Diabetic Ketoacidosis Pathophysiology Diagram

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Diabetic Ketoacidosis--pathogenesis, Prevention And Therapy.

Abstract Diabetic ketoacidosis is the principal cause of hospital admissions for diabetic patients under 20 years of age, and accounts for at least 4000 deaths per annum in the United States. Current mortality rates differ widely throughout the United States, ranging from 0-19 per cent, with an average of 10 per cent. The principal reason for this wide range in the percentage of mortality are the differing criteria for diagnosis and attributing deaths to diabetic ketoacidosis. There are many reported precipitating causes of diabetic ketoacidosis which may be reduced to four common pathways: insulin deficiency, stress hormone excess, dehydration and fasting. Infection is the most common precipitating cause in most reported series of diabetic ketoacidosis, but stress in any form can lead to metabolic decompensation. Omission of insulin is an unusual cause of ketoacidosis, and in approximately one-quarter of patients no cause can be identified. Each of the four common pathways through which these precipitating causes induce diabetic ketoacidosis results in a rise in ketone body and glucose production and/or concentration. Prevention of diabetic ketoacidosis has been underemphasized in Continue reading >>

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Popular Questions

  1. rnr1

    Lantus, Novolog, Metformin, Januvia...questions!

    I'm so glad I found this forum. I have spent a lot of time reading and learning, since starting insulin about a month ago.
    Question: my doc stopped my glimepiride and started me on Lantus and Novolog. She continued the Januvia, and the DM Educator I went to said I should stay on it, too.
    But reading here, it sounds like Januvia is a Bad Thing. Also, I will be 65 this year and my husband will be retiring so soon we won't have our good insurance and will have to figure out what to do with Medicare and supplemental, which worries me. I'm on a lot of meds and the costs would be awful without good insurance. So, being able to cut back on some prescriptions would be good.
    Twice now, I've stopped the Januvia on my own, but then my BS really climbs...especially the FBS,which rises to the 160-175 range. While on Januvia, it was in to 110-130 range.
    I'm supposed to be on 25u Lantus, 6u Novolog at brkfst (2-3 carbs) and 7u Novolog at L&S (4 carbs.) I actually eat 3 at L&D, but now I've had to increase the Novolog to 8 before L&D or my premeal BS goes too high.
    Someone here posted that they quit Januvia and it made no difference,
    but both times I tried stopping it my BS has gone up. I've been off of it for four days now, and my FBS was 175 this morning.
    What changes would you make in the insulin? Should I increase the lantus? I know to increase in small increments, but is there a point at which its just too much? Are there people who simply cannot get off the Januvia, or can it all be managed with the insulin doses? I do know how to count my carbs very carefully, BTW.
    I'm not due back to the DM Educator until summer, and don't want to go back earlier. And anyway, the educator recommends Januvia, Victoza and Byetta--says the local endochronologists here really like them and also warn about tight BS control. I was happy when I was keeping my FBS and premeal BS around 80-100, but she said that it was dangerous (risking hypos) to keep it so tight...and said that with repeated hypos, one is at risk for early dementia. I've found research that concurs.
    She says 160-180 is fine....but after reading books by Ruhl and Bernstein (sp?) I still want better control than that. Then again, I can get down to 66-70 and not feel it, so maybe she is right. I used to feel really crummy at 80, but since starting to be MUCH more careful with carbs (since starting insulin--which was a big wake up call!) I don't sense myself going low nearly a much. I do test 7-8 times a day.
    Sorry for this long-winded post.
    Comments? Suggestions? Should I just keep upping the Lantus? Give it up and add the Januvia back? Thanks so much!!!

  2. John.in.France

    I'm sorry to say that I can't really help on dosage management but I would echo the sentiment that you've already picked up. I struggle with the logic of using a drug to force your own body to generate insulin (in an uncontrolled amount and timescale) and in addition inject insulin.
    In managing insulin I think it is hard to beat Dr Bernstein's "Law of Small Numbers" but built into that is the idea that you know exactly how much insulin you are taking. You can't achieve that with Januvia in the equation.
    I've also have to ask you to clarify what you mean by "2-3 carbs". Do you mean 2 to 3 grams of carbohydrate or 2 to 3 carbohydrate units? (of 15 grams each).

  3. rnr1


    "I've also have to ask you to clarify what you mean by "2-3 carbs". Do you mean 2 to 3 grams of carbohydrate or 2 to 3 carbohydrate units? (of 15 grams each).
    Thanks for your reply. Sorry I wasn't clear. I'm using 12-15 grams CHO per "carb" unit. I know studies show that people tend to over/under estimate, but I've used this for years and do know the basic foods well, but also read labels carefully and look up items I don't know.
    Forgot to add that I did read "Think Like a Pancreas" and have read (and printed off for my DM notebook) the Law of Small Numbers. I love, love, love this forum, and how it has directed me to many excellent resources!

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