[diabetic Ketoacidosis With A Fatal Issue: Is It A Mody3 (maturity-onset Diabetes Of The Young Type 3)?].
Abstract Ketoacidotic coma is one of the possible diabetes mellitus first symptoms. It results from complete or relative lack of insuline and is often associated with type 1 diabetes. The authors report a case of a 45-years old woman with inaugural diabetes of which atypical features have motivated the study of MODY gene (maturity-onset diabetes of the young). Gly574ser polymorphism in the HNF-1alpha gene was found, in homozygous state, and the question of the responsibility of this polymorphism in this diabete is asked. Continue reading >>
Thyrotoxicosis Masked By Diabetic Ketoacidosis
A fatal complication A 48-year-old man had been treated at our hospital for type 2 diabetes and Graves' disease. He was diagnosed with diabetic ketoacidosis (DKA) twice during previous visits. He was prescribed methimazole (10 mg/day) and insulin, but his drug compliance was poor. He had not visited our hospital since 3 September 1998, when his HbAlc level was 11.6% (normal 4.3-5.8) and his thyroid function tests revealed euthyroidism. He had stopped taking medication 30 December 1998, and he was admitted to our hospital on 6 January 1999, with general fatigue, a sore throat, and excessive thirst. He appeared drowsy, and he presented with Kussmaul respirations, irregular tachycardia, dry skin, injected tonsils, and a diffuse goiter, but he had no fever or exophthalmos. Laboratory studies revealed excessive urine ketone bodies, a normal peripheral white blood cell count, a plasma glucose level of 763 mg/dl, a HbAlc level of 14.6%, and a C-reactive protein level of 13.6 mg/dl (normal <0.5). Arterial blood gas analysis revealed the following: pH 7.151, Po2 120.4 mmHg, Pco2 16.7 mmHg, and HCO3 5.6 mEq/l. Electrocardiography showed atrial fibrillation with a rate of 140 beats/min, and the chest radiograph was normal. He was diagnosed with DKA and tonsillitis. We began administering saline, insulin, antibiotics, methimazole (10 mg/day), and propranolol (30 mg/day). On 7 January he became alert and had sinus tachycardia at a rate of 110 beats/min. His temperature never exceeded 37.8°C, and his plasma glucose was under control. On 8 January, his tachycardia persisted, but he still had no fever. On admission, thyroid function tests revealed that his thyroid stimulating hormone was <0.03 μU/ml (normal 0.2-3.2), his free triiodothyronine level was 14.12 pg/ml (normal 2.9-6.0), a Continue reading >>
Acute Complications Of Diabetes - Diabetic Ketoacidosis
- [Voiceover] Oftentimes we think of diabetes mellitus as a chronic disease that causes serious complications over a long period of time if it's not treated properly. However, the acute complications of diabetes mellitus are often the most serious, and can be potentially even life threatening. Let's discuss one of the acute complications of diabetes, known as diabetic ketoacidosis, or DKA for short, which can occur in individuals with type 1 diabetes. Now recall that type 1 diabetes is an autoimmune disorder. And as such, there's an autoimmune destruction of the beta cells in the pancreas, which prevents the pancreas from producing and secreting insulin. Therefore, there is an absolute insulin deficiency in type 1 diabetes. But what exactly does this mean for the body? To get a better understanding, let's think about insulin requirements as a balancing act with energy needs. Now the goal here is to keep the balance in balance. As the energy requirements of the body go up, insulin is needed to take the glucose out of the blood and store it throughout the body. Normally in individuals without type 1 diabetes, the pancreas is able to produce enough insulin to keep up with any amount of energy requirement. But how does this change is someone has type 1 diabetes? Well since their pancreas cannot produces as much insulin, they have an absolute insulin deficiency. Now for day-to-day activities, this may not actually cause any problems, because the small amount of insulin that is produced is able to compensate and keep the balance in balance. However, over time, as type 1 diabetes worsens, and less insulin is able to be produced, then the balance becomes slightly unequal. And this results in the sub-acute or mild symptoms of type 1 diabetes such as fatigue, because the body isn Continue reading >>
