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Can You Have A Fever With Dka?

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Together with hyperglycemic coma, diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of diabetes mellitus [ 1 ]. Defined by the triad hyperglycemia, acidosis, and ketonuria, DKA can be inaugural or complicate known diabetes [ 2 ]. Although DKA is evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient's requirements and the treatment, DKA-related mortality is low among patients who receive standardized treatment, which includes administration of insulin, correction of hydroelectrolytic disorders, and management of the triggering factor (which is often cessation of insulin therapy, an infection, or a myocardial infarction) [ 3–8 ]. Although there is no proof that diabetics are more susceptible to infection, they seem to have more difficulty handling infection once it occurs [ 9 , 10 ]. Indeed, several aspects of immunity are altered in diabetic patients: polymorphonuclear leukocyte function is depressed, particularly when acidosis is present, and leukocyte adherence, chemotaxis, phagocytosis, and bactericidal activity may also be impaired [ 11–15 ]. Joshi et al. [ 10 ] reported recently on the lack of clinical evidence that diabetics are more susceptible to infection than nondiabetic patients. Nevertheless, infection is a well-recognized trigger of DKA. Earlier studies have investigated the prevalence of infection as a trigger of DKA and the impact of antimicrobial treatment [ 2 , 15–18 ]. However, none of these studies were of intensive care unit (ICU) patients only. Furthermore, most were descriptive, included small numbers of patients, used univariate analysis only, and did not designate infection as the sole outcome variable of interest. Efforts to identify correlates of infection h Continue reading >>

Type 1 Diabetes And Your Child: Preventing Diabetic Ketoacidosis (dka)

Type 1 Diabetes And Your Child: Preventing Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. It can lead to coma or death. A child with DKA has: High blood sugar (hyperglycemia) An imbalance of chemicals in the blood (metabolic acidosis) High levels of ketones in the blood and urine Ketones are the waste product when the body breaks down fat for energy. This happens when there isn't enough insulin and the body isn't able to use sugar (glucose). Ketones can build up in the blood and then in the urine. Ketosis is a warning sign of DKA. DKA is more common in children with type 1 diabetes. But, it can also occur in children with type 2 diabetes. DKA is a medical emergency. If your child has high ketones and symptoms of DKA described below, call 911 or take him or her to the hospital emergency department. What are the causes of DKA? The most common causes of DKA are: Missing a dose of insulin Illness (flu, cold, or infection) An insulin pump that is not working properly Insulin that has expired or has not been stored properly What are the symptoms of DKA? If your child has high ketones in the blood or urine and symptoms of DKA, call 911 or go to the hospital emergency department. Symptoms of DKA include: Nausea Vomiting Fruity-smelling breath Stomach cramps Very dark urine or no urine in 6 hours Fast breathing Thirst or very dry mouth Drowsiness, confusion, or unresponsiveness When to check for ketones Check for ketones in your child's urine or blood as instructed by his or her healthcare provider. In general, check for ketones when your child has any of the above symptoms, or has: Blood sugar above 250 mg/dL. Diarrhea or vomiting. Fever of 100.4?F (38?C) oral or 101.4?F (38.5?C) rectal or higher, or as directed by your child's healthcare provider How to check for ketones Ask your child's healthcare Continue reading >>

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than 100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for <1% of all primary diabetic admissions.1 Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness.2 Contrary to popular belief, DKA is more common in adults than in children.1 In community-based studies, more than 40% of African-American patients with DKA were >40 years of age and more than 2 Continue reading >>

Dengue Hemorrhagic Fever Complicated With Transient Diabetic Ketoacidosis: A Case Report

Dengue Hemorrhagic Fever Complicated With Transient Diabetic Ketoacidosis: A Case Report

Abstract The increasing global prevalence of both dengue and diabetes may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue. Dengue illness is rarely known to precipitate diabetic ketoacidosis among diabetic patients. Both type 1 and type 2 diabetes increase the release of pro-inflammatory cytokines by various mechanisms and increase the risk of plasma leak in dengue fever. Acute pancreatitis is an atypical and rare presentation of dengue fever. We report a case of transient diabetic ketoacidosis in a previously well man which was challenging for the treating physician. Case presentation A 26-year-old previously healthy Sri Lankan Sinhalese man presented to hospital with dengue hemorrhagic fever in compensated shock. He was found to have diabetic ketoacidosis and was managed with hydration and insulin infusion. Following recovery from dengue shock, his sugars normalized and ketogenesis stopped without exogenous insulin. Transient hyperglycemia with ketoacidosis, such as in our patient, has not been reported in the literature. Dengue virus inducing a transient pancreatitis during the viremic phase, however, is a possibility. Notes Not applicable Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. CD and IBG examined, assessed and were involved in the management of the patient. Both authors collected and analyzed data. Both authors read and approved the final manuscript. Ethics approval was not obtained for the publication of this case report as this does not involve sharing of any personal details or photographs of the patient. Written informed consent was obtained from the patient for publication of this case report and Continue reading >>

