Neurological Consequences Of Diabetic Ketoacidosis At Initial Presentation Of Type 1 Diabetes In A Prospective Cohort Study Of Children
Go to: To investigate the impact of new-onset diabetic ketoacidosis (DKA) during childhood on brain morphology and function. Patients aged 6–18 years with and without DKA at diagnosis were studied at four time points: <48 h, 5 days, 28 days, and 6 months postdiagnosis. Patients underwent magnetic resonance imaging (MRI) and spectroscopy with cognitive assessment at each time point. Relationships between clinical characteristics at presentation and MRI and neurologic outcomes were examined using multiple linear regression, repeated-measures, and ANCOVA analyses. Thirty-six DKA and 59 non-DKA patients were recruited between 2004 and 2009. With DKA, cerebral white matter showed the greatest alterations with increased total white matter volume and higher mean diffusivity in the frontal, temporal, and parietal white matter. Total white matter volume decreased over the first 6 months. For gray matter in DKA patients, total volume was lower at baseline and increased over 6 months. Lower levels of N-acetylaspartate were noted at baseline in the frontal gray matter and basal ganglia. Mental state scores were lower at baseline and at 5 days. Of note, although changes in total and regional brain volumes over the first 5 days resolved, they were associated with poorer delayed memory recall and poorer sustained and divided attention at 6 months. Age at time of presentation and pH level were predictors of neuroimaging and functional outcomes. DKA at type 1 diabetes diagnosis results in morphologic and functional brain changes. These changes are associated with adverse neurocognitive outcomes in the medium term. Continue reading >>
- Potato Consumption and Risk of Type 2 Diabetes: Results From Three Prospective Cohort Studies
- Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies
- Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study
Cerebral Edema In Children With Diabetic Ketoacidosis
INTRODUCTION Cerebral edema (or cerebral injury) is an uncommon but potentially devastating consequence of diabetic ketoacidosis (DKA). It is far more common among children with DKA than among adults. Young children and those with newly diagnosed diabetes are at highest risk. Symptoms typically emerge during treatment for DKA, but may be present prior to initiation of therapy. The pathophysiology, diagnosis, and treatment of cerebral edema in children with DKA will be discussed here. The diagnosis and treatment of DKA in children is discussed separately. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Treatment and complications of diabetic ketoacidosis in children and adolescents".) INCIDENCE Clinically significant cerebral edema occurs in approximately 1 percent of episodes of DKA in children and has a mortality rate of 20 to 90 percent [1-3]. Overall mortality rates for diabetic ketoacidosis (DKA) in children and adolescents range from 0.15 to 0.51 percent in national population studies in Canada, the United Kingdom, and the United States [4-9]; 50 to 80 percent of diabetes-related deaths are caused by cerebral edema [1,2,10]. Other causes of death from DKA include aspiration pneumonia, multiple organ failure, gastric perforation, and traumatic hydrothorax [5]. Subclinical brain swelling, as detected by ventricular narrowing on a computed tomography (CT) scan, has been reported in the majority of children with DKA in some studies [11,12], while others reported much smaller proportions [13]. All of these studies were limited by small numbers and lack of appropriate control groups. In a study of 41 children with DKA, the intercaudate width of the frontal horns of the lateral ventricles was measured by magnetic resonance Continue reading >>
Diabetic Ketoacidosis
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 (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. 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 DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>
Side Effects Of Sglt2 Inhibitors
