Euglycemic Diabetic Ketoacidosis, A Misleading Presentation Of Diabetic Ketoacidosis
Go to: Introduction Hyperglycemia and ketosis in diabetic ketoacidosis (DKA) are the result of insulin deficiency and an increase in the counterregulatory hormones glucagon, catecholamines, cortisol, and growth hormone. Three processes are mainly responsible for hyperglycemia: increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization by peripheral tissues. This might also be augmented by transient insulin resistance due to hormone imbalance, as well as elevated free fatty acids. DKA is most commonly precipitated by infections. Other factors include discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and illicit drug use. The diagnostic criteria of DKA, established by the American Diabetic Association, consists of a plasma glucose of >250 mg/dL, positive urinary or serum ketones, arterial pH of <7.3, serum bicarbonate <18 mEq/L, and a high anion gap. The key diagnostic feature of DKA is elevated circulating total blood ketone concentration. Hyperglycemia is also a key diagnostic criterion of DKA; however, a wide range of plasma glucose levels can be present on admission. Continue reading >>
Ketones — The 6 Must-knows
WRITTEN BY: Kyla Schmieg, BSN, RN Editor’s Note: Kyla Schmieg (BSN, RN) is a practicing pediatric endocrinology nurse in Cincinnati, OH, USA, and Type 1 Diabetic, working on the same unit she was diagnosed at 26 years ago. 1 – What are ketones? Ketones are chemicals that build up when your body starts to burn fat for energy. The most common cause of ketones in diabetics is insulin deficiency. Without enough insulin, glucose builds up in the blood stream and can’t enter cells. The cells then burn fat instead of glucose. This results in ketones forming in the blood and eventually spilling into urine. 2 – Why can ketones be dangerous? Having ketones can indicate that your body needs more insulin. (Always monitor your blood sugar levels to know how much insulin you need.) If you have a build up of ketones, this can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include moderate or large ketones, nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy. If left untreated, it can lead to a serious and life-threatening diabetic coma or death. High levels of ketones are toxic to the body and if you’re experiencing these, you should seek out medical attention. 3 – When should you check for ketones? You should be checked anytime your blood sugar is above 240 mg/dl (13.3 mmol/l) or any time you are sick. This includes any minor illness such as a cold. 4 – Can you get ketones with a high blood sugar? Ketones typically accompany high blood sugar. They indicate that your body needs more insulin. Most often if your body needs more insulin, it means you probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones Continue reading >>
Urine Tests For Diabetes: Glucose Levels And Ketones
The human body primarily runs on glucose. When your body is low on glucose, or if you have diabetes and don’t have enough insulin to help your cells absorb the glucose, your body starts breaking down fats for energy. Ketones (chemically known as ketone bodies) are byproducts of the breakdown of fatty acids. The breakdown of fat for fuel and the creation of ketones is a normal process for everyone. In a person without diabetes, insulin, glucagon, and other hormones prevent ketone levels in the blood from getting too high. However, people with diabetes are at risk for ketone buildup in their blood. If left untreated, people with type 1 diabetes are at risk for developing a condition called diabetic ketoacidosis (DKA). While rare, it’s possible for people with type 2 diabetes to experience DKA in certain circumstances as well. If you have diabetes, you need to be especially aware of the symptoms that having too many ketones in your body can cause. These include: If you don’t get treatment, the symptoms can progress to: a fruity breath odor stomach pain trouble breathing You should always seek immediate medical attention if your ketone levels are high. Testing your blood or urine to measure your ketone levels can all be done at home. At-home testing kits are available for both types of tests, although urine testing continues to be more common. Urine tests are available without a prescription at most drugstores, or you can buy them online. You should test your urine or blood for ketones when any of the following occurs: Your blood sugar is higher than 240 mg/dL. You feel sick or nauseated, regardless of your blood sugar reading. To perform a urine test, you urinate into a clean container and dip the test strip into the urine. For a child who isn’t potty-trained, a pa Continue reading >>
Ketones With Normal Blood Sugars
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I recently got the flu and was feeling awful with a temperature and all the fun that comes with it!. I knew I had to keep eating and taking in fluids though. I could barely get out of bed but I did what I had to. On the 3rd day in the night I checked and found I had high levels of ketones in my urine but in my blood it was 0.9. I checked again a little while later and it was 1.1 in my blood. Then 1.4. My sugars weren't too bad. As the ketones were rising and it was getting later I was worried at what point I would need help. The rule of thumb being getting advice at 1.5 and above and if higher and vomiting then going to A & E. I rang 111 as I didn't have anywhere else I could ring at that time. Then a paramedic phoned back to chat. She felt a dr was needed. A dr came round and said Id done the right thing. He found I had a UTI so prescribed antibiotics straight away. I was in a state but he said the ketones didn't concern him at this point particularly as they'd come down a bit since he arrived. Down to 1.1. I have since been in touch with my diabetic nurse during work hours and we have an appointment soon. She told me to check my pump Manual for sick days. I did and can't find any mention of ketones with normal blood sugars. She told me the treatment is the same. Go to hospital, get put on a glucose drip and double the insulin. We are 3 weeks on and I still have the tail end if this horrible flu virus thing. I live with ME and fibromyalgia too. I would rather avoid hospital at all costs. Last time I went in years ago for unrelated reasons I had to get my own blankets and meds back to deal with myself. I prefer to feel in some semblance of control in Continue reading >>
