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Can You Get Brain Damage From Ketoacidosis?

Drunk Versus Diabetes: How Can You Tell?

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 [1]. Advances in diabetic care have resulted in an impr Continue reading >>

Clinical Review: Ketones And Brain Injury

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 >>

Getting To Know Ketones

Getting To Know Ketones

People with diabetes, particularly those with Type 1 diabetes, have been at least vaguely aware of the word ketones for a long time. With the recent resurgence of popular interest in low-carbohydrate diets, however, just about everyone seems to be talking about ketones these days. But does anyone really know what ketones are? Are they a danger to your health (as in diabetic ketoacidosis), or a sign that you have lowered your carbohydrate intake enough to cause weight loss (as some people who follow low-carbohydrate diets believe)? What are ketones? Ketones are end-products of fat metabolism in the body. That is, they are formed when fat is burned for energy by the muscles. Chemically, they are acids known as ketone bodies, and there are three types: beta-hydroxybutyric acid, aceto-acetic acid, and acetone. But you don’t have to be a chemist to understand what role they play in the body. To get to know ketones, it’s helpful to understand how your body burns fuel. A simple analogy is that of an automobile. For a car engine to run, the engine must burn fuel (gasoline), and when the fuel is burned, exhaust (carbon monoxide) is created. The carbon monoxide is the end-product of gasoline combustion. Your body also has an engine that must burn fuel to operate. The engine is muscle, and the fuel is fat, carbohydrate (glucose), and, in certain conditions, protein. When fat is burned, the “exhaust” is ketones, and when glucose is burned, the “exhaust” is lactic acid. Fat is more desirable as a fuel than glucose because there are more calories in a gram of fat (9 calories per gram) than there are in a gram of glucose (4 calories per gram), so you get more energy per gram of fat burned. In a sense, you could call fat a high-test fuel. But there is one catch to burning f Continue reading >>

Is The Brain Affected In Diabetes Mellitus?

Is The Brain Affected In Diabetes Mellitus?

Didi....This is a very good question because the impact of diabetes on the brain is actually overlooked. Theoretically, one can say that since diabetes affects so many organs in the body, therefore, it might affect the brain as well. Practically speaking, it has been shown that chronic hyperglycemia leads to the release of mediators that cause chronic brain inflammation, reduce blood flow and damage the cells. In fact hyperglycemia raises the risk of having dementia and depression. The chances of becoming depressed or getting dementia increases when diabetes complications develop and decreases in diabetic people with good blood sugar control. Besides, cardiovascular complications could contribute to stroke by blocking the blood flow to the brain. Another way in which diabetes can affect the brain is ketoacidosis, that occurs most likely in Type I diabetes, where the brain cannot handle the excessive amounts of ketone bodies. We must not forget that hypoglycemia, resulting from an overdose of antidiabetic drugs, leads to hypoglycemic coma. Continue reading >>

How Does Type 1 Diabetes Affect Your Brain?

How Does Type 1 Diabetes Affect Your Brain?

Many tools and tips can help you control your type 1 diabetes. But left unchecked, it can affect several organs, including your brain. Big spikes and dips in blood sugar levels are linked to depression, shortened attention spans, and slowed reaction times, both physically and mentally. More research needs to be done for experts to figure out the exact short-term and long-term effects of diabetes on the brain -- but they're hopeful that they’ll find ways to prevent and even reverse damage. A 2014 study published by the American Diabetes Association shows that really high blood sugar (hyperglycemia) can slow the growth of a brain as it develops. The same is true when a child’s levels swing up and down a lot. Brain scans show differences between a child with diabetes and one without. Still researchers found no major differences in their IQs, mood, behavior, and learning and memory skills. It’s still unknown if the disease can affect things like their muscle movements and how fast they process information. Adults who’ve had type 1 for a long time have slower physical and mental reactions. The condition doesn’t seem to impact a person’s learning and thinking skills, researchers say. But memory and attention span can be affected. Type 1, like type 2, is linked with a high rate of depression. High blood sugar levels and the stress of managing a long-term disease are to blame. The best defense is to control your blood sugar, eat a healthy diet, and follow all of your doctor’s instructions. The longer your levels stay really high or low, or swing to extremes, the more likely your brain will be affected. Continuous glucose monitors are a great tool, since they measure blood sugar every 5 minutes. 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 >>

