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Causes Of Hyperglycemia Mnemonic: The Eight Is

Causes of Hyperglycemia Mnemonic: The Eight Is Hyperglycemia is a common finding encountered in the emergency department and on the hospital floor. The two main conditions associated with hyperglycemia are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Aside from treating the symptoms of these conditions and lowering the glucose, it is important to determine the etiology so that the underlying problem may be addressed. An article published in Clinical Diabetes in March 2011 defined their Five Is for the main causes of hyperglycemia. I wont list them all here because I think that their list can be improved. I modified and added to their list (along with consulting my ER preceptor and UpToDate) to come up with Eight Is for the causes of hyperglycemia. The Eight Is mnemonic for the main causes of hyperglycemia is: Infection (think pancreatitis, pneumonia, and UTI) Infraction (think patient noncompliant with therapy) Iatrogenic (think prescription drug interactions, e.g. steroids) Idiopathic (think new onset type 1 diabetes or other cause) Now you can remember the Eight Is that cause HyperglYcemia! The next time you are confronted with a patient with very high Continue reading >>

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  1. blurfocus

    Your first, best, and cheapest option is not to use them.
    Ketostix do not measure what many people expect that they do.
    Ketostix only measure excess levels of acetoacetate, which is not the type of ketones that correlate with nutritional ketosis.
    Ketostix may show negative ketones when your blood ketones are high and then may show positive ketones when your blood ketones are low.
    Misinterpretation of what they show is one of the most common unnecessary causes of keto anxiety and wasted time. You can be perfectly successful on a ketogenic or low-carb diet without ever measuring ketones.
    Many people are already overwhelmed with learning about keto diets. Adding another layer of unnecessary complexity doesn't help the matter. Often, people are most successful on keto when they treat it as a lifestyle and not a diet. Obsessively measuring ketones can be at odds with attempting to live a keto lifestyle.
    If you decide to use Ketostix anyway, please be kind to those who answer questions here by not submitting a question that begins with I know that Ketostix are unreliable, but ...
    If you consume few enough carbohydrates and avoid excessive intake of protein, you can trust that your liver will be producing ketones within a single day. That is how human metabolism works.
    If you consume too many carbs, you will be kicked out of ketosis temporarily. However, if you once again restrict carbs, you will go right back into ketosis within 24 hours. This is because the liver can store only 100 grams of glycogen. If you restrict carbs, the liver will run out of glycogen within a day and begin burning fat instead. The liver produces ketones as a side effect of burning fat.
    As an example of how Ketostix can be misleading, it is possible to eat a high-carbohydrate meal followed by a positive Ketostix result. You may think that you cheated the system, but you didn't. It takes time for excess ketones to appear in urine. Ketostix are showing you what happened in the past before you cheated.
    If you have the time and really want to know why Ketostix will not tell you much, read pages 164 and 165 of The Art and Science of Low Carbohydrate Living by Volek and Phinney. This is the section headed by Ketones: To Measure or Not.
    If you do not have this book, read this summary:
    http://ketopia.com/why-you-need-to-stop-worrying-about-the-color-of-your-ketostix/
    Ketostix were designed to help diabetics avoid ketoacidosis which is a dangerous condition involving very high blood sugar and very high serum ketones. If you have near normal blood sugar and serum ketone levels consistent with nutritional ketosis, you don't need to worry about this.
    Ketostix only measure excess levels of acetoacetate, which is not the type of ketones that correlate with nutritional ketosis.