Ketone Testing: What You Need To Know
What are ketones? Why should you test for ketones? How do you test for ketones? And what should you do when you find ketones? What are ketones? Ketones are produced when the body burns fat for energy or fuel. They are also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy. Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick. How can I test for ketones? You can test to see if your body is making any ketones by doing a simple urine test. There are several products available for ketone testing and they can be purchased, without a prescription, at your pharmacy. The test result can be negative, or show small, moderate, or large quantities of ketones. When should I test for ketones? Anytime your blood glucose is over 250 mg/dl for two tests in a row. When you are ill. Often illness, infections, or injuries will cause sudden high blood glucose and this is an especially important time to check for ketones. When you are planning to exercise and the blood glucose is over 250 mg/dl. If you are pregnant, you should test for ketones each morning before breakfast and any time the blood glucose is over 250 mg/dl. If ketones are positive, what does this mean? There are situations when you might have ketones without the blood glucose being too high. Positive ketones are not a problem when blood glucose levels are within range and you are trying to lose weight. It is a problem if blood glucose levels are high and left untreated. Untreated high blood glucose with positive ketones can lead to a life-threatening condition called diabetic ketoacidosis Continue reading >>
Ketones: Clearing Up The Confusion
Ketones, ketosis, ketoacidosis, DKA…these are words that you’ve probably heard at one point or another, and you might be wondering what they mean and if you need to worry about them at all, especially if you have diabetes. This week, we’ll explore the mysterious world of ketones, including if and how they may affect you. Ketones — what are they? Ketones are a type of acid that the body can form if there’s not enough carbohydrate to be burned for energy (yes, you do need carbs for fuel). Without enough carb, the body turns to another energy source: fat. Ketones are made in the liver from fat breakdown. This is called ketogenesis. People who don’t have diabetes can form ketones. This might occur if a person does extreme exercise, has an eating disorder, is fasting (not eating), or is following a low-carbohydrate diet. This is called ketosis and it’s a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy. Again, the body scrambles to find an alternate fuel source in the form of fat. You might be thinking that it’s a good thing to burn fat for fuel. However, for someone who has diabetes, ketosis can quickly become dangerous if it occurs due to a continued lack of insulin (the presence of ketones along with “normal” blood sugar levels is not necessarily a cause for concern). In the absence of insulin (which can occur if someone doesn’t take their insulin or perhaps uses an insulin pump and the pump has a malfunction, for example), fat cells continue to release fat into the circulation; the liver then continues to churn Continue reading >>
Ketones In Urine But Not Diabetic?
Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Got a quick call today from my doctor since I had a routine physical and got bloodwork and urine tests done. He said everything was normal except for really low vitamin D levels and oddly enough, ketones in my urine. He explained that typically it's a sign of uncontrolled diabetes but my blood sugar is fine. He ordered an a1c done at the time that I got all of my bloodwork done just to be thorough. I don't have the results in front of me but I could request a hard copy of them. Anyway, he assured me that I'm not diabetic. Is ketones in the urine a precursor to diabetes? I did read that fasting or starvation can lead to temporary high ketone levels. As a full-time college student, let's just say that my sleeping schedule is rather...irregular. I had to fast for the blood test that morning so my last meal was dinner that evening. I didn't sleep until 7 am that morning and my appointment was at 9 am, so...yeah... The doctor said the next step would be a 24 hr urine test since they double-checked my results to make sure I actually had ketones in my urine and I did. But he also said there's no rush at all. I can't get the test till I'm actually back home so I'm just wondering now what it could be Did you know the volume of ketones in your urine? Was it slight or high? Slight to moderate ketones can occur with exercise. Did you work out or do some strenuous physical activity before your appointment? People on low carbohydrate diets go into ketosis (usually preferably). These are things to consider if your testing does rule out Diabetes. Plus, this was a one time test. Without other symptoms or clin Continue reading >>
Ketones And Children With Type 1 Diabetes – What’s Important?