SGLT2 Inhibitors SGLT2 inhibitors work by acting on the kidneys. SGLT2 inhibitors have also been linked with multiple kidney-related problems such as renal impairment and acute kidney injury. Serious urinary tract infections that can affect the kidneys, known as pyelonephritis, or cause blood infections, known as urosepsis, are also potential side effects. Brand names of SGLT2 inhibitors include Invokana, Invokamet, Farxiga, Glyxambi, Jardiance, Xigduo XR and Synjardy. Each of these medications has been associated with health risks. Some people who have suffered the side effects of SGLT2 inhibitors have sought legal compensation. Diabetic Ketoacidosis As well as causing problems with kidneys, the U.S. Food and Drug Administration (FDA) warned in a May 2015 Safety Announcement that SGLT2 inhibitors may result in a serious condition known as diabetic ketoacidosis. Usually, this condition can occur when a diabetic’s blood-sugar levels dip below a normal range, indicating that the body does not have enough glucose (or blood sugar), the body’s preferred sustenance. When the body lacks glucose, the body instead uses fat for fuel. The process of burning fat to fuel the body can produce a large amount of ketones, which are blood acids that can poison the body in excessive amounts. This state of excessive ketones in the body is diabetic ketoacidosis. When diabetic ketoacidosis occurs, the sufferer can fall into a diabetic coma. The effects of ketoacidosis can be lethal if the condition is not promptly addressed. The FDA has advised that patients should “stop taking their SGLT2 inhibitor and seek medical attention immediately if they have any symptoms of ketoacidosis. …” Treatment of ketoacidosis usually requires hospitalization. Normally, diabetic ketoacidosis is broug Continue reading >>
Original Articles Regional Brain Water Content And Distribution During Diabetic Ketoacidosis
To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply. We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients. ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation. ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions. Continue reading >>
Diabetic Ketoacidosis In Dogs And Cats
Ketoacidosis is a complication of diabetes in pets, and is one of the most severe side effects that can accompany the condition. Finding your pet seriously ill and receiving a diagnosis of diabetic ketoacidosis can be a big shock to the pet owner, as most presentations of the condition occur in animals that were not actually known to be diabetic in the first place. This is of course extremely worrying for the pet owner, as they will have to face not only the very serious and possibly life-threatening immediate issue of diabetic ketoacidosis itself, but have to face the reality that assuming their pet survives, they will have to deal with the serious and potentially expensive diagnosis of diabetes as well. What is ketoacidosis? Ketoacidosis occurs when the animal’s metabolism is thrown severely out of whack, as part of the development of diabetes in the pet. Usually, an additional trigger such as an inflammation, infection or condition such as pancreatitis is also required to trigger ketoacidosis, as any of these things can interfere with the way that the body regulates and processes glucose. Ketoacidosis starves the body’s cells of glucose, despite the fact that sufficient glucose is present within the blood. The diabetic element of this is that sufficient natural insulin is not being made available to the body to allow the glucose in the blood to enter the cells, as glucose requires insulin in order to metabolise. The body responds to this issue by metabolising all of the fat stores and other sources of fuel available to it, breaking down the very structure of the body itself. This process causes the production of ketones, which the body then attempts to burn as fuel, which is not a normal healthy process. In turn, the burning of ketones by the body leads to a dang Continue reading >>
Physical Dangers And Effects Of An Eating Disorder
IN ENGLISH :: EN ESPAÑOL :: EN FRANÇAIS Dangers :: Deficiencies :: Substitutes Pregnancy :: Medic Alert :: Methods Heart Attack & Stroke Physical Dangers and Effects of an Eating Disorder There are many men and women suffering with all types of Eating Disorders that do not appear in any specific weight range. Those with Anorexia can be slightly overweight... while those with Compulsive Eating can be slightly underweight. Variations for all who suffer can be anywhere from extremely underweight to extremely overweight to anywhere in between. The outward appearance of anyone with an Eating Disorder does NOT dictate the amount of physical danger they are in, nor does is determine the emotional conflict they feel inside. They need not display even close to all of the below symptoms to be in danger. Behaviors Associated with Eating Disorders Starvation and restriction of food, calories and/or fat grams sometimes accompanied by self-induced vomiting, laxatives, diuretics and obsessive exercise with any food intake, or without food intake at all. also see definitions