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How Are Ketones Produced In Dka?

Diabetic Ketoacidosis (dka) And Ketone Strips

Diabetic Ketoacidosis (dka) And Ketone Strips

Diabetic Ketoacidosis (DKA) can be a life-threatening complication of diabetes. People with Type 1, or those on insulin pumps can experience DKA more frequently due to a lack of endogenous (internally produced) insulin. People with gestational diabetes can experience ketone production and DKA as well. Those with Type 2 diabetes rarely get DKA except when they have severe infections or trauma. DKA can occur when ketones form; your blood becomes acidic from ketone production and cause acidosis. What Are Ketones? Ketones are a toxic by-product of fat breakdown which can occur during times of severe stress, injury or illness in people with diabetes. The body’s blood sugar rises during illness and since there is not enough insulin, the body breaks down fat as an energy source. Ketones will accumulate in the blood and urine which can cause multiple systemic problems and eventual acidosis. Dietary ketones form from strict low carbohydrate diets, yet they are benign and do not cause acidosis. When Do I Test for Ketones? When your blood sugar exceeds 240 mg/dL and you are ill, you should be testing for ketones. If you exceed 240 mg/dL and have ketones you may require insulin. If you are pregnant and your glucose drops below 60 mg/dl, you should check for ketones; if you have low glucose and find ketones, you may need more carbohydrates in the diet. How Do I Test for Ketones? Certain meters such as the Nova Max Plus can test blood for ketones with a different colored strip. Using urine ketone strips are another fast, reliable and affordable way to test. The vial has a lining that helps preserve the strips so close the bottle as soon as you remove a strip. The strips are sensitive to heat, humidity, and light. It is easy and convenient to use. Your fingers should be clean and dr Continue reading >>

Five Things To Know About Ketones

Five Things To Know About Ketones

If you live with diabetes, you have probably heard that ketones are something to watch out for. That they have something to do with the dreaded diabetic ketoacidosis (DKA). But do you really understand what ketones are and why they happen? It’s scary to think about, sure. But it’s also very important to be in the know about ketones and to be prepared. 1) What are ketones? If there isn’t enough insulin in your system, you can’t turn glucose into energy. So your body starts breaking down body fat. Ketones are a chemical by-product of this process. This can occur when people with type 1 diabetes don’t take insulin for long periods of time, when insulin pumps fail to deliver insulin and the wearer does not monitor blood glucose, or during serious illness (in type 1 or type 2) when insulin doses are missed or not increased appropriately for the stress of illness. Ketones can happen to anyone with diabetes, but the condition is more common in people with type 1. 2) Why are ketones dangerous? Ketones upset the chemical balance of your blood and, if left untreated, can poison the body. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Eventually they build up in the blood. The presence of ketones could be a sign that you are experiencing, or will soon develop, diabetic ketoacidosis (DKA)—a life-threatening medical emergency. 3) When should I test for ketones, and how? There are several situations in which it is a good idea to check for ketones, usually every four to six hours. Talk to your doctor to know what makes the most sense for you and your diabetes management plan. Your blood glucose is more than 300 mg/dl (or a level recommended by your doctor) You feel nauseated, are vomiting or have abdominal pain You are Continue reading >>

Ketone Body Metabolism

Ketone Body Metabolism

Ketone body metabolism includes ketone body synthesis (ketogenesis) and breakdown (ketolysis). When the body goes from the fed to the fasted state the liver switches from an organ of carbohydrate utilization and fatty acid synthesis to one of fatty acid oxidation and ketone body production. This metabolic switch is amplified in uncontrolled diabetes. In these states the fat-derived energy (ketone bodies) generated in the liver enter the blood stream and are used by other organs, such as the brain, heart, kidney cortex and skeletal muscle. Ketone bodies are particularly important for the brain which has no other substantial non-glucose-derived energy source. The two main ketone bodies are acetoacetate (AcAc) and 3-hydroxybutyrate (3HB) also referred to as β-hydroxybutyrate, with acetone the third, and least abundant. Ketone bodies are always present in the blood and their levels increase during fasting and prolonged exercise. After an over-night fast, ketone bodies supply 2–6% of the body's energy requirements, while they supply 30–40% of the energy needs after a 3-day fast. When they build up in the blood they spill over into the urine. The presence of elevated ketone bodies in the blood is termed ketosis and the presence of ketone bodies in the urine is called ketonuria. The body can also rid itself of acetone through the lungs which gives the breath a fruity odour. Diabetes is the most common pathological cause of elevated blood ketones. In diabetic ketoacidosis, high levels of ketone bodies are produced in response to low insulin levels and high levels of counter-regulatory hormones. Ketone bodies The term ‘ketone bodies’ refers to three molecules, acetoacetate (AcAc), 3-hydroxybutyrate (3HB) and acetone (Figure 1). 3HB is formed from the reduction of AcAc i Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>