High Blood Sugars (ketoacidosis)
Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome Severe high blood sugars, ketosis (the presence of ketones prior to acidification of the blood), and ketoacidosis (DKA) are serious and potentially life-threatening medical problems which can occur in diabetes. High blood sugars become life-threatening in Type 1 or long-term Type 2 diabetes only when that person does not receive enough insulin from injections or an insulin pump. This can be caused by skipping insulin or not receiving enough insulin when large amounts are required due to an infection or other major stress. Ketoacidosis surprisingly occurs almost as often in Type 2 diabetes as it does in Type 1. However, people with Type 2 diabetes also encounter another dangerous condition called hyperglycemic hyperosmolar syndrome, which is roughly translated as thick blood due to very high blood sugars. Here, coma and death can occur simply because the blood sugar is so high. The blood will have ketones at higher levels but does not become acidotic. HHS usually occurs with blood sugar readings above 700 mg/dl (40 mmol) as the brain and other functions begin to shut down. When insulin levels are low, the body cannot use glucose present at high levels in the blood. The body then starts burning excessive amounts of fat which causes the blood to become acidic as excess ketone byproducts are produced. Even though the blood pH which measures acidity only drops from its normal level of 7.4 down to 7.1 or 7.0, this small drop is enough to inactivate enzymes that depend on a precise acid-base balance to operate. High blood sugars and ketoacidosis can be triggered by: not taking insulin severe infection severe illness bad insulin In Type 1 diabetes, ketoacidosis often occurs under the duress of an infection, and is also freque Continue reading >>
Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful. Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes.The primary cause of DKA is absolute or relative insulin deficiency: Absolute - eg, previously undiagnosed type 1 diabetes mellitus or a patient with known type 1 diabetes who does not take their insulin. Relative - stress causes a rise in counter-regulatory hormones with relative insulin deficiency. DKA can be fatal The usual causes of death are: Cerebral oedema - associated with 25% mortality (see 'Cerebral odedema', below). Hypokalaemia - which is preventable with good monitoring. Aspiration pneumonia - thus, use of a nasogastric tube in the semi-conscious or unconscious is advised. Deficiency of insulin. Rise in counter-regulatory hormones, including glucagon, cortisol, growth hormone, and catecholamines. Thus, inappropriate gluconeogenesis and liver glycogenolysis occur compounding the hyperglycaemia, which causes hyperosmolarity and ensuing polyuria, dehydration and loss of electrolytes. Accelerated catabolism from lipolysis of adipose tissue leads to increased free fatty acid circulation, which on hepatic oxidation produces the ketone bodies (acetoacetic acid and beta-hydroxybutyric acid) that cause the metabolic acidosis. A vicious circle is usually set up as vomiting usually occurs compounding the stress and dehydration; the cycle can only be broken by providing insulin and fluids; otherwise, severe acidosis occurs and can be fatal. Biochemical criteria The biochemical criteria required for a diagnosis of DKA to be made are Continue reading >>
What You Should Know About Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. It could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too. It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones and, if the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you miss a meal, you're sick or stressed, or you have an insulin reaction. DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration. Test your ketones when your blood sugar is over 240 mg/dL or you have symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot. You can check your levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work, if you have any of the symptoms below and your ketones aren't normal, or if you have more than one symptom. You've been throwing up for more than 2 hours. You feel queasy or your belly hurts. Your breath smells fruity. You're tired, confused, or woozy. You're having a hard time breathing. Continue reading >>
Is Invokana More Dangerous Than Type 2 Diabetes?