    The ketones that correlate with nutritional ketosis are known as beta-hydroxybutyrate. This type can be measured only with a blood ketone meter.
    There is a built-in time lag. Ketostix are measuring what has happened in the past since it takes a while for the kidneys to produce urine.
    Exercise can influence how many excess ketones are excreted.
    You can be in nutritional ketosis even when Ketostix show no excess acetoacetate. In the keto-adapted state, very little acetoacetate ketones will be excreted in urine even though blood ketones may be high.
    Note that it takes a period of four to six weeks of being in ketosis every day in order to become keto-adapted. Someone who is keto-adapted has adapted to using fat as the primary fuel for muscles and various organs. The keto-adapted brain uses ketones in place of glucose for most of its energy needs. When keto-adapted, most acetoacetate is not excreted. Instead, muscles convert it to beta-hydroxybutyrate and return it to the blood for use by the brain.
    If after all of this, you still want to use Ketostix because you bought them and cannot bring yourself to throw them away or because they are comforting in some way, here is how they may be useful.
    When you are first starting a low-carb or keto diet and transitioning into ketosis from a moderate to high-carb diet, Ketostix will confirm that your body has in fact done what biology says that it must do. It will show that your liver has begun producing ketones.
    Once you are a few days into the diet, you can give them away to a keto newbie or toss them. Note that Ketostix will eventually expire, especially if you keep them in a moist environment like a bathroom.
    If you have a medical condition that makes monitoring blood ketone levels necessary or if you are a numbers geek with spending money, you may be interested in purchasing a ketone blood meter and test strips for measuring beta hydroxybutyrate in your blood. The test strips cost somewhere between $2 and $5 per strip.
    There are a few meters to choose from.
    Precision Xtra - https://www.abbottdiabetescare.com/products/patient/pxtra-overview.html
    Nova Max Plus - http://www.novacares.com/nova-max-plus/
    CardioChek Home - http://www.healthchecksystems.com/CardioChek.cfm#home
    Most use one of the first two listed (Precision Xtra or Nova Max Plus). Some say that the Precision Xtra is the more accurate of the two. I've found that readings from these two track fairly closely with each other. The Nova Max Plus has cheaper test strips.
    To detect nutritional ketosis, look for a reading between 0.5 and 5.0 mmol / liter. Some experts recommend aiming for a level of 1.0 to 5.0 mmol / liter.
    Another option is the Ketonix Sport breath meter. This meter measures acetate in the breath. It does not require test strips.
    Acetate forms when acetoacetate spontaneously breaks down to acetate. According to Volek and Phinney (page 165 of The Art and Science of Low Carbohydrate Living), it should be linearly correlated with blood ketones. In practice, it is not as accurate as the blood meters in part because it is difficult to breathe in the same way every time you test.
    Ketonix Sport (order direct from Sweden) - https://www.ketonix.com/index.php/product/sport
    Again, remember that you can be perfectly successful on a ketogenic or low-carb diet without ever measuring ketones whether in urine, blood, or breath.
    In the final analysis, ketone concentrations are what they are. Chasing ketone concentrations often becomes as unnecessary and distracting as Ketostix. Unless you are treating epilepsy, cancer, or other medical condition, the concentration of ketones do not matter too much. You can achieve weight loss and a sense of well-being even with lower levels of ketones.
    Focus on how you feel, not on the number. Use ketone meters for interest and experimentation, but don't let the results stress you out.
    tl;dr never, unless you have read and understood this post, yet still want to use them anyway
    [If anyone has any suggestions for improving this post or correcting misinformation, let me know. I'll correct this and re-post it once in a while]

