Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>
Diabetic Diarrhea. Pathophysiology, Diagnosis, And Management.
Abstract Idiopathic diarrhea is a common complication of diabetes mellitus. It occurs frequently, but not exclusively, in patients with poorly controlled insulin-dependent diabetes who also have evidence of diabetic peripheral and autonomic neuropathy. Associated steatorrhea is common and does not necessarily imply a concomitant gastrointestinal disease. The diarrhea is often intermittent; it may alternate with periods of normal bowel movements, or with constipation. It is typically painless, and occurs during the day as well as at night and may be associated with fecal incontinence. Multiple pathogenic mechanisms have been implicated, autonomic neuropathy, bacterial overgrowth, and pancreatic exocrine insufficiency being the most important underlying aberrations. However, diabetic diarrhea does not have a uniform and unequivocal pathogenesis. The diagnosis depends on a judicious clinical assessment accompanied by a stepwise laboratory evaluation, which allows the differentiation idiopathic diabetic diarrhea from the many other causes of diarrhea that can occur in diabetic and nondiabetic patients. The management can be difficult but many therapies, including antibiotics to eradicate bacterial overgrowth, as well as antidiarrheal agents, oral and topical clonidine, and somatostatin analogues may be effective in controlling diabetic diarrhea. Continue reading >>
Diabetic Complications Just as with humans, untreated diabetes in cats can lead to a number of complications. These include pancreatitis, diabetic neuropathy (walking on the hocks), diabetic ketoacidosis, as well as hypoglycemia and kidney failure. Research in humans and mice has shown that organ damage begins to occur when the blood sugar is above 140 (7.8). Many of these studies can be found here: Research Connecting Organ Damage with Blood Sugar Level. Several of the more common complications are described below. Pancreatitis Pancreatitis is a condition that causes severe inflammation in and around the duct area. The pancreas is already damaged, to varying degrees, by the time our cats are diagnosed with feline diabetes (FD). Dr. Hodgkins states in her book Your Cat, Secrets to a Longer, Stronger Life; cats with FD typically have at least low-grade pancreatitis. As a result, when a cat comes along that is not achieving expected results with insulin, initial thoughts should turn to the likelihood of pancreatitis. Pancreatitis may be acute or chronic. Acute pancreatitis is a sudden inflammation of the pancreas, where chronic pancreatitis refers to a long-standing inflammation of the pancreas that alters its normal structure and functions. Both forms of pancreatitis can cause serious complications for our cats, some more severe than others. Malabsorption of food, internal bleeding, damage to tissue, infection, cysts, fluid accumulation, enzymes and toxins entering the bloodstream, damage to the heart, lungs, kidneys, and/or other organs may occur if left untreated. It is now suspected that pancreatitis may be a cause of diabetes in cats. Malabsorption of food is a very common outcome in humans with pancreatitis, as is diabetes. Diabetes develops because insulin-producin Continue reading >>
Understanding And Treating Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>
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.  Continue reading >>
Can Blood Sugar Levels Go Down Suddenly?