New drug celebrated, side effects downplayed When it arrived on the market in March 2013, Invokana was hailed as a breakthrough way to treat Type 2 diabetes. It lowered blood sugar by excreting the excess in urine. Until it was approved by the U.S. Food and Drug Administration (FDA), all drugs for diabetes were designed to control insulin levels in the blood. Just as marvelous, according to TV commercials about Invokana, patients might lose weight and lower their blood pressure. Both were off label benefits not approved by the FDA. During the 4th quarter of 2014, little more than a year after it was approved, Invokana (in tandem with Invokamet) racked up $201 million in sales for Johnson & Johnson. It’s estimated that more than 29 million Americans have diabetes. The majority have Type 2 Diabetes, putting scores at risk for complications caused by Invokana and other SGLT2 drugs. Invokana’s cardiovascular risks initially downplayed Even as Invokana made its debut, Johnson & Johnson, the drug’s manufacturer, knew that it could pose serious cardiovascular risks. So did the U.S. Food and Drug Administration (FDA). But the federal agency did not require the drug company to list the risks on Invokana’s label. It stated that their significance was “unclear” even though clinical trials conducted before the drug was approved showed that within 30 days, it increased LDL and HDL cholesterol. A month after the FDA approved Invokana, doctors involved in the approval process said they had mixed opinions of the drug, urging more studies to address “unanswered safety questions” - in particular Invokana’s effect on the heart. Since then, numerous lawsuits have been filed nationwide by victims who say it caused their heart problems. Invokana causes ketoacidosis – a da Continue reading >>
Diabetes: What Is Ketoacidosis And How Can Be Avoided & Treated?
Good question! According to Wikipedia: Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. In order to define ketoacidosis a little better, let's go back to the source: diabetes. Someone who is diabetic is unable to produce insulin, a hormone necessary for the transfer of sugar from the bloodstream to the cells, which in turn produce energy. If this progression is disrupted, through lack of insulin for example, the body has to try to compensate by creating energy elsewhere. And so the body starts to burn fat and muscle to meet its energy needs. Unfortunately, this chemical reaction produces molecules known as ketone bodies. In small quantities, these are fine, and it is in fact normal to have traces of them in your blood (approximately 1mg/dl). However, if the quantity of ketones surpasses this threshold by too much, it starts to affect the pH of your blood (which becomes progressively more acidic). Even the slightest drop in pH can have dangerous effects: as the quantity of the ketones in your blood increases, and the blood pH diminishes, your kidneys start having problems. Eventually, if the ketoacidosis is left untreated, your kidneys can fail and you can die from dehydration, tachycardia and hypotension. A number of other symptoms can appear in extreme cases. Fortunately for us, the quantity of ketones has to be consequential, and it usually takes a while before individuals start manifesting symptoms. In my case, my diabetes went undiagnosed for a month and a half before it was discovered, and even then my ketone levels were relatively normal. If you're a diabetic, ketoacidosis can be easily avoided by controlling your blood sugar levels and maintaining a healthy lifestyle. Some doctors, preferring to stay on the Continue reading >>
How Can Sepsis Be Fatal?
