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Dka Death Rate

National Diabetes Audit - 2011-12: Report 2

National Diabetes Audit - 2011-12: Report 2

Summary 2011-2012 National Diabetes Audit (NDA) report. Report 2 shows Complications and Mortality This national report from the ninth year of the NDA, presents key findings on complications in 2010-2012 and deaths in 2012 for all age groups. This report presents statistics about diabetes outcomes including Diabetic Ketoacidosis (DKA), chronic kidney disease and treatment of end stage disease (renal replacement therapy, RRT), lower limb amputations, retinopathy treatment, heart disease, stroke and mortality. Due to the size of this publication, the data have been organised alphabetically by CCG/LHB profile and split into several pages, which are linked to above. Key Facts More than a quarter of admissions to hospital with heart failure involve a patient with diabetes (28 per cent, or 198,200 of 717,100 admissions during 2010-2012). The National Diabetes Audit published today recorded over two million patients with diabetes and shows people with diabetes have a 74 per cent greater risk of being admitted to hospital for heart failure compared to the rest of the population. Of the 198,100 people in the audit with type 1 diabetes in England and Wales in 2012, 3,300 died during the year, whereas 1,440 would have been expected among the same number of the general population, giving a 130 per cent increased risk of death for people with this form of diabetes. Of the 1.9million people in the audit with type 2 diabetes in England and Wales in 2012, 70,900 died during the year, whereas 52,800 would have been expected among the same number of the general population, giving a 35 per cent increased risk of death for people with this form of diabetes. The risk of premature death for people with diabetes. compared to their peers in the general population (relative risk) is greatest fo Continue reading >>

The Occurrence Of Diabetic Ketoacidosis In

The Occurrence Of Diabetic Ketoacidosis In

Type 2 Diabetic Adults Chih-Hsun Chu; Jenn-Kuen Lee; Hing-Chung Lam; Chih-Chen Lu Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital-Kaohsiung, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Running title: The Occurrence of Diabetic Ketoacidosis in Type 2 Diabetic Adults Abstract OBJECTIVE. To study the diabetic ketoacidosis (DKA) episodes which occurred in the type 2 diabetic adults. STUDY DESIGN. We reviewed retrospectively the charts of patients who were admitted to the division of endocrinology and metabolism from Jan. 1991 to Dec. 1997 due to DKA. RESULTS. Total 121 adult patients with 137 episodes (57 females and 80 males) of DKA, with mean age of 45.90 years. 98 episodes (71.5%) occurred in type 2 diabetes mellitus (DM) with mean age of 48.73, which was significantly older than type 1 diabetic patients. Among ten patients suffered from repeated episodes of DKA, 2 four patients belonged to type 2 DM. 33 episodes (24.1%) occurred in patients without a history of DM, however, up to 24 episodes were classified as in type 2. Infection was the most important precipitating factor in type 2 diabetic patients, with respiratory tract and urinary tract accounting for the two most common foci. In type 1 diabetic patients, poor drug compliance accounted for the leading one. Twelve patients (one in type 1 DM and eleven in type 2 DM) expired, giving the mortality rate of 8.8%. Only old age contributed to fatality in type 2 diabetic patients. Type 2 diabetic patients had lower value of serum potassium and the occurrence of hyperkalemia was less than that of type 1. CONCLUSION. Owing to high percentage of adult DKA episodes occurred in type 2 DM, more attention should be pay to these patients. KEYWORDS: diabetes mellitu Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin deficiency, and the action of counter-regulatory hormones, blood glucose increases leading to hyperglycemia and glucosuria. Glucosuria causes an osmotic diuresis, leading to water & Na loss. In the absence of insulin activity the body fails to utilize glucose as fuel and uses fats instead. This leads to ketosis. Pathophysiology/2 The excess of ketone bodies will cause metabolic acidosis, the later is also aggravated by Lactic acidosis caused by dehydration & poor tissue perfusion. Vomiting due to an ileus, plus increased insensible water losses due to tachypnea will worsen the state of dehydr Continue reading >>

Diabetic Ketoacidosis: A Silent Death.

Diabetic Ketoacidosis: A Silent Death.