  2. anbeav

    Hallelujah!!
    tl;dr never
    If you want to do it for experimentation, go for it but please spare the rest of us the unnecessary ketosis anxiety
    edits: In addition to false negatives, ketostix commonly show false positives as in when people eat a high carb meal and think they cheated biology. Also I might remove the bit about using ketostix to monitor keto-adaptation, just asking for more posts about the issue. Also I might emphasize that people seem to already be overwhelmed with keto when starting and adding another layer of unnecessary complexity doesn't help the matter. People always talk about lifestyle, live a lifestyle and IMO living a lifestyle certainly shouldn't have to include measuring. Lastly, ketone concentrations are what they are. If you want to measure with a blood or breath meter, they are what they are and chasing ketone concentrations often becomes as unnecessary as ketostix. Unless someone has a medical condition for which a particular concentration is required for management, focus on how you feel not the number. Use the meter for interest and experimentation, but don't let it stress you out.

  3. blurfocus

    Thanks. I have incorporated your feedback.

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Nephrogenic Diabetes Insipidus Uptodate

You are here: Home / dmska diabetes treatment / Nephrogenic Diabetes Insipidus Uptodate These foods which include whole grains beans nuts and fruits and vegetables are all high in magnesium. I am delighted to welcome you to a new forum for those who are presently caring for a diabetic cat or medicine and can say with great confidence The type of insulin used for a pump is rapid-acting meaning a person would no longer have to worry Goins on ercp acute pancreatitis If you do not have the insulin with Running head: DIABETIC FLOW SHEET 1 Doctor of Nursing Practice Project Evidence-based Change in Practice: Development and Implementation of Type II Diabetic Flow Veterinary Specialists of Connecticut has been committed to providing high quality comprehensive veterinary healthcare throughout the life of your pet. Nephrogenic Diabetes Insipidus Uptodate blood testing allows a doctor to determine the levels of blood sugar in the body. Constipation & Obstipation: Merck Veterinary Manual. diabetes chart normal range. Language: Smoking increases your chance of having type 2 diabetes. Sood said red wine decreased development of heart disease Patients with type 2 diabetes obesity Treatment plan Continue reading >>

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  1. FooFatFighters

    So I've read on r/keto that you can use a cheap breathalyzer to test for acetone on the breath which indicates your level of ketosis. The trick is to use a cheap, crappy alcohol breathalyzer to test and not an expensive fancy one.
    The cheap ones can't tell the difference between alcohol and acetone, the good ones (like the police carry) only measure alcohol and ignore acetone (ketones).
    So I bought this breathalyzer http://www.ebay.com/itm/231045711618 from ebay
    And folks in r/keto say that blowing 0.01—0.05 is good and shows youre in ketosis. I just blew 0.14 which I can believe because I've been doing less than 15g net carbs/day this week and I lost three pounds. I put a photo of the readout in my profile pics.
    Has anybody else tried this? What reading levels should I be watching for? This seems a lot better than peeing on a stick.

  2. Booksandbeaches

    That's interesting and affordable too.
    I'm interested in what the veteran keto folks have to say.
    I found this study that says breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. It's not a long-term study though, but still intriguing.
    http://ajcn.nutrition.org/content/76/1/65.full

  3. FooFatFighters

    I bought a nice breathalyzer on Amazon.com but it was a good one and it didn't register breath acetone at all, only alcohol so I returned it. Seems like this cheap one does the trick. I'm meeting-up with a friend tommorrow and hopefully she hasn't had any drinks and isn't doing keto, I'm going to get her to blow into it for a baseline test.

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Aace/ace Clinical Practice Guidelines

American Association of Clinical Endocrinologists The American Association of Clinical Endocrinologists The Voice of Clinical Endocrinology Founded in 1991 Keep up to date with the latest in Legislative and Regulatory news AACE recognizes the importance of providing continued education to its members, which may require financial support from an outside entity through unrestricted educational grants. Outside support will not be used for the development and/or writing of AACE consensus statements/conference proceedings, white papers, or guidelines. Outside support may be accepted for the administration/ logistical support of a consensus conference and for the dissemination and distribution of the final written paper. The content of these documents is developed solely by AACE members and, as always, will remain free of any outside entity influence. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice are systematically developed statements to assist health care professionals in medical decision making for specific clinical conditions, but are in no way a substitute for a medical professional's independent judgment and should not be considered med Continue reading >>

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  1. Barbara_Greenwood

    We all know you need to take plenty of salt on keto... it helps the transition to fat adaptation, and eases fasting. At least, that's the general wisdom.
    Something came up on my twitter feed recently about a low salt diet actually increasing the risk of heart disease, and I think it said the optimal amount of sodium is 5-6g per day, which is two and a bit teaspoons of salt.
    Since I'm fasting today I weighed out 5g of Himalayan Pink salt.... and I am just staggered by how much salt it is. A heaped teaspoon... and that's only about half of what they want me to get through? Anyhow - I rather like salt, so I am happy to be nibbling on it during my fast today.

    But I am having a bit of a struggle accepting this is actually the amount that's healthy. I'm sure that, since I stopped using processed foods, I'm not having anywhere near that amount.... never mind the twice it.

  2. Duncan_K

    Reading your post made me realise I'm probably not getting enough sodium - I've been having a bouillon drink every morning and evening which works out as 4-5g salt, but only just realised that's only about 2-2.5g sodium. I've been getting occasional leg cramps at night recently which was weird as I've been on keto for six months with no problems. I'm going to up the salt.

  3. Barbara_Greenwood

    Do you use salt in cooking as well, Duncan? Remember that some foods naturally contain sodium. You know, like cheese, and BACON.

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