a ketoacidotic coma within a few hours. A person in a ketoacidotic crisis presents with: a complete lack of insulin in the body very high glucose levels dehydration break down of muscle abnormal potassium, sodium and other electrolyte levels. Causes of ketoacidotic crisis or coma A person who hasn’t been diagnosed with diabetes as yet Missing an insulin dose Illness such as gastroenteritis, nausea and vomiting Not adjusting insulin when glucose is high What to look out for if you suspect you may be going into a ketoacidotic crisis or coma Shortness of breath Fruity smelling breath Nausea and vomiting Severe fatigue Abdominal pain and headache Thirst Passing urine more often. Danger signs to watch out for Slurred speech Blurred vision Reduced concentration Coma. What you must do if yoususpect you may be going into a ketoacidotic crisis or coma Get to a casualty Continue reading >>
‘i Was 26 And Most Type 1 Diabetics Are Diagnosed In Childhood': The Deadly Danger Too Many Diabetics Aren't Warned About
Hannah Postles discovered she had type 1 diabetes after going to A&E with blurred vision. It wasn’t her only symptom. For the previous three weeks, she’d been thirsty, drinking two bottles of water at lunch, had lost weight and felt run down. Scroll down for video ‘My boss suggested I might have diabetes after looking up my symptoms online, but my GP seemed to dismiss it because of my age,’ says Hannah, a press officer for the University of Sheffield. ‘I was 26 and most type 1 diabetics are diagnosed in childhood.’ Luckily, Hannah spoke to a doctor friend who told her to go to A&E, where she was tested for diabetes, and immediately put on an insulin drip. Type 1 diabetes occurs when the body doesn’t make insulin, the hormone that regulates glucose levels in the blood. Typically, people with type 1 diabetes are diagnosed around the age of 12 — although occasionally adults are diagnosed in later life. Type 2 diabetes, which can be diagnosed at any age, occurs when the body doesn’t produce enough insulin, or the insulin itself does not work properly. Not only did Hannah have diabetes, her blood sugar levels were so out of control by the time she was diagnosed that she had developed diabetic ketoacidosis, a life-threatening condition when blood glucose levels remain persistently high for days or weeks. The condition can be caused by illness or infection or by the mismanagement of diabetes — which, as Hannah, now 29, discovered, can be the result of not knowing you have it. Symptoms include vomiting, headaches, abdominal pain and, if left too long, coma and even death. Had Hannah not gone to A&E, she might have died. In July 2012, new mother Nicky Rigby, 26, from the Wirral, did die from undiagnosed type 1 diabetes. She’d assumed her chronic tiredness a Continue reading >>
Drunk Versus Diabetes: How Can You Tell?
Dispatch calls your EMS unit to the side of a roadway, where police officers have detained a driver on suspicion of driving under the influence of alcohol intoxication. You find the female driver handcuffed in the back seat of a police cruiser. She is screaming profanities and hitting her head against the side window. An officer tells you that she was weaving in and out of traffic at highway speed, and it took several minutes to pull her over. She was noncooperative and it took several officers to subdue her. She sustained a laceration to her head, which the officers want you to evaluate. The woman continues to swear at you as you open the car door. You note that she is diaphoretic and breathing heavily. You can smell what appears to be the sour, boozy smell of alcohol, even though you are not close to her. You can see that the small laceration near the hairline on her right forehead has already stopped bleeding. Her speech is slurred and she appears to be in no mood to be evaluated. The police officers are ready to take her down to the station to be processed for driving under the influence. Sound familiar? It should — this is a scene that is played out often in EMS systems. While it may seem initially that these incidents are not medical in nature, they really deserve close attention by the EMS personnel. In this article we will focus on the challenges of evaluating a patient who is intoxicated versus a patient who is experiencing an acute diabetic emergency. There have been numerous instances where EMS providers have exposed themselves to serious liability secondary to medical negligence. Let's take a closer look. Diabetes Diabetes is a serious disease that affects nearly 29 million people in the United States . Advances in diabetic care have resulted in an impr Continue reading >>
How Does Diabetic Ketoacidosis Kill You
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Ketosis: What Is Ketosis?
Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>
Confusing Ketosis With Ketoacidosis
Confusing Ketosis with Ketoacidosis Confusing Ketosis with Ketoacidosis – Nutrition professionals often say low-carb diets, and a very low-glycemic diet like that of the Roman Diet, cause ketoacidosis, a medical emergency that can kill you. This is completely false. They are confusing the words “ketosis” and “ketoacidosis” – which are vastly different. Ketosis does happen on low-carb diets and when following the Roman Diet, ahich is very low-glycemic and low in insulin demand. When the body is not getting the usual amount of carbohydrates typical in the western lifestyle, it releases fats from the fat tissues, which go to the liver and are turned into ketone bodies. Ketones are molecules that can cross the blood-brain barrier and provide energy for the brain when it isn’t receiving enough glucose. This is the body’s natural response to low-carb or very low-glycemic intake. This is NOT to be confused with ketoacidosis, which is something that only happens in uncontrolled diabetes, mainly uncontrolled type 1 diabetes. It involves the bloodstream being flooded with both glucose and ketone bodies in extremely large amounts. Ketoacidosis is dangerous, that is true. But that simply has nothing to do with low-carb or very low-glycemic diets. It has to do with better management of blood glucose levels, primarily with type 1 diabetes. In nutritional ketosis, or keto-adaptation, as long as sufficient insulin is present, there is no such risk of ketoacidosis. Interestingly enough, nutritional ketosis can actually help make blood sugar control more manageable! The metabolic state of ketosis has been proven to be therapeutic in many ways. It can help with epilepsy, brain cancer and type 2 diabetes, to name a few. (1-3) Stories of type 1 diabetics following ketogenic Continue reading >>
Diabetic ketoacidosis has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it. August 4, 2009 Good article nominee Listed Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Diabetic ketoacidosis. PubMed provides review articles from the past five years (limit to free review articles or to systematic reviews) The TRIP database provides clinical publications about evidence-based medicine. Other potential sources include: Centre for Reviews and Dissemination and CDC WikiProject Medicine [hide](Rated GA-class, Mid-importance) This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine. GA This article has been rated as GA-Class on the project's quality scale. Mid This article has been rated as Mid-importance on the project's importance scale. Comment The section "Ketone body production" is very poor; it needs rewritten. Ketones needn't be desribed as "fuel for the brain" - they are used in the production of acetyl-CoA. —Preceding unsigned comment added by Dermotmallon (talk • contribs) 10:54, 10 June 2008 (UTC) more re ketone bodies The mechanism section does not clearly explain the pathophysiology of DKA. I am not an expert, but I believe the release of acidifying ketone bod Continue reading >>
Diabetic Ketoacidosis (dka) Myths
Recently, I was asked to give a lecture to both my residents and nurses at the University of Texas Health Science Center at San Antonio (UTHSCSA) on some common DKA myths. Now this topic was originally covered by my good friend Anand Swaminathan on multiple platforms and I did ask his permission to create this blogpost with the idea of improving patient care and wanted to express full disclosure of that fact. I specifically covered four common myths that I still see people doing in regards to DKA management: We should get ABGs instead of VBGs After Intravenous Fluids (IVF), Insulin is the Next Step Once pH <7.1, Patients Need Bicarbonate Therapy We Should Bolus Insulin before starting the infusion DKA Myths Case: 25 y/o female with PMH of Type I DM who presents via EMS with AMS. Per EMS report, the patient ran out of her insulin 3 days ago….. Vital Signs: BP 86/52 HR 136 RR 30 O2Sat 97% on room air Temp 99.1 Accucheck: CRITICAL HIGH EMS was not able to establish IV access, so decided to just bring her to the ED due to how sick she looks. Your nurses are on point today and get you two large bore 18G IVs and start to draw blood work to send to the lab. You state I need a blood gas, and the nurse turns to you and asks do you need an ABG or VBG? Myth #1: We should get ABGs instead of VBGs in DKA So you do a literature review and come across two studies that specifically look at ABG vs VBG in an ED population: Study #1: Kelly AM et al. Review Article – Can Venous Blood Gas Analysis Replace Arterial in Emergency Medical Care. Emery Med Australas 2010; 22: 493 – 498. PMID: 21143397 For pH, 3 studies of patients with DKA (265 patients) were reviewed showing a weighted mean difference of 0.02 pH units. Only one study, which was the largest study (200 patients) reported 95% Continue reading >>
Why Diabetes Is So Dangerous
There’s a common saying in the diabetes community that diabetes won’t kill you, but it’s complications will. Still, according to the American Diabetes Association, diabetes was the 7th leading cause of death in the United States in 2010, with over 69,000 death certificates listing it as the underlying cause of death.  Add to that the common complications, like cardiovascular disease, kidney disease, and infection, and you can multiply that number by 10! Yet despite these eye-opening statistics, I still see far too many people not taking diabetes seriously. They approach it as something that’s a nuisance rather than something that can and does cause major health complications, and yes even death, if uncontrolled. “Sometimes I pretend I’m not diabetic, but that’s a dangerous game.” – Unknown Diabetes is more dangerous than most people assume, and so it becomes easy for many people with diabetes to get lax in their efforts to manage the dysfunction. A 2012 GAPP2 (Global Attitude of Patients and Physicians 2) survey found that 22% of insulin-using diabetic patients missed a basal insulin dose during a 30-day period.  There are very real dangers diabetes poses if left unchecked or mismanaged, and one of my goals today is to motivate you into taking better care of yourself or helping a loved one manage the disease better. Why is diabetes so dangerous? Because if not managed correctly, it can wreak havoc on just about every system and organ in the body. Let’s take a look at some of the biggest risks diabetic complications pose: Diabetic Ketoacidosis Diabetic Ketoacidosis is a very dangerous condition that can occur when patients neglect to take their insulin and have uncontrolled blood sugar. Since insulin is necessary to break down glucose as a sourc Continue reading >>
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 >>