Abstract Diabetic ketoacidosis (DKA) results from severe insulin deficiency and can be diagnosed at autopsy despite no known history of the disease. Diabetic ketoacidosis may be the initial manifestation of type 1 diabetes or may result from increased insulin requirement in type 1 diabetic patients. The purpose of this study was to determine the percentage of DKA death investigated by the Office of Chief Medical Examiner that was not associated with a known history of diabetes.Cases investigated by the Office of Chief Medical Examiner during a 6-year period whose cause of death was DKA were identified using a centralized database. To determine the percentage with known history of diabetes, investigation reports were reviewed for any documentation of this history. The toxicology reports of all DKA deaths were reviewed together with histologic slides, if available, for possible microscopic changes. Concentrations of vitreous glucose, vitreous acetone, and blood acetone were used to diagnose DKA in these autopsied cases.Nearly a third of all death from DKA (32 of 92 during a 6-year period) occurred in individuals who had no known history of diabetes, emphasizing the importance of regular physicals that include a check of glucose concentration, and especially if any warning signs are present. In a case of sudden death, it is recommended that the volatile toxicology analysis at a medical examiner's office should include tests for acetone concentration, which when elevated, together with an elevated vitreous glucose, indicates DKA. Continue reading >>

Trends In Diabetic Ketoacidosis Death Rates Among Adults With Diabetes, United States, 1984-2002

Trends In Diabetic Ketoacidosis Death Rates Among Adults With Diabetes, United States, 1984-2002

Trends in Diabetic Ketoacidosis Death Rates among Adults with Diabetes, United States, 1984-2002 Diabetes ketoacidosis (DKA) is Diabetes ketoacidosis (DKA) is a potential life-threatening complication of diabetes for which effective prevention and treatment strategies exist. The purpose of this study is to examine trends in DKA death rates from 1984 to 2002 among persons with diabetes aged 18 years and older. Deaths with DKA as underlying cause were identified from vital records and the number of people with diabetes was estimated from National Health Interview Survey. We age-adjusted death rates using the 2000 U.S. population as the standard and tested for trends using linear regression. During the study period, the age-adjusted DKA death rate decreased by one third, from 30.5 to 20.5 per 100,000 diabetic population (p for trend[lt]0.01). DKA death rates declined in all age groups with the greatest decrease among those 65 years or older (65% decrease, p[lt]0.01)). Persons aged 18-44 years had the highest rates which were over twice that of older persons. Age-adjusted DKA death rates declined for white males and females and black females (p[lt]0.05) but not for black males whose rates were generally at least twice that of the other groups. From 1992 through 2002, rates for DKA death occurring in all healthcare sites declined (49% decrease for hospital, 38% for emergency rooms/outpatient clinics, and 59% for nursing home (p[lt]0.01)) but the rates for death occurring at residence did not. In 2002, 52% of DKA deaths occurred in hospital, 12% at emergency rooms or outpatient clinics, 26% at residence and 10% at other places. In conclusion, downward trends in DKA death rates were observed in almost all subgroups, implying reduced DKA incidence and/or improved clinical pract Continue reading >>

Short-term Case Fatality Rate And Associated Factors Among Inpatients With Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar State: A Hospital-based Analysis Over A 15-year Period

Short-term Case Fatality Rate And Associated Factors Among Inpatients With Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar State: A Hospital-based Analysis Over A 15-year Period

Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. Methods DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients. Results The 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients. Conclusion Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities. Continue reading >>

Emergency Management Of Diabetic Ketoacidosis In Adults

Emergency Management Of Diabetic Ketoacidosis In Adults

Diabetic ketoacidosis (DKA) is a potentially fatal metabolic disorder presenting most weeks in most accident and emergency (A&E) departments.1 The disorder can have significant mortality if misdiagnosed or mistreated. Numerous management strategies have been described. Our aim is to describe a regimen that is based, as far as possible, on available evidence but also on our experience in managing patients with DKA in the A&E department and on inpatient wards. A literature search was carried out on Medline and the Cochrane Databases using “diabetic ketoacidosis” as a MeSH heading and as textword. High yield journals were hand searched. Papers identified were appraised in the ways described in the Users’ guide series published in JAMA. We will not be discussing the derangements in intermediary metabolism involved, nor would we suggest extrapolating the proposed regimen to children. Although some of the issues discussed may be considered by some to be outwith the remit of A&E medicine it would seem prudent to ensure that A&E staff were aware of the probable management of such patients in the hours after they leave the A&E department. AETIOLOGY AND DEFINITION DKA may be the first presentation of diabetes. Insulin error (with or without intercurrent illness) is the most common precipitating factor, accounting for nearly two thirds of cases (excluding those where DKA was the first presentation of diabetes mellitus).2 The main features of DKA are hyperglycaemia, metabolic acidosis with a high anion gap and heavy ketonuria (box 1). This contrasts with the other hyperglycaemic diabetic emergency of hyperosmolar non-ketotic hyperglycaemia where there is no acidosis, absent or minimal ketonuria but often very high glucose levels (>33 mM) and very high serum sodium levels (>15 Continue reading >>