Diabetic Ketoacidosis

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 >>

Ketogenic Diet: 25 Proven Benefits And How To Know If It’s Right For You

Ketogenic Diet: 25 Proven Benefits And How To Know If It’s Right For You

The ketogenic diet has been touted for its many health benefits such as weight loss, cognitive function, neurodegenerative diseases, and cancer. In this post, we cover: Different ways to get into ketosis Physiology and pathways that are changed when you are in ketosis, which explains how the ketogenic diet derives its benefits Genetic factors that may affect the safety and effectiveness of ketosis 17 Health conditions that may be helped by the ketogenic diet Negative effects of ketosis and how to mitigate them Ketogenic Diets Improve Cognitive Function and Brain Health Ketogenic Diet as a Cancer Treatment Ketogenic diets are defined by a low carbohydrate (typically under 50 grams/day) and high fat intake, leading to an elevation of free fatty acids and ketone bodies in the blood (R). The first ketogenic diets in the medical literature are noted in publications in the 1920s, although wider popularity and increased research was not seen in medical literature until the 1960s (R). Variations of the diets have remained popular for the past 20-30 years, with proponents claiming that the diets boost weight loss and energy while offering protection from certain metabolic diseases (R). A ketogenic diet and fasting affect the body similarly. Both deplete the body’s glucose reserves, so the body starts turning fatty acids into ketones (R). When the body doesn’t have enough carbohydrates from food, it burns fat by producing ketones or ketone bodies (R, R). In non-diabetics, ketosis can be achieved in 3 ways, i.e. Fasting or severe caloric restriction (R) Prolonged physical exercise in fasted state, depending on intensity and duration (R, R2) Nutritional ketosis, i.e. by consuming a very low carbohydrate diet Supplementation, such as by supplementing with medium chain triglyceri 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. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>

Children With Type 1 Diabetes At Risk For Life-threatening Diabetic Ketoacidosis

Children With Type 1 Diabetes At Risk For Life-threatening Diabetic Ketoacidosis

Two weeks before a family vacation last spring, 10-year-old Hailey Evans started to drink a lot more water. Her parents didn’t think much of it, given that Hailey had just joined a running team at her school in Northern Virginia and was exercising more. Not long after landing in Bolivia, where one of Hailey’s grandparents lives, she complained of a stomachache and nausea. Altitude sickness, her parents figured. Then Hailey took a sudden turn for the worse. Hospitalized the next day, she was diagnosed with Type 1 diabetes within an hour. A few hours after that, she was in coma caused by swelling in her brain and severe dehydration. The next morning, April 20th, Hailey died, two weeks shy of her 11th birthday. Hailey’s devastated parents, Vanessa and Derrick Evans, now have joined a growing chorus of voices determined to raise awareness of Type 1 diabetes and push for more regular blood sugar testing. While Type 1 diabetes is the second most common chronic illness of childhood—trailing only asthma—it can mimic other common ailments and often is missed until it has taken a potentially deadly turn. “We had no idea,” Vanessa Evans says. “I wish I would have known, because maybe taking her to the doctor sooner would have saved her life. I would have never thought this could happen to anyone, much less us, yet here we are, left without our beautiful daughter. I don’t wish this pain on anyone. As we learned the hard way, with this disease, every minute, every hour, every day counts.” Cases of Type 1 diabetes are increasing worldwide, particularly in young children. Warning signs can include extreme thirst, frequent urination, a fruity breath odor and blurred vision, as well as generalized symptoms such as fatigue, nausea, stomachache, appetite changes and we 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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin deficiency, and the action of counter-regulatory hormones, blood glucose increases leading to hyperglycemia and glucosuria. Glucosuria causes an osmotic diuresis, leading to water & Na loss. In the absence of insulin activity the body fails to utilize glucose as fuel and uses fats instead. This leads to ketosis. Pathophysiology/2 The excess of ketone bodies will cause metabolic acidosis, the later is also aggravated by Lactic acidosis caused by dehydration & poor tissue perfusion. Vomiting due to an ileus, plus increased insensible water losses due to tachypnea will worsen the state of dehydr Continue reading >>

