Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. 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. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>
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 . 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 . 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 >>
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 >>
What Can Happen To My Body If My Sugar Is Higher Than 600 For Many Hours?
Dangerously high blood sugar levels cause ketoacidosis. A blood sugar level over 600 for many hours is considered extremely dangerous and should be treated at a hospital. Hyperglycemia is the medical term for elevated blood sugar levels. According to the American Diabetes Association, blood sugars more than 240 can cause ketoacidosis – a condition where the body starts using fat for energy. Ketoacidosis can lead to coma and death. Video of the Day Ketones And High Blood Sugar When blood sugar levels are high for prolonged periods of time and the body starts using fat for energy, toxic ketones are produced. The presence of ketones can be measured in the urine. They are the acid byproduct of fat breakdown. Diabetes is the most common cause of high blood sugar levels. Hyperglycemia can also be caused by acute pancreatitis. Early symptoms include frequent urination that leads to dehydration and excessive thirst. Blood sugar more than 600 for many hours could then lead to difficulty breathing, weakness, confusion and decreased level of consciousness. Blood sugar levels become dangerously high when the body does not have enough insulin, which is produced in the pancreas. When ketones develop in the body, the liver produces more glucose to correct the problem, but without insulin, blood sugar levels continue to rise. For patients diagnosed with diabetes, ketoacidosis can develop from missed insulin doses, not enough insulin, infection, trauma or other acute illness. Prolonged high blood sugar levels can cause swelling in the brain – cerebral edema. Children are more susceptible, but adult cases have been documented, according to Elliot J. Crane, MD, Departments of Pediatrics and Anesthesiology, Stanford University Medical Center. Other complications include organ damage fr 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 >>
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 >>
Type 1 Diabetes Diagnosis May Come With Brain Changes In Kids, Including Memory Loss
Diabetes is the seventh leading cause of the death in the United States. A new study reveals another disturbing detail. Researchers found that type 1 diabetes in children can cause brain loss, affecting memory and attention cognition. Diabetic ketoacidosis (DKA) is a harmful complication of Type 1 Diabetes that can gradually alter brain matter in newly diagnosed children. "Children and adolescents diagnosed with type 1 diabetes with diabetic ketoacidosis have evidence of brain gray matter shrinkage and white matter swelling," the study's lead author Dr. Fergus Cameron, head of diabetes services at Royal Children's Hospital in Victoria, Australia, told HealthDay. The recent study includes 36 children and teens with DKA and 59 without it. MRIs were taken over the course of six months. Those with DKA experienced a decrease in gray matter volume along with swelling of white matter. There was also evidence of memory loss and reduced sustained and divided attention. Symptoms tended to develop over time, raising a big concern for parents who might not notice any differences in their child right away. "Any decrement in attention or memory in children is a concern as children are acquiring new knowledge and learning new skills all the time," Cameron said. Cameron and his team found that 20 to 30 percent of children newly diagnosed with type 1 diabetes had DKA. According to the CDC, from 2002 to 2003, 15,000 youth in the United States were newly diagnosed with type 1 diabetes each year. "DKA still kills people, so we need to do better. We need better tools. And we need to educate doctors more on the symptoms of type 1 diabetes," Cameron said. The Juvenile Diabetes Research Foundation reports that type 1 diabetes is on the rise. Each year, 30,000 U.S. adults and children are diagn Continue reading >>
Introduction Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes caused by a lack of insulin in the body. Diabetic ketoacidosis occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a by-product called ketones. Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes. Symptoms of diabetic ketoacidosis include: passing large amounts of urine feeling very thirsty vomiting abdominal pain Seek immediate medical assistance if you have any of these symptoms and your blood sugar levels are high. Read more about the symptoms of diabetic ketoacidosis. Who is affected by diabetic ketoacidosis? Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes. Younger children under four years of age are thought to be most at risk. In about 1 in 4 cases, diabetic ketoacidosis develops in people who were previously unaware they had type 1 diabetes. Diabetic ketoacidosis accounts for around half of all diabetes-related hospital admissions in people with type 1 diabetes. Diabetic ketoacidosis triggers These include: infections and other illnesses not keeping up with recommended insulin injections Read more about potential causes of diabetic ketoacidosis. Diagnosing diabetic ketoacidosis This is a relatively straightforward process. Blood tests can be used to check your glucose levels and any chemical imbalances, such as low levels of potassium. Urine tests can be used to estimate the number of ketones in your body. Blood and urine tests can also be used to check for an underlying infec Continue reading >>
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 >>
Facts About The Vegetative And Minimally Conscious States After Severe Brain Injury