Treatment And Complications Of Diabetic Ketoacidosis In Children And Adolescents

Treatment And Complications Of Diabetic Ketoacidosis In Children And Adolescents

INTRODUCTION Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM), with a case fatality rate ranging from 0.15 percent to 0.31 percent [1-3]. DKA also can occur in children with type 2 DM (T2DM); this presentation is most common among youth of African-American descent [4-8]. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) The management of DKA in children will be reviewed here (table 1). There is limited experience in the management and outcomes of DKA in children with T2DM, although the same principles should apply. The clinical manifestations and diagnosis of DKA in children and the pathogenesis of DKA are discussed elsewhere. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) DEFINITION Diabetic ketoacidosis – A consensus statement from the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2014 defined the following biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) [9]: Hyperglycemia – Blood glucose of >200 mg/dL (11 mmol/L) AND Metabolic acidosis – Venous pH <7.3 or a plasma bicarbonate <15 mEq/L (15 mmol/L) AND 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 >>

Rates Of Diabetic Ketoacidosis: International Comparison With 49,859 Pediatric Patients With Type 1 Diabetes From England, Wales, The U.s., Austria, And Germany

Rates Of Diabetic Ketoacidosis: International Comparison With 49,859 Pediatric Patients With Type 1 Diabetes From England, Wales, The U.s., Austria, And Germany

OBJECTIVE Diabetic ketoacidosis (DKA) in children and adolescents with established type 1 diabetes is a major problem with considerable morbidity, mortality, and associated costs to patients, families, and health care systems. We analyzed data from three multinational type 1 diabetes registries/audits with similarly advanced, yet differing, health care systems with an aim to identify factors associated with DKA admissions. RESEARCH DESIGN AND METHODS Data from 49,859 individuals <18 years with type 1 diabetes duration ≥1 year from the Prospective Diabetes Follow-up Registry (DPV) initiative (n = 22,397, Austria and Germany), the National Paediatric Diabetes Audit (NPDA; n = 16,314, England and Wales), and the T1D Exchange (T1DX; n = 11,148, U.S.) were included. DKA was defined as ≥1 hospitalization for hyperglycemia with a pH <7.3 during the prior year. Data were analyzed using multivariable logistic regression models. RESULTS The frequency of DKA was 5.0% in DPV, 6.4% in NPDA, and 7.1% in T1DX, with differences persisting after demographic adjustment (P < 0.0001). In multivariable analyses, higher odds of DKA were found in females (odds ratio [OR] 1.23, 99% CI 1.10–1.37), ethnic minorities (OR 1.27, 99% CI 1.11–1.44), and HbA1c ≥7.5% (≥58 mmol/mol) (OR 2.54, 99% CI 2.09–3.09 for HbA1c from 7.5 to <9% [58 to <75 mmol/mol] and OR 8.74, 99% CI 7.18–10.63 for HbA1c ≥9.0% [≥75 mmol/mol]). CONCLUSIONS These multinational data demonstrate high rates of DKA in childhood type 1 diabetes across three registries/audits and five nations. Females, ethnic minorities, and HbA1c above target were all associated with an increased risk of DKA. Targeted DKA prevention programs could result in substantial health care cost reduction and reduced patient morbidity and mor Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

Recurrent Diabetic Ketoacidosis Raises Mortality Risk In T1d

Recurrent Diabetic Ketoacidosis Raises Mortality Risk In T1d

Recurrent episodes of diabetic ketoacidosis (DKA) were associated with a substantially increased risk of death in patients with type 1 diabetes, according to a retrospective cohort study. Patients with a single hospitalization for DKA during the study period had a 5.2% risk of death, compared with a 23.4% risk of death for patients hospitalized for DKA more than five times (hazard ratio 6.18; P=0.001), reported a research team led by Fraser Gibb, MBChB, PhD, of the Royal Infirmary of Edinburgh in Scotland. Patients with recurrent hospitalizations for DKA tended to be younger, poorer, have higher glycated hemoglobin levels, and to have mental health problems, Gibb and colleagues reported in Diabetologia. "Most strikingly, a greater than one in five risk of death was observed in those with the highest frequency of DKA presentation over a median 2.4 years of follow-up, compared with a one in 20 risk of death in those with a single DKA admission over a median of 4 years. This represents a substantially elevated risk of death when compared with the Scottish type 1 diabetes population," Gibb and colleagues said. "The main implications of the study are that we have identified a significant risk of death in patients with recurrent DKA, many of whom are young," Gibb told MedPage Today via email. "With this in mind, we need to build an evidence base for strategies to help prevent mortality in this at-risk group. I suspect this will focus on community-based, multi-disciplinary care for this group of patients." The deaths almost always occurred at home rather than in the hospital, the investigators noted. "In keeping with other modern cohorts, we found a low rate of inpatient mortality in patients presenting with DKA," they said. "However, the frequency of subsequent sudden death a Continue reading >>