This is actually a rather common experience for those with impaired glucose tolerance and in the prediabetes range. It is a condition called reactive hypoglycemia, where a carbs heavy meal triggers a huge and delayed insulin response, driving down the blood glucose rapidly and resulting in a vicious cycle of intense/uncontrolled refeeding… The solution is rather simple… Continue reading >>
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Tweet Diarrhoea is commonly experienced as a result of gastroenteritis but may also be caused by specific medication including statins and metformin. Diarrhoea is defined as passing loose, watery stools more than three times a day. Diarrhoea may also result from conditions such as irritable bowel syndrome, coeliac disease and autonomic neuropathy. Common causes of diarrhoea The NHS lists gastroenteritis, bowel infection, as the most common cause of diarrhoea. Gastroenteritis can be caused by a bacterial or viral infection. Other relatively common causes of diarrhoea include: Food intolerances - such as lactose or gluten intolerance Irritable Bowel Syndrome Drinking too much coffee or alcohol Read further below for causes more specifically related to diabetes. Diagnosing diarrhoea In most cases diarrhoea will clear within a week. If diarrhoea persists longer is accompanied by other symptoms such as: Fever Blood in your stools Vomiting Unexplained weight loss If you have recently been treated in hospital or have recently been put onto antibiotics see your GP. To diagnose the cause of persistent diarrhoea, your GP will review the medications you are on and will likely ask questions about your bowel movements and other questions which may help to isolate a possible cause. Your GP may need to take a stool sample or a blood test or perform a rectal examination if further information is needed. Treating diarrhoea Depending on the cause of diarrhoea, treatment may vary. See further below for more about specific causes related to diabetes. Whilst you have diarrhoea, it is important to take regular drinks of fluid, ideally water, as you will lose more water than usual through diarrhoea. High blood glucose, which can also commonly result from viral infections, can also increase th Continue reading >>
Hyperkalemia (high Blood Potassium)
How does hyperkalemia affect the body? Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract) and skeletal muscle (muscles of the extremities and torso), as well as the muscles of the heart. It is also important for normal transmission of electrical signals throughout the nervous system within the body. Normal blood levels of potassium are critical for maintaining normal heart electrical rhythm. Both low blood potassium levels (hypokalemia) and high blood potassium levels (hyperkalemia) can lead to abnormal heart rhythms. The most important clinical effect of hyperkalemia is related to electrical rhythm of the heart. While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG changes (EKG is a reading of theelectrical activity of the heart muscles), and severe hyperkalemia can cause suppression of electrical activity of the heart and can cause the heart to stop beating. Another important effect of hyperkalemia is interference with functioning of the skeletal muscles. Hyperkalemic periodic paralysis is a rare inherited disorder in which patients can develop sudden onset of hyperkalemia which in turn causes muscle paralysis. The reason for the muscle paralysis is not clearly understood, but it is probably due to hyperkalemia suppressing the electrical activity of the muscle. Common electrolytes that are measured by doctors with blood testing include sodium, potassium, chloride, and bicarbonate. The functions and normal range values for these electrolytes are described below. Hypokalemia, or decreased potassium, can arise due to kidney diseases; excessive losses due to heavy sweating Continue reading >>
Which Foods Increase Blood Acidity?
Before Having Your Tonsils Removed Tonsillectomies are performed under general anesthesia. You will be completely asleep and will not be able to feel pain during the procedure. You will not be able to eat before surgery. This is because there is a risk of vomiting with anesthesia. Your physician or nurse will give you exact instructions about when to stop eating and drinking. In addition to not eating or drinking, you should not smoke, chew gum, or suck on mints or candy. Tonsillectomies are mostly performed in same day surgery settings. This means that you will go home the same day that you have your tonsils removed. You should wear loose comfortable clothing to the surgical center. Arrive on time. In some cases a medication called Versed can be given prior to the procedure to reduce anxiety, especially in small children. If you have other health problems, your doctor may order blood work or other tests before the surgery. If you are a woman of childbearing age (usually age 12 to 55 unless you have had a hysterectomy), it is mandatory that you have a pregnancy test before the surgery. This requires a small amount of urine. If the patient is a child and has a comfort item, such as a blanket or a favorite toy, bring it with you. Also, if your child drinks from a bottle or special cup, bring it along so your child can drink after the surgery. Make sure you bring comfortable clothing and extra diapers or underwear. Prior to having your tonsils removed, you will need to remove any metal from your body, including jewelry, retainers or body piercings. You will also need to remove contact lenses, dentures, and hearing aids. You will also need to refrain from medications that have the ability to thin your blood for one to two weeks before surgery. These medications include aspi Continue reading >>
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 >>
Do Low-carb Diets Have Any Negative Side Effects?