What are ketones and when do you check for them in children with type one diabetes? This is a common question I get! I think when children are diagnosed, this a frequent part of the education that is easily forgotten or misunderstood due to the overwhelming amount of information being taught. So let’s look at why we would check ketones, how to check them, what the colors on the strips mean, and what to do if ketones are present. Why Check Ketones: When someone with type 1 diabetes does not not get enough insulin, their blood sugar levels rise, so the body is forced to use fat for energy. When fat is used for energy for an extended period of time, ketones develop. Ketones are a waste product of fat. If someone with type 1 diabetes does not get enough insulin, diabetic ketoacidosis (DKA) can develop. The length of time it takes and how high one’s blood sugar are varies, however DKA can occur in a few hours. Symptoms of DKA: high blood sugars ketones in blood and urine nausea, vomiting, and abdominal pain confusion lethargy (tired, sluggish, weak) difficulty breathing unconsciousness DKA is a very serious and life threatening situation. Speak with your health care providers to determine how you are to treat ketones and when you are to go to the emergency room. When to check ketones: Your doctor can tell you exactly, but usually when your blood sugars are over 250, especially if the blood sugar is not responding to insulin and remaining high after the second blood sugar check. Always check ketones when your child is sick, even if blood sugar numbers are not high. Anytime your child has nausea and vomiting, check ketones. How to check ketones: Ketones can be checked by using ketone urine strips. To check ketones, urinate on a strip, or collect urine and dip stick into ur Continue reading >>
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis is a serious condition characterized by high blood sugar (hyperglycemia), low insulin, and the presence of moderate to large amounts of ketones in the blood. It's a medical emergency that requires treatment in a hospital. If not treated in a timely fashion, ketoacidosis can lead to coma and death. While diabetic ketoacidosis (or DKA) is much more common among people with type 1 diabetes, it can also occur in people with type 2 diabetes, so ketone monitoring is something everyone with diabetes should understand. Diabetic Ketoacidosis Symptoms Signs and symptoms of ketoacidosis include: Thirst or a very dry mouth Frequent urination Fatigue and weakness Nausea Vomiting Dry or flushed skin Abdominal pain Deep breathing A fruity breath odor What Are Ketones? Ketones, or ketone bodies, are acidic byproducts of fat metabolism. It's normal for everyone to have a small amount of ketones in the bloodstream, and after a fast of 12 to16 hours, there may be detectable amounts in the urine. As is the case with glucose, if blood levels of ketones get too high, they spill over into the urine. An elevated level of ketones in the blood is known as ketosis. People who follow low-carbohydrate diets often speak of ketosis as a desirable state — it's evidence that their bodies are burning fat, not carbohydrate. But the level of ketosis that results from low carbohydrate consumption isn't harmful and is much lower than the level seen in diabetic ketoacidosis. When Should Ketones Be Monitored? Ketone monitoring is less of a concern for people with type 2 diabetes than for those with type 1 diabetes. This is because most people with type 2 diabetes still make some of their own insulin, making diabetic ketoacidosis less likely to develop. Nonetheless, people with type 2 d Continue reading >>
How To Treat Ketoacidosis
Fri, 11/19/2010 - 14:57 -- Richard Morris Immediately drink a large amount of non-caloric or low caloric fluid. Continue to drink 8 to 12 oz. every 30 minutes. Diluted Gatorade, water with Nu-Salt and similar fluids are good because they help restore potassium lost because of high blood sugars. Take larger-than-normal correction boluses every 3 hours until the blood sugar is below 200 mg/dl (11 mmol) and ketones are negative. It will take much more rapid insulin than normal to bring blood sugars down when ketones are present in the urine or blood. Often, one and a half to two times the normal insulin dose for a high blood sugar will be necessary. Higher insulin doses than these will be needed if there is an infection or other major stress. If nausea becomes severe or last 4 hours or more, call your physician. If vomiting starts or you can no longer drink fluids, have a friend or family member call your physician immediately, then go directly to an emergency room for treatment. Never omit your insulin, even if you cannot eat. A reduced insulin dose might be needed, but only if your blood sugar is currently low. When high blood sugars or ketoacidosis happen, it is critical that you drink lots of fluid to prevent dehydration. Take extra amounts of Humalog, Novolog or Regular insulin to bring the blood sugars down. Children with severe ketoacidosis lose 10-15 % of their previous body weight (i.e., a 60 lb. child can lose 6 to 9 lbs. of weight) due to severe dehydration. Replacement of fluids should be monitored carefully. The dehydration is caused by excess urination due to high blood sugars and is quickly worsened when vomiting starts due to the ketoacidosis. The start of vomiting requires immediate attention at an ER or hospital where IV fluid replacement can begin. If o Continue reading >>