The Emedicinehealth Doctors Ask About Diabetic Ketoacidosis:

The Emedicinehealth Doctors Ask About Diabetic Ketoacidosis:

A A A Diabetic Ketoacidosis (cont.) A person developing diabetic ketoacidosis may have one or more of these symptoms: excessive thirst or drinking lots of fluid, frequent urination, general weakness, vomiting, loss of appetite, confusion, abdominal pain, shortness of breath, a generally ill appearance, increased heart rate, low blood pressure, increased rate of breathing, and a distinctive fruity odor on the breath. If you have any form of diabetes, contact your doctor when you have very high blood sugars (generally more than 350 mg) or moderate elevations that do not respond to home treatment. At initial diagnosis your doctor should have provided you with specific rules for dosing your medication(s) and for checking your urinary ketone level whenever you become ill. If not, ask your health care practitioner to provide such "sick day rules." If you have diabetes and start vomiting, seek immediate medical attention. If you have diabetes and develop a fever, contact your health care practitioner. If you feel sick, check your urinary ketone levels with home test strips. If your urinary ketones are moderate or higher, contact your health care practitioner. People with diabetes should be taken to a hospital's emergency department if they appear significantly ill, dehydrated, confused, or very weak. Other reasons to seek immediate medical treatment include shortness of breath, chest pain, severe abdominal pain with vomiting, or high fever (above 101 F or 38.3 C). Continue Reading A A A Diabetic Ketoacidosis (cont.) The diagnosis of diabetic ketoacidosis is typically made after the health care practitioner obtains a history, performs a physical examination, and reviews the laboratory tests. Blood tests will be ordered to document the levels of sugar, potassium, sodium, and oth Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Short-term high blood sugars are rarely lethal. However, for people with type 1 diabetes and some with type 2 who are not producing enough insulin, periods of high blood sugars can lead to diabetic ketoacidosis. The absence of insulin allows your blood to slowly become acidic. The body’s cells cannot survive under acidic conditions so the liver will try to help the cells that are starved for glucose and secrete glucose. When combined with dehydration, this process accelerates into a poisonous cocktail that undermines the heart, impairs the brain, and can lead to death in days. Prolonged high blood sugars can be caused by missing insulin doses, problems with an insulin pump, being sick with the flu or other illness, or eating more carbohydrates than your body has insulin to process. Who Can Develop Diabetic Ketoacidosis (DKA)? People with type 1 diabetes and type 2 diabetes can develop DKA. Most at risk however, are people with type 1 diabetes because they don’t make any insulin of their own and most people with type 2 diabetes do usually make some of their own insulin. Oftentimes DKA develops in people who have not yet been diagnosed with diabetes. Once diagnosed, people with diabetes can avoid DKA if they learn to recognize the beginning symptoms. How Do I Know If I Have Diabetic Ketoacidosis (DKA)? DKA can develop slowly or quickly. At first, it mimics the symptoms of high blood sugar: thirstiness dry mouth frequent urination You will likely have high blood sugars and ketones in your urine (more on this below). If your body still doesn’t get the insulin it needs, your blood becomes more acidic. you will likely feel tired your body might start to feel very achy like when you have a high fever. When any of the following symptoms occur, your condition has likely pr Continue reading >>