of: Anorexia | Bulimia | Compulsive Overeating Binge and Purge episodes - abnormally large intake of food followed by self-induced vomiting, intake of laxatives or diuretics, obsessive exercise and/or periods of starvation. also see definitions of: Anorexia | Bulimia | Compulsive Overeating Overeating. Binge Episodes - abnormally large, uncontrollable intake of food. also see definitions of: Anorexia | Bulimia | Compulsive Overeating ALL Eating Disorders are Dangerous It is important to understand that even though a person may be suffering specifically with Anorexia, Bulimia or Compulsive Overeating, it is not uncommon for them to exhibit behaviors from each of the three. It is also not uncommon for one Eating Di Continue reading >>
Cerebral Edema: A Complication Of Dka
DKA, or diabetic ketoacidosis, is a severe life-threatening medical complication that must be treated by doctors in a hospital. DKA is a condition in which blood glucose levels have risen dangerously high due to lack of insulin and insulin resistance. Fat begins to break down in response to energy requirements leading to high ketone levels in the blood causing your blood to become too acidic. DKA sometimes leads to cerebral edema, which is brain swelling, and if left untreated, cerebral edema can cause brain damage or lead to death. Cerebral Edema: Its relationship to DKA In order to understand cerebral edema, you must understand diabetic ketoacidosis (DKA). DKA is a situation in which blood sugar levels rise to dangerous levels in response to a lack of insulin and insulin resistance. The liver keeps producing glucose, which collects in the blood. Normally, insulin will move that glucose out of the blood and into the cells that need it, but when there is insufficient insulin or significant insulin resistance, the glucose builds up to dangerous levels (severe hyperglycemia). Because the cells that need the glucose are not getting it (remember the glucose is stuck in the blood), they signal the body to produce more glucose through the breakdown of fat. The breakdown of fat results in fat components called ketones. When ketones continue to build up in your blood stream, the patient develops a condition called diabetic ketoacidosis or DKA. Symptoms include: Abdominal pain Signifant thirst Blurry vision Nausea and vomiting[1] Polyuria (Frequent urination) Polydipsia – excessive thirst that lasts for a day or more Weight loss Weakness Confusion Cold body temperature Acetone on the breath, Rapid breathing that is shallow then deep and labored– called Kussmaul’s respirati Continue reading >>
Cerebral Proton Magnetic Resonance Spectroscopy In Children With Diabetic Ketoacidosis
BACKGROUND AND PURPOSE: Subclinical cerebral edema occurs in many, if not most, children with diabetic ketoacidosis (DKA) and may be an indicator of subtle brain injury. Brain ratios of N-acetylaspartate (NAA) to creatine (Cr), measured by proton MR spectroscopy, decrease with neuronal injury or dysfunction. We hypothesized that brain NAA/Cr ratios may be decreased in children in DKA, indicating subtle neuronal injury. MATERIALS AND METHODS: Twenty-nine children with DKA underwent cerebral proton MR spectroscopy during DKA treatment (2–12 hours after initiating therapy) and after recovery from the episode (72 hours or more after the initiation of therapy). We measured peak heights of NAA, Cr, and choline (Cho) in 3 locations within the brain: the occipital gray matter, the basal ganglia, and periaqueductal gray matter. These regions were identified in previous studies as areas at greater risk for neurologic injury in DKA-related cerebral edema. We calculated the ratios of NAA/Cr and Cho/Cr and compared these ratios during the acute illness and recovery periods. RESULTS: In the basal ganglia, the ratio of NAA/Cr was significantly lower during DKA treatment compared with that after recovery (1.68 ± 0.24 versus 1.86 ± 0.28, P < .005). There was a trend toward lower NAA/Cr ratios during DKA treatment in the periaqueductal gray matter (1.66 ± 0.38 versus 1.91 ± 0.50, P = .06) and the occipital gray matter (1.97 ± 0.28 versus 2.13 ± 0.18, P = .08). In contrast, there were no significant changes in Cho/Cr ratios in any region. CONCLUSIONS: NAA/Cr ratios are decreased in children during DKA and improve after recovery. This finding suggests that during DKA neuronal function or viability or both are compromised and improve after treatment and recovery. Clinically apparent Continue reading >>
Clinical Review: Ketones And Brain Injury
