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Euglycemic Diabetic Ketoacidosis Symptoms

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Euglycemic Diabetic Ketoacidosis: An Easily Missed Diagnosis

SESSION TITLE: Critical Care Student/Resident Case Report Posters I SESSION TYPE: Student/Resident Case Report Poster INTRODUCTION: A 47 year-old woman with type 1 diabetes presented with euglycemic diabetic ketoacidosis (DKA) that initially went undiagnosed. Recognition and treatment with insulin resulted in rapid resolution of her clinical condition. CASE PRESENTATION: A 47 year-old woman presented to our hospital with four days of fever, abdominal pain, diarrhea, nausea, vomiting, lethargy and malaise. She had a history of type 1 diabetes mellitus managed with an insulin pump. Her blood pressure was 88/51. She was disoriented with a diffusely tender but soft abdomen. Laboratory studies revealed blood glucose of 109 mg/dL, bicarbonate of 15 mmol/L, anion gap of 27 mmol/L, lactic acid of 2.4 mmol/L, and a bandemia of 11%. Rapid flu test was positive. She was admitted to the intensive care unit, resuscitated with intravenous fluid, and started on oseltamivir, cefepime and vancomycin. Hemodialysis was initiated soon thereafter. The patient received no insulin due to her euglycemia. Influenza A was detected by PCR on the second hospital day and antibiotics were discontinued. Her gast Continue reading >>

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  1. Dryden Cope

    Many consequences of the Continuum Hypothesis can be found in the paper: http://www.math.yorku.ca/~stepra... . Also this review of Sierpinski's book on the Continuum Hypothesis mentions several similar references:http://www.ams.org/bull/1936-42-... . There is a web page dedicated to the Continuum Hypothesis here: http://www.ams.org/bull/1936-42-... www.ii.com/math/ch/ .

  2. David Joyce

    The largest consequence is a lack of completeness. The Continuum Hypothesis lacks axiomatic support and therefore from Kurt Godel we know it is impossible to logically prove that it is true using our set of axioms in ZFC. Completeness is what makes mathematics solid and without it, and assuming one case of the GCH creates a false sense of completeness within ZFC. You can't actually prove it works or doesn't work in ZFC.

  3. Manees Mehta

    Watch this explanation

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Susan Cornell, PharmD, CDE, FAPhA, FAADE, describes the risks for ketoacidosis and serious urinary tract infection associated with use of SGLT2 inhibitors. This video was recorded at APhA's 2016 Annual Meeting and Exposition in Baltimore, Maryland.

Euglycemic Diabetic Ketoacidosis: The Clinical Concern Of Sglt2 Inhibitors

Euglycemic diabetic ketoacidosis is a post market warning in patients with type 1 diabetes and type 2 diabetes treated with SGLT-2 inhibitors. We report a case of a 39-year-old obese female with presumed type 2 diabetes for seven years who presented to the emergency department with three days of nausea, vomiting, and abdominal pain. Due to previous total non-adherence with a prescribed insulin regimen, she was recently started on canagliflozin and liraglutide. The diagnosis of euDKA was missed in the initial evaluation as the blood glucose level was only 167 mg/dL. Further work up showed severe metabolic acidosis with an anion gap of 25 and positive ketones in the urine. She was treated successfully with dextrose water 5%/half normal saline and an insulin drip. As part of the work up, she tested positive for glutamic acid decarboxylase autoantibodies. Given the increasing utilization of SGLT-2 inhibitors and the fact that patients can present with near-normal glycemia, the diagnosis can be missed. Vigilance with the use of SGLT-2 inhibitors is necessary to decrease morbidity and potentially mortality particularly in patients with long-standing type 2 diabetes associated with marked Continue reading >>

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  1. BigdogEMT

    Hello I'm new here, not new to low carb (but keto is a bit diff). I have been a type 2 diabetic for maybe 8 years diagnosed. And take metformin, glipizide, and januvia. My sugars stay high unless I'm low carbing it. Last a1c was 6.4 down from 7.4 3 months earlier.
    So I know it works but mu question is why I still have a 160-200 fasting blood sugar in the am? I haven't had over 10-15 gm of carbs for 4 days!
    It's just frustrating, my doctor tells me to not sweat it he just looks at the a1c!
    But I know what it's doing to my body while its high!

  2. Barbara_Greenwood

    Hi Bigdog, welcome.
    Let me guess.... if you test before lunch or dinner, your level is lower, yes? If so, you are experiencing Dawn Phenomenon, which is very common among T2's. Due to loads of hormone stuff which is to do with getting ready to wake up and take on the day, your liver dumps glucose into your blood. Actually, this always happens, but in people with T2 it really goes overboard.
    I have recently (3 days ago) started using the Freestyle Libre, which is a flash glucose monitoring system. I have a patch stuck on my arm, with a little filament sticking just under my skin. It measures glucose in interstitial fluid, which tracks blood glucose pretty well. It records it every 15 minutes, I scan it with a little reader device and then I can see exactly what has been going on.
    I've discovered that my BG is at a normal level right through the night, starts creeping up about 5am and rises inexorably till about 10am, after which it decreases slightly. And when the meals I eat are low carb, it barely rises at all after eating. However, the rise in the morning is so steep that, depending what time I tested my blood, it would be either a good or a bad day.
    So, your doctor has a point in that your A1C averages out what's going on across the day as a whole. But it is still important to get those morning readings down, because they do contribute to damage at the levels you mentioned.
    I would say give it more time - stick with the very low carb, and you will see your morning readings improve. But also - there are various things people suggest to blunt Dawn Phenomenon. Some swear by a protein snack before bed, or a fatty snack, or a small breakfast..... but what works for one apparently doesn't work for all.