Diabetes With Ketone Bodies In Cats

Diabetes With Ketone Bodies In Cats

Diabetes Mellitus with Ketoacidosis in Cats The term “ketoacidosis” refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies.” Meanwhile, diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. Typically, the type of condition affects older cats; in addition, female cats are more prone diabetes with ketoacidosis than males. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the cat's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your cat’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azotemia), low sodium levels Continue reading >>

Ketones: Clearing Up The Confusion

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 >>

Diabetes With Ketone Bodies In Dogs

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) is a serious condition that can be life threatening. It most commonly occurs when a diagnosis of Type 1 diabetes is first made. It can occur when a person with known Type 1 diabetes becomes unwell or has very high blood glucose levels (BGLs) resulting from a lack of insulin. It can even occur in the presence of normal glucose levels in children and young people with known diabetes. Type 1 diabetes is the most common form of diabetes affecting children and adolescents in Australia. The condition occurs when the body does not have enough insulin (a hormone which helps glucose move from the blood into the cells). Insulin is also responsible for controlling the level of glucose in the blood. Without insulin, glucose levels will build up in the blood. Type 1 diabetes is treated by replacing the body’s missing insulin, with injectable insulin. Some of the signs and symptoms of Type 1 diabetes include nausea, vomiting and/or abdominal pain, dehydration, deep breathing or breathlessness, extreme drowsiness and/or a fruity odour to the breath. What causes DKA? DKA occurs when there is an accumulation of toxic substances called ketones. Ketones are produced when there is not enough insulin in the body. Glucose cannot enter the cells to provide energy which results in a breakdown of fat as an energy source which then results in ketones being produced. Ketones are a form of pollution in the blood. They make the blood too acidic and this can result in the person becoming seriously unwell very quickly. This condition requires immediate medical management. Managing Type 1 diabetes Everyday illnesses, infection, or missed doses of insulin will nearly always cause a rise in BGLs in someone with Type 1 diabetes. Therefore, at the earliest sign of any form of Continue reading >>

Ketones And Exercise – What You Need To Know

Ketones And Exercise – What You Need To Know

A researcher on diabetes and exercise describes why exercise elevates risk of DKA for people with Type 1 diabetes. In a new set of guidelines for Type 1 diabetes and exercise, I and my fellow researchers warn that people with Type 1 diabetes need to monitor for elevated levels of ketones during exercise. If you have Type 1 and exercise regularly, testing for ketones could save your life. Ketones develop in our bodies when we mobilize fat as fuel. Fat is an important energy source that is used by the body at rest and during exercise. Ketones are a general term in medicine used to describe the three main ketone bodies that the liver produces – acetoacetate, beta-hydroxybutyrate, and acetone. Read “Too Many with Type 1 Don’t Test for Ketones.” sponsor Ketone bodies help fuel the brain and skeletal muscle during times of prolonged fasting or starvation, so in a way ketones are very important for survival. We actually have enough stored fat to generate energy for days, but this can cause a number of metabolic problems, the most important of which is ketoacidosis. In Type 1 diabetes, ketone levels can rise even without starvation, if insulin levels drop too much and levels of other hormones like glucagon and catecholamines rise. This rise in ketone levels in diabetes can cause a life-threatening condition called diabetic ketoacidosis (DKA). Read “How DKA Happens and What to Do About it.” The symptoms of ketoacidosis include: A lack of energy, weakness, and fatigue Nausea and vomiting, stomach pain, decreased appetite Rapid weight loss Decreased perspiration, foul or fruity breath Altered consciousness, mild disorientation or confusion Coma sponsor The reasons for developing high ketone levels in Type 1 diabetes include: Missed insulin injections Failure of insulin Continue reading >>

Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

Do Sglt2 Inhibitors Like Invokana Cause Ketoacidosis?

Do Sglt2 Inhibitors Like Invokana Cause Ketoacidosis?