Low carb diets are generally considered to be safe for most people (not all). However, it may lead to a few negative side effects, especially in the beginning: “Keto Flu” - the symptoms are headache, fatigue, brain fog, disturbed sleep, nausea. The condition is generally short lived. Bad breath caused by formation of ketones that smell like acetone Cramping of leg muscles due to water and mineral loss in the beginning of ketosis Digestive issues such as constipation (from neglecting to drink enough water or intake adequate fiber) or in some cases diarrhea Palpitations or increased heart rate which may be caused by decreased intake of water and salt or too much coffee These short term negative side effects can be corrected by increasing the intake of water, salt/ Sodium, minerals/ Magnesium, fiber from natural sources such as nuts, seeds, berries, low carb vegetables, all natural low carb products like GET FIT Roti Wrap FIT ROTI (full disclosure, I co-founded the company that makes this product). In a few cases, less common longer term negative side effects have been noted. These include: 1. Ketoacidosis (a serious condition that occurs in uncontrolled diabetes) triggered in some breastfeeding women on a ketogenic diet 2. Kidney stones in epileptic children and 3. Raised overall cholesterol and LDL levels in some people 4. Hormonal problems such as increased production of stress hormone cortisol and disruption of the Hypothalamic- Pituitary-Adrenal axis which is responsible for regulating stress levels, mood, emotions, digestion, immune system, sex drive, metabolism and energy levels. Researchers at Stanford also found that in an obesity research study where 300 participants were split into two groups and administered a low fat/ low carb diet, a small percentage of p Continue reading >>
What Causes A Pulsating Abdomen?
There are 67 conditions associated with distended stomach, pain or discomfort and pulsating sensation- Constipation (adult)Constipation is having less than three bowel movements a week, causing hard stools, abdominal pain and more. Take care Continue reading >>
How To Treat Diabetic Diarrhea?
I have a problem that I never see addressed. I've had type 1 diabetes for 36 years and been diagnosed as having diabetic diarrhea. Numerous tests have ruled out all other gastrointestinal problems. Is there any treatment for this problem? Continue reading >>
Diabetes With Ketone Bodies In Dogs
Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA. Diabetes with ketone bodies is also described in veterinary terms as diabetic ketoacidosis or DKA. It is a severe complication of diabetes mellitus. Excess ketone bodies result in acidosis and electrolyte abnormalities, which can lead to a crisis situation for your dog. If left in an untreated state, this condition can and will be fatal. Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below: Change in appetite (either increase or decrease) Increased thirst Frequent urination Vomiting Abdominal pain Mental dullness Coughing Fatigue or weakness Weight loss Sometimes sweet smelling breath is evident Slow, deep respiration. There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease. While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA: Fasting Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerba Continue reading >>
Is Diabetes Causing My Nausea?
Nausea comes in many forms. Sometimes it can be mild and short-lived. Other times, it can be severe and last for a long time. For people with diabetes, nausea is a common complaint. It can even be a sign of a life-threatening condition that requires swift medical attention. 5 common causes of nausea Factors related to your diabetes may cause you to feel nausea. Medication Metformin (Glucophage) is one of the more common medications used to treat diabetes. Nausea is a potential side effect for people taking this medication. Taking metformin on an empty stomach may make nausea worse. Injectable medications used to treat diabetes, such as exenatide (Byetta), liraglutide (Victoza), and pramlintide (Symlin), may also cause nausea. The nausea may go away after extended use. Your doctor may also start you on a lower dosage to try to reduce or eliminate nausea. Hypo- and hyperglycemia Hyperglycemia (elevated blood sugar levels) or hypoglycemia (blood sugar levels that are too low) may cause nausea. Check your blood sugar and respond appropriately if you suspect abnormal blood sugar levels. To avoid hypo- and hyperglycemia, stick to your diabetes meal plan, monitor your blood sugar, and take your medication as prescribed. You should also avoid exercising in extreme temperatures and keep cool by drinking cold liquids during outside activities, advises Sheri Colberg, PhD, author, exercise physiologist, and expert on diabetes management. Diabetic ketoacidosis Severe nausea may be a sign of diabetic ketoacidosis. This is a dangerous medical condition that must be treated to avoid coma or even death. Symptoms include: nausea excessive thirst frequent urination abdominal pain weakness or fatigue shortness of breath confusion fruity-scented breath If you suspect diabetic ketoacidosis, Continue reading >>