Abstract Although much feared by clinicians, the ability to produce ketones has allowed humans to withstand prolonged periods of starvation. At such times, ketones can supply up to 50% of basal energy requirements. More interesting, however, is the fact that ketones can provide as much as 70% of the brain's energy needs, more efficiently than glucose. Studies suggest that during times of acute brain injury, cerebral uptake of ketones increases significantly. Researchers have thus attempted to attenuate the effects of cerebral injury by administering ketones exogenously. Hypertonic saline is commonly utilized for management of intracranial hypertension following cerebral injury. A solution containing both hypertonic saline and ketones may prove ideal for managing the dual problems of refractory intracranial hypertension and low cerebral energy levels. The purpose of the present review is to explore the physiology of ketone body utilization by the brain in health and in a variety of neurological conditions, and to discuss the potential for ketone supplementation as a therapeutic option in traumatic brain injury. Introduction Ketogenesis is the process by which ketone bodies (KB), during times of starvation, are produced via fatty acid metabolism. Although much feared by physicians, mild ketosis can have therapeutic potential in a variety of disparate disease states. The principle ketones include acetoacetate (AcAc), β-hydroxybutyrate (BHB) and ace-tone. In times of starvation and low insulin levels, ketones supply up to 50% of basal energy requirements for most tissues, and up to 70% for the brain. Although glucose is the main metabolic substrate for neurons, ketones are capable of fulfilling the energy requirements of the brain. The purpose of the present review is to e 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 >>
Diabetic Seizures – What Are They? Symptoms, Causes, And Treatments
A diabetic seizure is a serious medical condition and without emergency treatment, it has proven to be fatal. Extremely low levels of sugar in the diabetic’s blood cause these seizures. That is why it is so important for those who have diabetes to monitor and control their blood sugar. What Are the Causes? A number of different things can actually cause a diabetic seizure to occur. It could happen because too much insulin is injected, or because the diabetic did not eat right after taking insulin. Some of the other potential causes include not eating meals regularly or drinking too much alcohol. Even certain oral diabetes medications can make the body produce excess insulin. Those who are exercising too much without taking into account how this will affect their insulin levels will also be at a greater risk of suffering a diabetic stroke. No matter what causes the seizure, it is always a medical emergency and those who have one need immediate medical attention. What Are the Symptoms? When entering the first stages of a diabetic seizure, the person may exhibit a number of different symptoms. Some of the most common symptoms include: Sweating Clamminess Drowsiness Confusion Bodily shakes Hallucinations Rapid and unexpected emotional changes Weakness in the muscles Anxiety Vision changes Loss of ability to speak clearly After these initial symptoms, the next phase of symptoms begin and the danger level rises. Now, the person may stare into space and be non-communicative and uncontrollable body movements and contractions of the muscles may occur. In some cases, the diabetic will be unaware of the movements and may even fall into unconsciousness. What Is the Prevention and Treatment? The best way to deal with this problem is by ensuring it does not occur in the first place Continue reading >>
Diabetic Encephalopathy
Diabetic encephalopathy is damage to the brain caused by diabetes. A relatively unknown complication, encephalopathy is becoming more widely recognized as more people are diagnosed with type 1 and type 2 diabetes. Diabetic encephalopathy presents itself both mentally and physically. It can induce an altered mental state, cognitive decline, changes in personality, memory lapses, or severe impairment like dementia. The complication can also cause tremors, lack of coordination, and even seizures. Diabetic encephalopathy is largely due to acute hypoglycemia (blood sugar levels are too low) or severe hyperglycemia (blood sugar levels are too high). The condition manifests itself differently between the two major types of diabetes. Type 2 diabetes Encephalopathy in those with type 2 diabetes increases the risk of developing Alzheimer’s disease or other forms of dementia. According to a 2011 study, those with type 2 diabetes