Diabetic Ketoacidosis Clinical Presentation

Diabetic Ketoacidosis Clinical Presentation

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

A Case Of Diabetic Ketoacidosis Following Chikungunya Virus Infection

A Case Of Diabetic Ketoacidosis Following Chikungunya Virus Infection

Go to: Case Report A 50-year-old Puerto Rican man with type 1 diabetes mellitus and hyperlipidemia visiting St. Louis, MO on a business trip presented to our hospital on the third day of his trip complaining of 2 days of subjective fever, weakness, diffuse myalgias, nausea, and large-volume diarrhea. He denied recent or ongoing arthralgias. Symptoms started 1 day after landing in the United States. He took over-the-counter acetaminophen (paracetamol) with some relief. He denied recent travel outside of Puerto Rico or the United States. Additional history revealed several mosquito bites in Puerto Rico prior to the day of travel. In addition, he denied sick contacts, dietary changes, or abdominal pain. Home medicines included simvastatin 40 mg by mouth (PO) daily, insulin glargine 40 units (U) administered subcutaneously at night, and 10 U of subcutaneous insulin lispro three times daily with meals. Per history, he did not take his insulin lispro and self-reduced his insulin glargine dose from 40 to 15 U for the 2 days prior to presentation due to poor PO intake. The patient had no known drug allergies, was single, drank alcohol socially, and denied tobacco or illicit drug use. There was no history of travel to west Africa. The review of systems was otherwise negative except as noted. Upon admission in the emergency department, the patient's temperature was 36.9°C, heart rate 99 beats per minute, respiratory rate 12 breaths per minute, blood pressure 107/69 mmHg, and oxygen saturation 98% on room air. He was a well-dressed, well-nourished man in mild distress, preferring to keep his eyes closed and was speaking quietly. He had dry mucous membranes and anicteric sclerae. Cardiac exam revealed regular rate and rhythm without jugular venous distension or lower extremity ede Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

WHAT YOU NEED TO KNOW: What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your blood sugar levels become high because your body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels. What increases my risk for DKA? Not enough insulin Poorly controlled diabetes Infection or other illness Heart attack, stroke, trauma, or surgery Certain medicines such as steroids or blood pressure medicines Illegal drugs such as cocaine Emotional stress Pregnancy What are the signs and symptoms of DKA? More thirst and more frequent urination than usual Abdominal pain, nausea, and vomiting Blurry vision Dry mouth, eyes, and skin, or your face is red and warm Fast, deep breathing, and a faster heartbeat than normal for you Weak, tired, and confused Fruity, sweet breath Mood changes and irritability How is DKA treated? DKA can be life-threatening. You must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring your blood sugar level back to normal. How can I help prevent DKA? The best way to prevent DKA is to control your diabetes. Ask your healthcare provider for more information on how to manage your diabetes. The following may help decrease your risk for DKA: Monitor your blood sugar levels closely if you have an infection, are stressed, sick, or experience trauma. Check your blood sugar levels often. You may need to check at least 3 times each day. If your blood sugar level is too high, give yourself insulin as Continue reading >>

Ketoacidosis: A Diabetes Complication

Ketoacidosis: A Diabetes Complication

Ketoacidosis can affect both type 1 diabetes and type 2 diabetes patients. It's a possible short-term complication of diabetes, one caused by hyperglycemia—and one that can be avoided. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious complications of diabetes. These hyperglycemic emergencies continue to be important causes of mortality among persons with diabetes in spite of all of the advances in understanding diabetes. The annual incidence rate of DKA estimated from population-based studies ranges from 4.8 to 8 episodes per 1,000 patients with diabetes. Unfortunately, in the US, incidents of hospitalization due to DKA have increased. Currently, 4% to 9% of all hospital discharge summaries among patients with diabetes include DKA. The incidence of HHS is more difficult to determine because of lack of population studies but it is still high at around 15%. The prognosis of both conditions is substantially worsened at the extremes of age, and in the presence of coma and hypertension. Why and How Does Ketoacidosis Occur? The pathogenesis of DKA is more understood than HHS but both relate to the basic underlying reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counter regulatory hormones such as glucagons, catecholamines, cortisol, and growth hormone. These hormonal alterations in both DKA and HHS lead to increased hepatic and renal glucose production and impaired use of glucose in peripheral tissues, which results in hyperglycemia and parallel changes in osmolality in extracellular space. This same combination also leads to release of free fatty acids into the circulation from adipose tissue and to unrestrained hepatic fatty acid oxidation to ketone bodies. Some drugs ca Continue reading >>

