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Complications Of Untreated Dka

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Lack Of Diabetes Awareness Putting Children At Risk Of Dangerous Complications

Doctors are calling for better diabetes awareness as almost 1 in 5 children with diabetes develop a dangerous complication known as Diabetic Ketoacidosis (DKA) – a lack of insulin in the body - before they are officially diagnosed with the condition. Furthermore, rates of DKA, in those already diagnosed with diabetes remain high and are highest in females aged between 10 and 19 in England and Wales, according to a report from the National Paediatric Diabetes Audit (NPDA), published today by the Royal College of Paediatrics and Child Health. If left untreated, DKA can cause mental confusion, rapid heartbeat and breathing, sickness and unconsciousness and can be life threatening if not diagnosed and treated urgently. Dr Justin Warner, RCPCH’s Clinical Lead for the NPDA and a Consultant in Paediatric Endocrinology and Diabetes, said: “Managing diabetes in childhood is a complex problem requiring close collaboration and partnership between the child, family and healthcare teams. An admission to hospital for an acute complication, such as DKA, in a child with established diabetes, can be deemed as a failure of that partnership.” “Understanding the mechanisms which may lead up Continue reading >>

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  1. Jj123

    The common notion is that in order to gain muscle you must be a "calorie surplus", and in order to burn fat/lose weight you must be a in a "calorie deficit. However the cyclic-ketogenic diet claims that it allows muscle building AND fat loss? How is this possible and what is the mechanism behind it? Since surely you cannot be in a surplus and deficit at the same time?

  2. Berin Loritsch

    I know someone who recently used the cyclic ketogenic diet to get good results. Based on his experience, and some of the other experiences I've read who used the approach, it's important to set your expectations appropriately.
    The only demographic that can build muscle while losing weight is an overweight beginner. This is the same regardless of diet used.
    Intermediate and advanced lifters will lose some maximum intensity, but their volume work would be unaffected.
    The cyclic ketogenic diet is effective at fat loss while preserving the muscle you have acquired.
    Ketosis is itself a contentious subject with researchers on both sides of the argument having studies to back up their arguments. Unfortunately, most studies use readily available sedentary people, and rarely any demographic that would match my own. I will also say that ketosis is not for everyone. I did well with it, but I have friends who didn't. I recommend a trial run without any exercise to see how you adjust. The principles behind ketosis are fairly simple and straightforward:
    The brain needs roughly 125g of energy per day--blood glucose is the primary source. Lipids can't cross the blood-brain barrier, but glucose and ketones can.
    When the blood glucose drops, the pancreas secretes glucagon to pull energy out of fat, muscles, and organs. The muscles and organs store glucose in the form of glycogen.
    When there are no dietary sources of blood glucose for a prolonged period, the liver will start making ketone bodies which process the stored fat in a way that can pass the blood-brain barrier.
    Ketone bodies cannot be reabsorbed back into the fat cells. Unused ketone bodies are urinated out.
    About the same time that ketone bodies are created, the body also starts gluconeogenisis which is the process of converting proteins to blood glucose.
    All ketogenic diets share a common trait: medium to high protein intake. The higher protein intake is necessary to provide the gluconeogenisis process a source of protein other than your muscles and organs. Additionally, if you are lifting weights, the higher protein intake is needed to repair your muscles and supply the necessary amino acids. Building muscle does take a lot of energy, but thankfully the body can use fat as a source of energy.
    Ketosis based diets will completely deplete the glycogen stores in your muscles and organs by design. This has a negative impact on performance. Unchecked, high intensity exercise like weight lifting can increase the demands of energy enough where ketosis alone isn't enough to supply the energy requirements. This is a bad thing. The cyclic ketogenic diet replenishes the glycogen stores once a week. This gives you most of the week to burn fat, while keeping your energy up to meet the demands of exercise.
    There have been several studies to show that there is a direct correlation between your body's maximum ability and its weight. As you lose weight, you can expect a loss of your maximum strength. Part of this is due to any cut causing a loss of lean mass as well as fat mass. That doesn't mean you are losing muscle, it very well could be some of the energy support systems that feed the muscle. However, this loss of absolute strength is relatively small compared to your fat loss. Once you reach your goal, you can rebuild that max strength.
    The high fat content during the week in the cyclic ketogenic diet is sufficient to fuel your training. However, the body does do better with a periodic refeed when you are training hard.