In an announcement released May 15, the FDA called attention to 20 case reports it had received between March 2013 and June 6, 2014 of 20 persons, most with type 2 diabetes, who had been treated with Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors such as canagliflozin (Invokana), dapagliflozin (Farxiga, Forxiga), and empagliflozin (Jardiance), for an average of 2 weeks, but in some for as much as six months and who had diabetic ketoacidosis. Diabetic ketoacidosis is typically a condition of uncontrolled diabetes seen in type 1 diabetes, or in adolescents with severe type 2 diabetes, with elevated blood glucose and evidence of ketoacidosis with elevated blood or urine ketones and acidosis with a high blood “anion gap,” reflecting the presence of substances called organic anions in the bloodstream. Another unusual feature noted in the FDA release was that blood glucose levels were typically only mildly elevated, below 200 mg/dl. What is ketoacidosis? The body uses insulin not only to move glucose into cells, but also as a signal to increase fat and protein synthesis in fat cells and other body tissues. When a persons who does not have diabetes goes a long period without eating, ketones act as an important source of energy. Their insulin concentrations in blood fall, acting as a negative signal to cause the body to break down fat into fatty acids and protein into amino acids. A subsequent step, also signaled by low levels of insulin, is the further breakdown of fatty acids and the removal of amino groups from certain amino acids to form ketone bodies, particularly an organic acid called beta-hydroxy butyrate, as well as acetoacetic acid, which is less important in ketoacidosis but which is measured in urine ketone test strips. For a diabetic person who has true insu Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

Can Serum Β-hydroxybutyrate Be Used To Diagnose Diabetic Ketoacidosis?

Can Serum Β-hydroxybutyrate Be Used To Diagnose Diabetic Ketoacidosis?

Abstract OBJECTIVE—Current criteria for the diagnosis of diabetic ketoacidosis (DKA) are limited by their nonspecificity (serum bicarbonate [HCO3] and pH) and qualitative nature (the presence of ketonemia/ketonuria). The present study was undertaken to determine whether quantitative measurement of a ketone body anion could be used to diagnose DKA. RESEARCH DESIGN AND METHODS—A retrospective review of records from hospitalized diabetic patients was undertaken to determine the concentration of serum β-hydroxybutyrate (βOHB) that corresponds to a HCO3 level of 18 mEq/l, the threshold value for diagnosis in recently published consensus criteria. Simultaneous admission βOHB and HCO3 values were recorded from 466 encounters, 129 in children and 337 in adults. RESULTS—A HCO3 level of 18 mEq/l corresponded with βOHB levels of 3.0 and 3.8 mmol/l in children and adults, respectively. With the use of these threshold βOHB values to define DKA, there was substantial discordance (∼≥20%) between βOHB and conventional diagnostic criteria using HCO3, pH, and glucose. In patients with DKA, there was no correlation between HCO3 and glucose levels on admission and a significant but weak correlation between βOHB and glucose levels (P < 0.001). CONCLUSIONS—Where available, serum βOHB levels ≥3.0 and ≥3.8 mmol/l in children and adults, respectively, in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO3 level for that purpose. The marked variability in the relationship between βOHB and HCO3 is probably due to the presence of other acid-base disturbances, especially hyperchloremic, nonanion gap acidosis. Recently published consensus criteria for diagnosing diabetic ketoacidosis (DKA) include a serum bicarbonate (HCO3) Continue reading >>

Diabetes And Ketones

Diabetes And Ketones

Tweet The presence of high levels of ketones in the bloodstream is a common complication of diabetes, which if left untreated can lead to ketoacidosis. Ketones build up when there is insufficient insulin to help fuel the body’s cells. High levels of ketones are therefore more common in people with type 1 diabetes or people with advanced type 2 diabetes. If you are suffering from high levels of ketones and seeking medical advice, contact your GP or diabetes healthcare team as soon as possible. What are ketones? Ketones are an acid remaining when the body burns its own fat. When the body has insufficient insulin, it cannot get glucose from the blood into the body's cells to use as energy and will instead begin to burn fat. The liver converts fatty acids into ketones which are then released into the bloodstream for use as energy. It is normal to have a low level of ketones as ketones will be produced whenever body fat is burned. In people that are insulin dependent, such as people with type 1 diabetes, however, high levels of ketones in the blood can result from taking too little insulin and this can lead to a particularly dangerous condition known as ketoacidosis. How do I test for ketones? Ketone testing can be carried out at home. The most accurate way of testing for ketones is to use a blood glucose meter which can test for ketones as well as blood glucose levels. You can also test urine for ketone levels, however, the testing of urine means that the level you get is representative of your ketone levels up to a few hours ago. Read about testing for ketones and how to interpret the results Who needs to be aware of ketones? The following people with diabetes should be aware of ketones and the symptoms of ketoacidosis: Anyone dependent on insulin – such as all people Continue reading >>

Understanding And Treating Diabetic Ketoacidosis

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 >>

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