Sepsis is a life-threatening illness caused by your body’s response to an infection. Your immune system protects you from many illnesses and infections, but it’s also possible for it to go into overdrive in response to an infection. Sepsis develops when the chemicals the immune system releases into the bloodstream to fight an infection cause inflammation throughout the entire body instead. Severe cases of sepsis can lead toseptic shock , which is a medical emergency. People may experience: Whole body: chills, dizziness, fatigue, fever, flushing, low blood pressure, low body temperature, or shivering Respiratory: fast breathing, rapid breathing, respiratory distress, or shortness of breath Cognitive: altered level of consciousness or mental confusion Also common: delirium, fast heart rate, insufficient urine production, organ dysfunction, skin discolouration, or sleepiness Significantly decreased urine output Abrupt change in mental status Decrease in platelet count Difficulty breathing Abnormal heart pumping function Abdominal pain When organs get’s damaged they function improperly and we all know that to live healthy our organs should work properly. Heart,Brain,Lungs,Kidneys,Liver are vital organs.Any damage to them will cause improper functioning in body and severity will ultimately leads to death! Continue reading >>
Diabetes Life Expectancy
Tweet After diabetes diagnosis, many type 1 and type 2 diabetics worry about their life expectancy. Death is never a pleasant subject but it's human nature to want to know 'how long can I expect to live'. There is no hard and fast answer to the question of ‘how long can I expect to live’ as a number of factors influence one’s life expectancy. How soon diabetes was diagnosed, the progress of diabetic complications and whether one has other existing conditions will all contribute to one’s life expectancy - regardless of whether the person in question has type 1 or type 2 diabetes. How long can people with diabetes expect to live? Diabetes UK estimates in its report, Diabetes in the UK 2010: Key Statistics on Diabetes, that the life expectancy of someone with type 2 diabetes is likely to be reduced, as a result of the condition, by up to 10 years. People with type 1 diabetes have traditionally lived shorter lives, with life expectancy having been quoted as being reduced by over 20 years. However, improvement in diabetes care in recent decades indicates that people with type 1 diabetes are now living significantly longer. Results of a 30 year study by the University of Pittsburgh, published in 2012, noted that people with type 1 diabetes born after 1965 had a life expectancy of 69 years. How does diabetic life expectancy compare with people in general? The Office for National Statistics estimates life expectancy amongst new births to be: 77 years for males 81 years for females. Amongst those who are currently 65 years old, the average man can expect to live until 83 years old and the average woman to live until 85 years old. What causes a shorter life expectancy in diabetics? Higher blood sugars over a period of time allow diabetic complications to set in, su Continue reading >>
Type 1 Diabetes Complications
Type 1 diabetes is complicated—and if you don’t manage it properly, there are complications, both short-term and long-term. “If you don’t manage it properly” is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if you’ve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage. Diabetes complications are all related to poor blood glucose control, so you must work carefully with your doctor and diabetes team to correctly manage your blood sugar (or your child’s blood sugar). Short-term Diabetes Complications Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar). It develops when there’s too much insulin—meaning that you’ve taken (or given your child) too much insulin or that you haven’t properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose). There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when it’s in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely). The signs and symptoms of low blood glucose are usually easy to recognize: Rapid heartbeat Sweating Paleness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech For more information about hypoglycemia and how to treat it, please read our article on hy Continue reading >>
How Many Fatal Accidents Can Be Traced To Pilots Failing A Crosswind Landing?
The viral nature of the embedded video makes a question like this inevitable, and I'm happy to dig into it a bit for you. At the same time, I have to tell you that I'm not entirely comfortable with the "hero captain" references I've seen accompanying at least some of the coverage of it. I don't know what his company policies are regarding crosswind landings, and I don't know what his fuel state was, and I don't know the exact crosswind limitations are for a Boeing 777, but I have to wonder whether he even should have started the approach in the first place, let alone gotten so close to touchdown before deciding to go around. That's some scary last-minute stuff, and the decision-making leading up to it should at least be inquired into a bit. Okay -- that's the investigator in me venting. All better now! I decided to inquire into the NTSB database regarding this issue, because landing accidents still are among the most common types of accidents. The leading factor in landing accidents is an "unstabilized" approach, which usually refers to a situation where the proper airspeed and rate of descent haven't been established and maintained throughout final approach. In my experience, the presence of crosswinds hasn't been addressed with any real urgency in the context of landing accidents in general or unstabilized approaches in particular, so I was curious as to what the data would show. During the ten-year period from 2003 through 2012, there were just under 4,000 fatal accidents in the NTSB database. However, when I searched that timeframe for all types of accidents (both fatal and non-fatal) where the word "crosswind" was in the report, I was shocked to find more than 1,300 events returned. I changed the search parameters to look only for fatal accidents, and still got 113 Continue reading >>
How Can Flu Be Fatal?