    I've just set out on a programme of quantifying my Dawn Phenomenon when I try different food/drink options, both in the evening and at bedtime. Over time, I'll be able to track down what works for me - and the Libre will help a lot with that because I don't have to guess when is the best time to test, I get a pretty good picture each day of how much my BG has risen over the morning.

  3. BillJay

    BigdogEMT:


    My sugars stay high unless I'm low carbing it. Last a1c was 6.4 down from 7.4 3 months earlier.
    As @Barbara_Greenwood says, Dawn Phenomenon (DP) is probably why your fasting glucose is high.
    As I mentioned in another thread, I'm a recovered T2DM that had it pretty bad initially until I realized that I had a disease of blood glucose that was too high and it made no sense whatsoever to eat foods that turn into blood glucose, ever.
    The problem was that I struggled for years with the cognitive dissonance from what I had heard about carbs=good and fat=bad, but I remained aware that I have a disease of blood sugar regulation and if I ate something that raised it, it was bad.

    Finally, I gave in to keto and as far as I'm concerned, carbs are poison unless they come from non-starchy vegetables.

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In this video, I am sharing with you the stocking stuffers that we bought for Andrew, Ashley, and Christina's Christmas stockings. Music Credit: "Deck The Halls" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/b... Other Places To Find Us: Address: PO Box 4773 Winchester, KY 40392 Patreon: https://www.patreon.com/tamisclock?ty=h Tamis Snapchat: tamisclock Tamis Twitter: https://twitter.com/tamisclock Tamis Pinterest: https://www.pinterest.com/tamisclock/ Tamis Instagram: https://www.instagram.com/tamisclock/ Tamis Facebook: https://www.facebook.com/tamidunnyoutube Tamis Google+: https://plus.google.com/+TamiDunn/posts Kevins Lunchtime Review: https://www.youtube.com/channel/UCRU5... Kevins Gaming & Lecturing Channel: https://www.youtube.com/channel/UCGgx... Kevins Instagram: https://www.instagram.com/moviehq/ Kevins Twitter: https://twitter.com/MovieHQ Kevins Google+: https://plus.google.com/+MovieHQ/videos Dunn Family Bloopers https://www.youtube.com/watch?v=qdjZm... Dunn Family Bloopers Part II https://www.youtube.com/watch?v=dXQ5v... Dunn Family Bloopers Part III https://www.youtube.com/watch?v=Blfg4... Ashleys Instagram: https://www.instagram.com/ashley_e_dunn/

Euglycemic Diabetic Ketoacidosis In A 27 Year-old Female Patient With Type-1-diabetes Treated With Sodium-glucose Cotransporter-2 (sglt2) Inhibitor Canagliflozin

Received 2015 October 17; Revised 2016 January 30; Revised 2016 March 14; Revised 2016 March 17; Accepted 2016 March 25. Copyright : Pakistan Journal of Medical Sciences This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We are reporting a timely case of atypical euglycemic diabetic ketoacidosis in a type 1 diabetic patient treated with sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin. The clinical history, physical examination findings and laboratory values are described. Other causes of acidosis such as salicylate toxicity or alcohol intoxication were excluded. Ketoacidosis resolved after increasing dextrose and insulin doses supporting the hypothesis that SGLT-2 inhibitors may lead to hypoinsulinemia. Euglycemic ketoacidosis did not recur in our patient after discontinuing canagliflozin. We recommend reserving SGLT2 inhibitor therapy to type 2 diabetics, discontinuing medication and treating patients presenting with ketoacidosis due to SGLT-2 inhibitors with higher concentrations of de Continue reading >>

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  1. bigmama5

    How do I know when I am there or not, where can find this out my coach has given no information on this.

  2. glenlorie

    Although I don't look for ketosis, I have done a lot of research and they most common thing that many of my weight loss friends use is a stick that is similar to a EPT (pregnancy test). A few of them said they purchase them from walmart, however I've never seen them there. A lot of them also order them online, so I'm sure if you do some online research you can find them. I hope this helps. Best wishes!!

  3. JerseyGyrl

    The ketosis sticks do not work for everyone....I 've lost over 100 lbs on Atkins and they never changed color for me. They are also pretty costly.
    Key signs of ketosis are bad breath, a metallic taste in the mouth, foul smelling urine and thirst.

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