were twice as likely to develop Alzheimer’s and 1.75 times more likely to develop other forms of dementia than healthy participants. This increased risk could be due to many different factors brought about from type 2 diabetes. It could be caused by the body’s resistance to insulin, which makes it difficult for the brain to break down amyloid, a protein that forms brain plaques. Brain plaques are abnormal clusters of this protein that block cell-to-cell signaling at the synapses—a symptom infamous for contributing to the development of Alzheimer’s disease. Type 2 diabetic encephalopathy can also be generated from hyperglycemia or the conditions that commonly accompany type 2 diabetes like high blood pressure, obesity, or high cholesterol. Oxidative stress is another provoker of the complication. This stems from an imbalance between reactive oxyge Continue reading >>
Diabetic Ketoacidosis: Information On Causes, Diagnosis & Treatments
Diabetic ketoacidosis (DKA) is a potentially life-threatening diabetes complication caused by the buildup of acids in the bloodstream when cells are unable to retrieve glucose (sugar) required for energy. DKA is often the result of the body not producing sufficient levels of insulin that allows sugar to transfer into the cells. Instead, the glucose builds up in the bloodstream producing dangerous levels of acid. The Cause of DKA Typically, diabetic ketoacidosis is caused when the body does not produce enough insulin and the body is unable to transfer glucose energy from the bloodstream into cells. Instead, the body burns fat for fuel. However, this process causes ketones (acids made by burning fat) to build up in the bloodstream. The high levels of acid can significantly change the chemical balance of the bloodstream and disrupt normal body functioning. Infections can also result in the development of diabetic ketoacidosis because the infectious bacteria can cause the body to produce excessive levels of cortisol, adrenaline and other hormones that affect the production of insulin. These include urinary tract infections and pneumonia. Preventing DKA Who Gets Diabetic Ketoacidosis? Typically, individuals suffering from Type I diabetes have the highest potential risk of developing ketoacidosis. This is because the condition causes the body to make insulin. Instead, the development of ketones can occur when the individual misses a meal, become stressed or sick and or has experiences of insulin reaction. Any problem associated with insulin therapy can trigger diabetic ketoacidosis as can other events including a heart attack, emotional or physical trauma, drug use, alcohol abuse, and taking certain drugs including diuretics and corticosteroids. Additionally, individual suffe Continue reading >>
How To Help Someone In A Coma
Author's Sidebar: Every once in a while, I'll get a phone call or an email message from a person, who has a relative in the hospital in a diabetic coma. I can usually tell by the tone in their voice that they are desperate, afraid and uncertain what to do. These types of phone calls are difficult, because there's nothing that I can do to help them. Usually, I suggest that the person make sure that they share as much information that they can about the person's health with the doctors and nurses. The more that you know about the person's health, the better it can help the doctors understand what is happening. Another thing that I usually suggest is to keep a notebook or journal of what's going on and ask questions, but be respectful to the medical staff. Use the notebook for taking notes when the doctors tell you things about the patient's condition, etc. Otherwise, you will never remember what was said to relay to other family members. When a large family is involved it gets tiring to keep repeating the same information -- so they can read your notebook. Also, write down all the pertinent phone numbers and emails of people who would need to be contacted when changes in condition occur. There are usually a lot of people who want this information and having email addresses makes it easier than trying to call everyone. Keeping notes is also a good way to keep busy. A journal may not only serve as a method for coping with grief, it may also be helpful for the patient when they come out of the coma -- to realize what happened to them. If the person has a smartphone or similar device, usually I'll suggest that they google phrases like "diabetic coma" to better understand what is going on. If the hospital allows it, bring a small CD player or tape player and play some of the p Continue reading >>