Incidence And Outcome Of Adults With Diabetic Ketoacidosis Admitted To Icus In Australia And New Zealand

Incidence And Outcome Of Adults With Diabetic Ketoacidosis Admitted To Icus In Australia And New Zealand

Abstract Over the last two decades, there have been several improvements in the management of diabetes. Whether this has impacted on the epidemiology and outcome of diabetic ketoacidosis (DKA) requiring intensive care unit (ICU) admission is unknown. This was a retrospective study of 8533 patients with the diagnosis of DKA admitted to 171 ICUs in Australia and New Zealand between 2000–2013 with separate independent analysis of those on established insulin (Group I) or not on insulin (Group NI) at the time of hospitalisation. Of the 8553 patients, 2344 (27 %) were identified as NI. The incidence of ICU admission with DKA progressively increased fivefold from 0.97/100,000 (95 % CI 0.84–1.10) in 2000 to 5.3/100,000 (95 % CI 4.98–5.53) in 2013 (P < 0.0001), with the proportions between I and NI remaining stable. Rising incidences were observed mainly in rural and metropolitan hospitals (P < 0.01). In the first 24 hours in the ICU, mean worst pH increased over the study period from 7.20 ± 0.02 to 7.24 ± 0.01 (P < 0.0001), and mean lowest plasma bicarbonate from 12.1 ± 6.6 to 13.8 ± 6.6 mmol/L (P < 0.0001). In contrast, mean highest plasma glucose decreased from 26.3 ± 14 to 23.2 ± 13.1 mmol/L (P < 0.0001). Hospital mortality was significantly greater in NI as compared to I (2.4 % vs 1.1 %, P > 0.0001). Elevated plasma urea in the first 24 hours (≥25 mmol/L, adjusted odds ratio 20.6 (6.54–65.7), P < 0.0001) was the strongest individual predictor of mortality. The incidence of ICU admission of patients with DKA in Australia and New Zealand has increased fivefold over the last decade, with a significant proportion of patients not on insulin at presentation. Overall physiological status in the first 24 hours of ICU admission has progressively improved and mortali Continue reading >>

Outcome Of Patients With Diabetic Ketoacidosis And Acute Respiratory Failure

Outcome Of Patients With Diabetic Ketoacidosis And Acute Respiratory Failure

Abstract SESSION TITLE: Respiratory Support Posters SESSION TYPE: Original Investigation Poster PURPOSE: Diabetic ketoacidosis (DKA) is a life threatening metabolic derangement. Acute respiratory failure in DKA is a strong mortality predictor and is usually secondary to both a decreased level of consciousness and severe acidosis. We assessed the outcome of patients admitted with DKA and acute respiratory failure. METHODS: A retrospective cohort analysis was done on patients admitted to our hospital with DKA and acute respiratory failure between January 2008 and December 2013. The baseline demographic information, clinical and laboratory characteristics were collected. The primary outcome of the study was in-hospital mortality. A univariate analysis was done to identify association of variables with the outcome. Continuous variables were reported as mean (SD) and compared via the student t test. Comparison of categorical data was made via the chi-square test. RESULTS: The cohort consisted of 76 patients admitted with diabetic ketoacidosis and acute respiratory failure. Of these patients, 28 deaths were noted resulting in a mortality rate of 37%. On univariate analysis, the presence of shock on admission and infection were significantly associated with mortality with a p value of 0.004 and 0.03 respectively. Pneumonia was the cause of death in 9 patients (32%). The potential of hydrogen (pH) was not statistically associated with mortality {Alive 7.12 vs dead 7.15; p value 0.42}, while the anion gap was statistically lower in patients who died {Dead 21.4 vs. alive 27; p value 0.001}. CONCLUSIONS: Mortality rate for diabetic ketoacidosis has significantly decreased with insulin therapy, however, patients with acute respiratory failure and altered mental status have a higher Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

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