Ketones And Normal Blood Sugar
Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. I still dont see why ketones (small-moderate) are dangerous if your BS is in range and you are ill. It has been explained many of times. Dont you have ketones becuase you are ill, the stress on the body,not becuase you are at risk of DKA? Can someone explain it in lame man terms? Here is the argument as I've heard it: Ketones are a result of not enough insulin. Often high bg is present as well, as another result of not enough insulin. Type 1 diabetics aren't able to clear ketones like other people would, so if they build up, you can end up with DKA. I've heard several instances where someone started going into DKA with "normal" blood sugar and ended up with one IV in each arm - one dextrose and one insulin. Anecdotally, it seems to me that this is more of a risk with children and not adults. Still, I wouldn't take chances with it. If I had moderate or high ketones, I would try to clear them out (by carb and insulin intake). .... Ketones are a result of not enough insulin. .... Not quite. Ketones in the urine are the result of burning fat. This can happen with adequate insulin and normal blood glucose, in which case it is not dangerous. Not quite. Ketones in the urine are the result of burning fat. This can happen with adequate insulin and normal blood glucose, in which case it is not dangerous. Well, if you're concerned about what kind of ketones, you can always get a blood ketone meter, which tests for diabetic ketones, unlike the urine strips. It also shows you what's going on in real time. If the ketones are small to moderate, I personally don't put them in the catgory of "dangerous". I am Continue reading >>
What Are Ketones And Their Tests?
A ketone test can warn you of a serious diabetes complication called diabetic ketoacidosis, or DKA. An elevated level of this substance in your blood can mean you have very high blood sugar. Too many ketones can trigger DKA, which is a medical emergency. Regular tests you take at home can spot when your ketone levels run too high. Then you can take insulin to lower your blood sugar level or get other treatments to prevent complications. What Exactly Are Ketones? Everyone has them, whether you have diabetes or not. Ketones are chemicals made in your liver. You produce them when you don't have enough of the hormone insulin in your body to turn sugar (or “glucose”) into energy. You need another source, so your body uses fat instead. Your liver turns this fat into ketones, a type of acid, and sends them into your bloodstream. Your muscles and other tissues can then use them for fuel. For a person without diabetes, this process doesn’t become an issue. But when you have diabetes, things can run out of control and you build up too many ketones in your blood. If the level goes too high, it can become life-threatening. Who Needs a Ketone Test? You might need one if you have type 1 diabetes. In this type, your immune system attacks and destroys cells in your pancreas that make insulin. Without it, your blood sugar rises. People with type 2 diabetes can also get high ketones, but it isn't as common as it is with type 1. Tests can show you when your level gets high so you can treat it before you get sick. When Should You Test? Your doctor will probably tell you to test your ketones when: Your blood sugar is higher than 250 milligrams/deciliter (mg/dl) for two days in a row You're sick or you've been injured You want to exercise and your blood sugar level is over 250 mg/dl Continue reading >>
High Blood Sugar Emergencies