Cerebral Edema And Diabetic Ketoacidosis

Cerebral Edema And Diabetic Ketoacidosis

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. Fortunately, it is relatively rare, but the rarity can lead to some confusion when it comes to its management. We recently discussed the use of mannitol and hypertonic saline for pediatric traumatic brain injury, but when should we consider these medications for the patient presenting with DKA? Cerebral Edema is a relatively rare. Incidence <1% of patients with DKA. Overall tends to occur in the newly diagnosed diabetic patient (4.3% vs 1.2%). While rare, it is a devastating complication. 1990 study showed case fatality rate was 64%. Those treated BEFORE respiratory failure had lower rate of mortality (30%). Lesson = treat early! The exact mechanism is not known… and may be varied between individual patients. Signs and Symptoms develop in: 66% within the first 7 hours of treatment (these tend to be younger). 33% within 10-24 hours of treatment. The diagnosis is clinical! ~40% of initial brain imaging of kids with cerebral edema are NORMAL! This is the area that often leads to finger pointing… most often those fingers being pointed toward the Emergency Physician who was initially caring for the kid. Much of the literature focused on interventions, but: Administration of Bicarb Sodium Bicarb was shown to be associated with Cerebral Edema in one study… Unfortunately, this study did not adjust for illness severity. Type of IV Fluids Generally, there is an absence of evidence that associates volume, tonicity, or rate change in serum glucose with Cerebral Edema development. There are cases presenting with cerebral edema prior to any therapies. Risk Factors that seem to stay consistent: Kids < 5 years of age More likely to have delayed diagnosis More severely ill at presentation S Continue reading >>

Dka In Hypoglycemia

Dka In Hypoglycemia

#2 0 They are two different entities. While they will both cause acidosis the mechanism of acidosis is different. DKA is from ketosis and acidosis from Hypoglycamia is lactic acid. Is this what you are asking? Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. Diabetic Ketoacidosis Causes, Symptoms, and Treatment by eMedicineHealth.com An insulin reaction occurs when a person with diabetes becomes confused or even unconscious because of hypoglycemia (hypo=low + glycol = sug Continue reading >>

Increased Activity Of Inflammasomes As Osmosensors As Cause Of Cerebral Edema In Diabetic Ketoacidosis

Increased Activity Of Inflammasomes As Osmosensors As Cause Of Cerebral Edema In Diabetic Ketoacidosis

Abstract Diabetic ketoacidosis (DKA) related cerebral edema (CE) is associated with a high mortality and rate of neurodisability and neurocognitive difficulties. In 54% of children with DKA there is subclinical evidence of CE on MRI studies. It is known that DKA is accompanied by a systemic inflammatory response characterized by elevated cytokine levels including interleukin-1 (IL-1) and interleukin-6. IL-1 has been linked to the pathogenesis of CE. Inflammasomes like nucleotide binding domain and leucine-rich repeat containing proteins 3 (NRLP3) are multiprotein complexes generating the active form of IL-1 in response to high glucose levels. The resulting hypothesis is that increased activity of inflammasomes as osmosensors is the cause of CE in diabetic ketoacidosis. Confirmation of the hypothesis could be achieved by correlation of IL-1 and NRLP3 levels and expression with degree of subclinical CE on MRI imaging and peripheral blood glial fibrillary acidic protein levels (a marker of brain injury). If confirmed future randomized controlled trials could use NRLP3 inhibitors and IL-1 antagonists as auxiliary treatment in DKA and measure neurocognitive outcome. Key words NLRP, cerebral edema, systemic inflammatory response syndrome Background Clinically manifest cerebral edema (CE) in diabetic ketoacidosis is rare in high income countries (0 to 5.5% of cases) and significantly more common in low income countries (24 to 26% of cases) [1]. Mortality of severe diabetic ketoacidosis (DKA) is high with more than 20% and survivors are at a significant risk of at least 27% [2] of permanent neurodisability. The pathogenesis of the associated CE is unclear. There is subclinical and mild, not formally diagnosed CE, which was detected in a previous study, which measured the interc Continue reading >>

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