  3. Greg E.

    I don't think there's very much reliable empirical evidence available on the subject. Every mention of this diet that I've seen tends to be either hyperbolic, anecdotal, or very clearly tainted by conflict-of-interest. Wikipedia's page on the subject, for example, uses as its main reference a book which advocates said diet. It's possible that the author is a verified expert who's diligently studied the matter and scrupulously documented all his sources, but my default reaction is extreme skepticism. For what it's worth, ketogenic diets have been used in the treatment of epilepsy for decades, and the medical consensus appears to be that they're generally safe. That said, there's some evidence that ketogenic diets will, if anything, impair performance during anaerobic activities due to more rapid glycogen depletion (q.v., http://www.ncbi.nlm.nih.gov/pmc/articles/PMC524027/), though aerobic performance should not be detrimentally impacted. Given that muscle-building gains are largely dependent on anaerobic types of exercise, and that greater intensity and increased repetition to failure are generally correlated with greater gains, I would expect negative results, if anything.
    As far as the hypothetical mechanism for these diets, the idea is that if the body is deprived of carbohydrates it is forced to begin to metabolize fat into fatty acids through lipolysis. Those fatty acids are then further metabolized into ketone bodies (hence, the name of the diet). Whether this actually results in improved fat loss vs. carb-containing diets while holding caloric intake constant isn't known with any certainty.

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Preventing Ketoacidosis Complications In Diabetes

Risk factors associated with diabetic ketoacidosis typically do not change. Preventing DKA should focus on identification of those most at risk and educating them good self-care to avoid incidents. Diabetic ketoacidosis (DKA) a hyperglycemic crisis most commonly associated with type 1 diabetes mellitus (T1DM) is often the first symptom of diabetes to appear in the undiagnosed population. Managing the condition effectively to prevent incidence is important because of the associated mor-bidity and resulting economic impact.1 Studies have shown that hospitalizations resulting from DKA amount to an annual cost of more than $2.4 billion in the United States.1 THE PATHOLOGY BEHIND KETOACIDOSIS? Reduced concentrations of effective insulin and increased amounts of coun-ter-regulatory hormones. Since the body cannot break down and use sugar as an energy source, it draws energy from fat tissue; increased lipolysis releases free fatty acids in the blood and causes oxi-dation of hepatic fatty acids to ketone bodies, resulting in ketonemia and metabolic acidosis.1,2 DKA is also observed in type 2 diabetes mellitus (T2DM) patients, most of-ten a result of uncontrolled blood sugar, missed doses o Continue reading >>

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  1. MarkM

    Originally Posted by 10xdiabetic
    ... the units of insulin I am having to take seem excessive. I feel my body is no longer sensitive to the insulin. ... Getting most calories from fat can be expected to reduce insulin sensitivity. There is a whole lot of science behind this, but the bottom line is that when in ketosis (eating low carb, high fat), we need a lot more insulin than the consumed carbs suggests. So you will have to adjust insulin dosing accordingly. Once you have done that, maintaining good control should get a lot easier.
    I gave up on the ketogenic diet because sticking to it was just too hard. Especially in China, where I have been living for a while. After switching back to a 'normal' diet, my control became somewhat more difficult, but my insulin requirements went down. I have become more insulin sensitive, and my TDD is now lower than it has ever been. Using a pump also helps with that, but I suspect that much of the difference is because of less fat in the diet.