Diabetic Emergencies, Part 5: Dka Case Studies

Diabetic Emergencies, Part 5: Dka Case Studies

Case Study 1 A 32-year-old male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Fever and cough started 2 days ago and the patient could not eat or drink water. He has been treated with an intensive insulin regimen (insulin glargine 24 IU at bedtime and a rapid-acting insulin analog before each meal). On examination he was tachypneic, his temperature was 39° C (102.2° F), pulse rate 104 beats per minute, respiratory rate 24 breaths per minute, supine blood pressure 100/70 mmHg; he also had dry mucous membranes, poor skin turgor, and rales in the right lower chest. He was slightly confused. Rapid hematology and biochemical tests showed hematocrit 48%, hemoglobin 14.3 g/dl (143 g/L), white blood cell count 18,000/ μ l, glucose 450 mg/dl (25.0 mmol/L), urea 60 mg/dl (10.2 mmol/L), creatinine 1.4 mg/dl (123.7 μ mol/L), Na+ 152 mEq/L, K+ 5.3 mEq/L, PO4 3−2.3 mEq/L (0.74 mmol/L), and Cl− 110 mmol/L. Arterial pH was 6.9, PO 2 95 mmHg, PCO 2 28 mmHg, HCO 3−9 mEq/L, and O 2 sat 98%. The result of the strip for ketone bodies in urine was strongly positive and the concentration of β-OHB in serum was 3.5 mmol/L. Urinalysis showed glucose 800 mg/dl and specific gravity 1030. What is your diagnosis? The patient has hyperglycemia, ketosis, and metabolic acidosis. Therefore, he has DKA. In addition, because of the pre-existing fever, cough, localized rales on auscultation and high white blood cell count, a respiratory tract infection should be considered. The patient is also dehydrated and has impaired renal function. Do you need more tests to confirm the diagnosis? Determination of the effective serum osmolality and anion gap should be performed in all patients presenti Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Case Reports in Medicine Volume 2015 (2015), Article ID 821397, 3 pages Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA Academic Editor: Christos D. Lionis Copyright © 2015 Omar Nadhem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis. 1. Introduction Latent autoimmune diabetes in adult (LADA) is an autoimm Continue reading >>

Take Care Of Yourself When Sick Or Under Stress

Take Care Of Yourself When Sick Or Under Stress

When we're stressed, our bodies need extra energy to help us cope and recover. This is true whether bodies are under stress from illness or injury or are dealing with the effects of emotional stress, both good and bad. To meet the demand for more energy, the body responds by releasing into the bloodstream sugar that's been stored in the liver, causing blood sugar levels to rise. In someone without diabetes, the pancreas responds to the rise in blood sugar by releasing enough insulin into the bloodstream to help convert the sugar into energy. This brings blood sugar levels back down to normal. In someone with diabetes, the extra demand usually means needing to take more diabetes medicine (insulin or pills.) To make sure your body is getting enough medicine to help keep your blood sugar levels close to normal, you'll need to test more often when you are: Sick Recovering from surgery Fighting an infection Feeling upset Under more stress than usual Traveling Type 1 Diabetes In people with type 1 diabetes, blood sugar levels rise in response to stress, but the body doesn't have enough insulin to turn the sugar into energy. Instead, the body burns stored fat to meet energy needs. When fat is burned for energy, it creates waste products called ketones. As fat is broken down, ketones start to build up in the bloodstream. High levels of ketones in the blood can lead to a serious condition known as diabetic ketoacidosis (DKA), which can cause a person to lose consciousness and go into a diabetic coma. Type 2 Diabetes In people with type 2 diabetes, the body usually has enough insulin available to turn sugar into energy, so it doesn't need to burn fat. However, stress hormones can cause blood sugar levels to rise to very high and even dangerous levels. People with type 2 diabetes Continue reading >>

Symptoms Of Diabetic Ketoacidosis: What You Need To Know

Symptoms Of Diabetic Ketoacidosis: What You Need To Know

Diabetes can be hard to manage, but not properly controlling the disease can have dangerous and potentially deadly consequences. Ketoacidosis is one of them. This condition happens in people who don’t have enough insulin in their body, perhaps because they have not taken some of their insulin shots. The U.S. National Library of Medicine explains that when insulin is lacking, and the body cannot use ingested sugar as a fuel source, it starts to break down fat, which releases acids called ketones into the bloodstream. In large numbers, those ketones are poisonous and can cause deep, rapid breathing, dry skin and mouth, frequent thirst, a flushed face, headache, nausea, stomach pain, muscle stiffness, muscle aches, frequent urination, difficulty concentrating and fruity-smelling breath. If left untreated, the condition can be fatal, in part because it can eventually cause fluid to build up in the brain and for the heart and kidneys to stop working. There are ways to tell whether you have the condition or are approaching it, the Mayo Clinic says. A routine blood sugar test like the kind diabetics take all the time will show high blood sugar, and there are tests to measure the ketone levels in urine. The American Diabetes Association says that experts usually recommend using a urine test strip to check for ketones when blood glucose levels reach higher than 240 milligrams per deciliter. And when sick with a cold or flu, a person should “check for ketones every four to six hours” to be safe. That’s because infections or other illnesses can increase hormones like adrenaline and cortisol in the body, which then counter the work of insulin — “pneumonia and urinary tract infections are common culprits,” the Mayo Clinic warns. In addition to missed insulin shots and Continue reading >>

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