Blood sugar levels that are too high (hyperglycemia) can quickly turn into a diabetic emergency without quick and appropriate treatment. The best way to avoid dangerously high blood sugar levels is to self-test to stay in tune with your body, and to stay attuned to the symptoms and risk factors for hyperglycemia. Extremely high blood sugar levels can lead to one of two conditions—diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS; also called hyperglycemic hyperosmolar nonketotic coma). Although both syndromes can occur in either type 1 or type 2 diabetes, DKA is more common in type 1, and HHNS is more common in type 2. Diabetic Ketoacidosis (DKA) Ketoacidosis (or DKA) occurs when blood sugars become elevated (over 249 mg/dl, or 13.9 mmol/l) over a period of time and the body begins to burn fat for energy, resulting in ketone bodies in the blood or urine (a phenomenon called ketosis). A variety of factors can cause hyperglycemia (high blood glucose), including failure to take medication or insulin, stress, dietary changes without medication adjustments, eating disorders, and illness or injury. This last cause is important, because if illness brings on DKA, it may slip by unnoticed, since its symptoms can mimic the flu (aches, vomiting, etc.). In fact, people with type 1 diabetes are often seeking help for the flu-like symptoms of DKA when they first receive their diagnosis. Symptoms of diabetic ketoacidosis may include: fruity (acetone) breath nausea and/or vomiting abdominal pain dry, warm skin confusion fatigue breathing problems excessive thirst frequent urination in extreme cases, loss of consciousness DKA is a medical emergency, and requires prompt and immediate treatment. A simple over-the-counter urine dipstick test (e.g., Keto Continue reading >>
Ketone Bodies (urine)
Does this test have other names? Ketone test, urine ketones What is this test? This test is used to check the level of ketones in your urine. Normally, your body burns sugar for energy. But if you have diabetes, you may not have enough insulin for the sugar in your bloodstream to be used for fuel. When this happens, your body burns fat instead and produces substances called ketones. The ketones end up in your blood and urine. It's normal to have a small amount of ketones in your body. But high ketone levels could result in serious illness or death. Checking for ketones keeps this from happening. Why do I need this test? You may need this test if you have a high level of blood sugar. People with high levels of blood sugar often have high ketone levels. If you have high blood sugar levels and type 1 or type 2 diabetes, it's important to check your ketone levels. People without diabetes can also have ketones in the urine if their body is using fat for fuel instead of glucose. This can happen with chronic vomiting, extreme exercise, low-carbohydrate diets, or eating disorders. Checking your ketones is especially important if you have diabetes and: Your blood sugar goes above 300 mg/dL You abuse alcohol You have diarrhea You stop eating carbohydrates like rice and bread You're pregnant You've been fasting You've been vomiting You have an infection Your healthcare provider may order this test, or have you test yourself, if you: Urinate frequently Are often quite thirsty or tired Have muscle aches Have shortness of breath or trouble breathing Have nausea or vomiting Are confused Have a fruity smell to your breath What other tests might I have along with this test? Your healthcare provider may also check for ketones in your blood if you have high levels of ketones in your urine Continue reading >>
Caution: Don’t Get Caught With Ketones
Ketoacidosis is an extremely serious diabetic complication that can lead to coma and even death. Unfortunately it is also fairly common. The good news, however, is that with proper care and an eye towards prevention, this costly and dangerous complication can be avoided. What Is Ketoacidosis? When there isn't enough insulin present for the metabolism of glucose, or when insufficient food has been eaten to satisfy energy requirements, the body burns fat for energy. Ketones are toxic, acidic byproducts of this process. Ketones are normally processed by the kidneys and excreted in the urine. But when more ketones are produced than the kidneys can handle, they can build up in the blood and lead to a dangerous condition known as diabetic ketoacidosis (DKA). Ketoacidosis raises the acidity of the body, which leads to "a cascade of problems throwing off a number a parameters in the body," says Cindy Onufer, RN, MA, CDE, the diabetes research and clinical care coordinator at Oregon Health Sciences University. Ketoacidosis rarely occurs in people with type 2 diabetes, who usually do not suffer from insufficiency of insulin, but is of great concern to those with type 1 diabetes. In fact, ketoacidosis is the number one cause of hospitalization for children with known diabetes in the United States. However, these hospitalizations are completely preventable if a urine ketone test is done and a care provider is called when indicated, says H. Peter Chase, MD, with the Barbara Davis Center for Childhood Diabetes in Denver, Colorado. Timely testing and prevention are of utmost importance as the condition can cause coma and death if proper treatment is not administered quickly. Higher ketone levels are a warning sign that your diabetes is out of control or that you may be in danger of ke Continue reading >>