Mark Sherer, Ph.D., Monica Vaccaro, M.S., John Whyte, MD, Ph.D., Joseph T. Giacino, Ph.D., and the Consciousness Consortium, Model Systems Knowledge Translation Center Severe brain injury causes a change in consciousness. Consciousness refers to awareness of the self and the environment. Brain injury can cause a wide range of disturbances of consciousness. Some injuries are mild and may cause relatively minor changes in consciousness such as brief confusion or disorientation. The most severe injuries cause profound disturbance of consciousness. Twenty to 40% of persons with injuries this severe do not survive. Some persons who survive have a period of time of complete unconsciousness with no awareness of themselves or the world around them. The diagnosis given these people depends on whether their eyes are always closed or whether they have periods when their eyes are open. The state of complete unconsciousness with no eye opening is called coma. The state of complete unconsciousness with some eye opening and periods of wakefulness and sleep is called the vegetative state. As people recover from severe brain injury, they usually pass through various phases of recovery. Recovery can stop at any one of these phases. Characteristics of coma No eye-opening Unable to follow instructions No speech or other forms of communication No purposeful movement Characteristics of the vegetative state Return of a sleep-wake cycle with periods of eye opening and eye closing May moan or make other sounds especially when tight muscles are stretched May cry or smile or make other facial expressions without apparent cause May briefly move eyes toward persons or objects May react to a loud sound with a startle Unable to follow instructions No speech or other forms of communication No purposef Continue reading >>
Neurological Consequences Of Diabetic Ketoacidosis At Initial Presentation Of Type 1 Diabetes In A Prospective Cohort Study Of Children
OBJECTIVE To investigate the impact of new-onset diabetic ketoacidosis (DKA) during childhood on brain morphology and function. RESEARCH DESIGN AND METHODS 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. RESULTS 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. CONCLUSIONS 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. The incidence of childhood-onset type 1 diabetes varies from 0.1 to 57.6 per 100,000 and is increasing worldwide (1). Long 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
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 >>
Are People With Diabetes More Prone To Aggression?
Relationship Between Blood Glucose Level and Self-Control Blood sugar can make people do crazy things. According to a recent scientific study on the link between low blood glucose level and relationship clashes (Bushman et al, 2014), being hungry makes an individual generally cranky and act more hostile to others. In the study, couples who are hungry tend to have a much higher tendency to exhibit aggression towards each other and become more impulsive in their reactions. This phenomenon is often referred to “hangry” (meaning feeling angry when you are hungry). If this irritable state can happen to any healthy person who experiences a change in their blood glucose level, imagine the ordeals individuals with diabetes frequently go through on a daily basis. However, do not jump to the conclusion that diabetes leads to aggression. In fact, scientists find a more direct correlation between blood glucose level and self-control. I recommend reading the following articles: In a way, you can visualize self-control as a muscle that requires a lot of energy to sustain so that it does not become ineffective quickly. This energy source comes from the glucose in the blood. So what kind of activities can wear out this “muscle”? Any daily activities that require self-discipline such as forcing yourself to get out of bed early to exercise, resisting from having a soda drink or another cookie with your meal, stopping yourself from smoking, dealing with stressful situations at work and at home, and abstaining yourself from road rage. As you can see, self-control plays a crucial part in restraining inappropriate and aggressive behaviors. So when people are low in glucose, the self-control mechanism cannot function properly to prevent these outbursts of hostile actions. In a researc Continue reading >>
What is Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) is the hallmark of type 1 (insulin-dependent) diabetes mellitus. DKA is an emergency condition caused by a disturbance in your body’s metabolism. Extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Statistics on Diabetic Ketoacidosis Diabetic ketoacidosis can occur in between 16%-80% of children presenting with newly diagnosed diabetes. It remains the most common cause of death for young type 1 diabetes sufferers. Before the discovery of insulin, mortality rates were up to 100%. Today, the mortality has fallen to around 2% due to early identification and treatment. Death is usually caused by cerebral oedema (swelling of the brain). DKA is most common in type 1 diabetes sufferers but may also occur in those with type 2 diabetes mellitus. However, the latter group usually has at least some functioning insulin so suffer from another disorder called hyperosmolar non-ketotic coma (HONK). DKA tends to occur in individuals younger than 19 years, the more brittle of type 1 diabetic patients. However, DKA can affect diabetic patients of any age or sex. Risk Factors for Diabetic Ketoacidosis People with diabetes lack sufficient insulin, a hormone the body uses to metabolise glucose (a simple sugar) for energy. Therefore in diabetic patients glucose is not available as a fuel, so the body turns to fat stores for energy. However when fats are broken down they produce byproducts called ketones which build up in the blood and can be damaging to the body. In particular, accumulated ketones can “spill” over into the urine and make the blood become more acidic than body tissues (ketoacidosis). Blood gl 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 >>