People at great risk for serious complications are those over 65 years and those with chronic medical illnesses . Influenza A is the most severe strain. Influenza B tends to be milder. Pneumonia is the major complication of influenza and can be very serious. It can develop about 5 days after viral influenza. More than 90% of the deaths caused by influenza and pneumonia occur among older adults. Flu-related pneumonia occurs in high-risk individuals, such as the following: People with weak immune systems, such as AIDS Elderly patients Very young children Hospitalized patients And anyone with serious medical conditions, such as diabetes, heart, circulation, or lung disorders, particularly chronic lung disease Combinations of these factors further increase the risk. It should be noted that pneumonia is an uncommon outcome of influenza in healthy adults. Influenza increases the risk for complications in the central nervous system of small children. Febrile seizures are the most common neurologic complication in children especially infants . Continue reading >>
How Long Does Diabetes Ketoacidosis Last?
Diabetic ketoacidosis (DKA) is a common complication of diabetes in children, which needs hospitalisation and can be fatal. In most cases of diabetic ketoacidosis, death is caused due to cerebral edema or complication of DKA. Diabetic ketoacidosis (DKA) can be the first sign or presenting symptom in some cases of type 1 diabetes (before diabetes is diagnosed or they have any other symptoms). According to studies, about 20 to 40% of newly diagnosed patients of type 1 diabetes are admitted in DKA. Duration of Diabetic ketoacidosis: with appropriate treatment (fluid replacement and insulin therapy), DKA can be corrected in about 24-48 hours (depending on the severity of DKA at presentation). In most cases, the duration of therapy is about 48 hours. Treatment for DKA aims to correct the metabolic abnormalities of DKA such as high blood sugar level, high ketone levels and serum osmolality with insulin and fluids. Treatment of DKA includes: Insulin replacement to correct blood glucose levels. Fluid and electrolyte replacement to correct dehydration and imbalance of electrolytes in the body. Treating the cause of DKA (such as infection, injury etc). Duration of fluid replacement: fluid is replaced slowly; if it is given at an excessive rate or more than required, it can cause brain swelling (cerebral edema). Most cases have a fluid deficit of about 10% or 100 ml/kg. Fluid is given intravenously (into a vein) slowly with the aim of replacing 50% of the fluid deficit during the first 12 hours of presentation and the remainder within the next 12-16 hours. As high blood sugar is corrected more rapidly than ketoacidosis (high blood ketone levels), glucose-containing fluids is given once the glucose falls to < 14 mmol/l to prevent the fall in blood glucose levels hypoglycaemia). Dur Continue reading >>
Diabetic ketoacidosis (DKA) is a serious complications of untreated diabetes. In this complication, severely insufficient insulin levels in the body results into high blood sugar that leads to the production and buildup of ketones in the blood. These ketones are slightly acidic, and large amounts of them can lead to ketoacidosis. If remained untreated, the condition leads to diabetic coma and may be fatal. Diabetic ketoacidosis (DKA) gets triggered by a stressful event on the body, such as an illness or severe lack of insulin. DKA is more common in people with type 1 diabetes. In some cases, identification of DKA is the first indication that a person has diabetes. Early Sluggish and extreme tiredness Fruity smell to breath (like acetone) Extreme thirst, despite large fluid intake Constant urination/bedwetting Extreme weight loss Presence of Oral Thrush or yeast infections that fail to go away Muscle wasting Agitation / Irritation / Aggression / Confusion Late At this stage, Diabetic ketoacidosis reaches a life-threatening level: Vomiting. Although this can be a sign of hyperglycemia and isn't always a late-stage sign, it can occur with or without ketoacidosis. Confusion Abdominal pain Loss of appetite Flu-like symptoms Unconsciousness (diabetic coma) Being lethargic and apathetic Extreme weakness Kussmaul breathing (air hunger). In this condition, patients breathe more deeply and/or more rapidly The major risk factors accelerating on set of diabetic ketoacidosis include the following: Diabetes mellitus: Type 1 diabetics are at a higher risk of DKA, because they must rely on outside insulin sources for survival. DKA can occur in patients with type 2, particularly in obese children. Age: DKA may occur at any age, but younger people below 19 years of age are more susceptib Continue reading >>