  2. hughman

    The only thing constant about insulin dosing for me over the last 40+ years is change. At one point I was taking at least a total of 120 units a day, but that was with massive aspartame consumption. Once I stopped diet pop (soda), I now take a total of around 60 units, and take it totally differently amounts at different times than I used to. I could take less insulin if I ate less carbs, but we all make our decisions on our lifestyle.
    Everyone is different, and our environment and what we consume effects us all differently. And women have it even tougher with those pesky hormones.

  3. 10xdiabetic

    Thank you for that insight. This is what my feeling was also. I tried to find science to confirm my hypothesis. Could you share an article / source where you read about that so I can explore this further?

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Pediatric Diabetic Ketoacidosis Emergency Department Care

Exenatide extended-release causes an increased incidence in thyroid C-cell tumors at clinically relevant exposures in rats compared to controls. It is unknown whether BYDUREON BCise causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of exenatide extended-release-induced rodent thyroid C-cell tumors has not been determined BYDUREON BCise is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with the use of BYDUREON BCise and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for detection of MTC in patients treated with BYDUREON BCise Acute Pancreatitis including fatal and non-fatal hemorrhagic or necrotizing pancreatitis has been reported. After initiation, observe patients carefully for symptoms of pancreatitis. If suspected, discontinue promptly and do not restart if confirmed. Consider other antidiabetic therapies in patients with a hi Continue reading >>

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  1. datums

    Unfortunately, biochemistry is not the kind of topic that can be easily researched online without formal training. There are a number of points you make that are incorrect. I keto myself, so don't think I am trying to attack your general position here.
    Starvation and the keto diet are actually nearly identical from a biochemical perspective. The key pathway is fat mobilization, where fatty acid chains are broken down two carbons at a time to produce energy. When this process starts to happen faster than your body can manage it, some of the chemical constituents of the process actually break down to become the ketones that can be detected in the urine and breath. In other words, ketones are a side effect, rather than a major player.
    The idea that a calorie deficit, ie starvation, is somehow bad, is incorrect. Anybody who is using diet and exercise to become more lean is doing the same thing. There is no magic method to lose weight without some form of starvation. The reason why the keto diet does not cause significant lean tissue loss is that the starvation involved is not sufficiently severe.
    An important point that you bring up is the idea that the keto diet stabilizes insulin levels. This is basically correct. Insulin signals cells to take up glucose from the blood, and also tells the liver to begin glycogenesis - the process of packing glucose into glycogen. High blood sugar triggers this. These effects are basically reversed by adrenaline, which tells the liver to start breaking glycogen down to make glucose.
    Part of the difficulty with this is that with a normal diet, blood sugar spikes after meals. This leads to cyclic variance in levels of glucose, insulin and adrenaline. As the cycle progresses toward the adrenaline end, you start to get cravings for foods that will once again spike your blood glucose.
    However, when you are relying on fat mobilization to make glucose, these spikes are greatly reduced. Fat mobilization is not efficient, and is not able to provide sudden bursts of glucose. It is more constant. This makes athletic activity much more difficult aswell.
    But this is the real reason why the keto diet works - it mitigates the cycle of spiking and lowering blood sugar, providing a more level and constant supply. This reduces the propensity for craving food.
    In essence, the keto diet is not unique in terms of the basic biochemistry of metabolism. It simply makes 'starvation' more tolerable, and easier to manage. For many of us, that is exactly what we need.
    Edit - swapped 'gluconeogenesis' with 'glycogenesis'.

  2. gogge

    Insulin signals cells to take up glucose from the blood, and also tells the liver to begin gluconeogenesis - the process of packing glucose into glycogen. High blood sugar triggers this. These effects are basically reversed by adrenaline, which tells the liver to start breaking glycogen down to make glucose.
    Insulin inhibits gluconeogenesis (creation of new glucose), you probably meant glycogenesis (conversion of glucose to glycogen)?

  3. datums

    You are right on that one. The word I was looking for was glycogenesis. It can be a little tricky to remember that between glycolysis, glucogenesis, and gluconeogenesis, one means glycogen synthesis, and the other two mean glycogen breakdown.

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