A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>
Casey Johnson Died Of Dka; Could Diabulemia Be To Blame?
Today, the Los Angeles coroner's office revealed that Casey Johnson's, heiress to the Johnson & Johnson fortune (who died on January 4, 2010) "natural death" was a result of diabetic ketoacidosis, also known as DKA. Naturally, Hollywood gossip columnists, including TMZ, were all over the story (see here for the TMZ report) and sources with the Los Angeles Police Department confirmed that they believed the cause was "medically related." The original news story on her death can be viewed here: Of course, many of these tabloid stories are misleading. For example, TMZ just couldn't resist mentioning insulin, diet and exercise, for all practical purposes, blaming the troubled 30-year old for her death, when several commenters rightly noted that would be a painful and agonizing cause of death, unlike say an overdose of an illegal narcotic. Instead of acknowledging this as a legitimate tragedy, in a practice that has been all-too-common, blame has been shifted away from the disease itself and difficult and imperfect treatment protocols to the person who had this disease. Shame on all of them, and especially the doctors who seem much too quick to blame the victim, rather than the disease or the relentless treatment protocol prescribed. The Los Angeles Times was somewhat more objective in its reporting of the news, and you can catch that news story here. But if you go back to my Twitter posts on January 4-5, when there was some chatter about Casey Johnson's death possibly due to HYPOglycemia, I countered I thought she might have diabulemia instead -- the girl was rail-thin and looked sickly thin, much like someone looks like before they're officially diagnosed with type 1 diabetes does. To be sure, photographs of Johnson suggested that she may have been battling a disorder known 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 >>
Why Are So Many Kids Dying From Undiagnosed Type 1 Diabetes?
An Open Letter To The Non-Diabetes Medical Community At Large and All Parents With Kids of Every Age, Everywhere! Dear pediatricians, nurses, medical staff, medical office personnel, hospitals, hospital staff, school nurses, physicians, ER medical staff, urgent care facilities, and any other medical office/facility that treats sick kids: I have a question for you. Why are so many kids dying from undiagnosed Type 1 diabetes? Why are they not being tested for Type 1 diabetes when their parents bring them to you when they’re sick? I know that sometimes, Type 1 symptoms can be similar to the flu or a stomach bug, so as a matter of caution, why can’t a 5 second finger stick be done as a matter of protocol just to try to potentially rule out the chance that it could be Type 1 diabetes instead of the flu? Why? Yes, I know, I know. You’re extremely busy, understaffed, and buried in mountains of paperwork at your medical offices. I get it. You’re working twice as hard for half as much, (or less- I’m a woman, so I get that too, but I digress) and you have to carry outrageously expensive liability insurance, etc. Yes, I get that too, loud and clear. Welcome to the club. We are busy too and many of us experience similar situations in our businesses as well. But, that is a lousy excuse for not trying to rule out Type 1 diabetes in your little patients who are counting on you to help them when they are sick. It was you who chose a profession that is designed to take care of sick people. So, take care of sick people. I’m Trying To Figure This Out Countless healthcare professionals have told me that their patients (or parents of patients) are much more informed and that these patients often come into the office with health information printed from online resources. So, are Continue reading >>
How Did Anna Garcia Die?
Transcript of How did Anna Garcia Die? How did Anna Garcia Die? Contributing Factors Elevated Glucose levels - 280mg/DL, normal range 70-125 mg/DL, uncontrolled diabetes Elevated A1C - 11%, normal range 4 1/2% - 6%, evidence of blood sugar being greater than 250 for past 3 months Overweight - caused by inadequate diet that would be needed to maintain healthy glucose levels Elevated blood ketones - 1.2 mmol/L, normal range below 0.6 mmol/L, due to uncontrolled diabetes, extreme risk factor for DKA (Diabetic Ketoacidosis) Blood Acidity - low, pH 6.95, normal pH 7.4 caused by low blood sugar Ketones present in urine - caused by the body's inability to get enough glucose for energy Protein in urine - caused by prolonged high glucose levels UTI - Anna had a recent Urinary Tract Infection which led to an increase in blood sugar levels Cause of Death Anna Garcia died of Diabetic Ketoacidosis in her home most likely causing her to pass out into a coma. Ketoacidosis is triggered by multiple factors elevated blood ketones, ketones in urine, and recent infection, Anna was being treated for a UTI which in turn caused her blood sugar levels to decrease in blood sugar levels all of which Anna had. Also stress and a high fever which Anna was believed to have due to her wearing a sweater as documented by a witness a few days before a result of her infection. The final autopsy report abrasions were noted of Anna most likely attempting to inject insulin but was unable to reach the muscle causing her to die of the ketones, dehydration and lack of glucose. Though not a direct cause of death, Anna also had a history of Sickle Cell Anemia a disease where the red blood cells are crescent shape making it difficult to go through arteries causing blood clots and heart attack, Anna showed no evid Continue reading >>
Diabetic Ketoacidosis In Dogs
My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>
How Dka Happens And What To Do About It
Certified Diabetes Educator Gary Scheiner offers an overview of diabetic ketoacidosis. (excerpted from Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin by Gary Scheiner MS, CDE, DaCapo Press, 2011) Diabetic Ketoacidosis (DKA) is a condition in which the blood becomes highly acidic as a result of dehydration and excessive ketone (acid) production. When bodily fluids become acidic, some of the body’s systems stop functioning properly. It is a serious condition that will make you violently ill and it can kill you. The primary cause of DKA is a lack of working insulin in the body. Most of the body’s cells burn primarily sugar (glucose) for energy. Many cells also burn fat, but in much smaller amounts. Glucose happens to be a very “clean” form of energy—there are virtually no waste products left over when you burn it up. Fat, on the other hand, is a “dirty” source of energy. When fat is burned, there are waste products produced. These waste products are called “ketones.” Ketones are acid molecules that can pollute the bloodstream and affect the body’s delicate pH balance if produced in large quantities. Luckily, we don’t tend to burn huge amounts of fat at one time, and the ketones that are produced can be broken down during the process of glucose metabolism. Glucose and ketones can “jump into the fire” together. It is important to have an ample supply of glucose in the body’s cells. That requires two things: sugar (glucose) in the bloodstream, and insulin to shuttle the sugar into the cells. A number of things would start to go wrong if you have no insulin in the bloodstream: Without insulin, glucose cannot get into the body’s cells. As a result, the cells begin burning large amounts of fat for energy. This, of course, Continue reading >>
Diabetic Ketoacidosis Explained
Twitter Summary: DKA - a major complication of #diabetes – we describe what it is, symptoms, who’s at risk, prevention + treatment! One of the most notorious complications of diabetes is diabetic ketoacidosis, or DKA. First described in the late 19th century, DKA represented something close to the ultimate diabetes emergency: In just 24 hours, people can experience an onset of severe symptoms, all leading to coma or death. But DKA also represents one of the great triumphs of the revolution in diabetes care over the last century. Before the discovery of insulin in 1920, DKA was almost invariably fatal, but the mortality rate for DKA dropped to below 30 percent within 10 years, and now fewer than 1 percent of those who develop DKA die from it, provided they get adequate care in time. Don’t skip over that last phrase, because it’s crucial: DKA is very treatable, but only as long as it’s diagnosed promptly and patients understand the risk. Table of Contents: What are the symptoms of DKA? Does DKA occur in both type 1 and type 2 diabetes? What Can Patients do to Prevent DKA? What is DKA? Insulin plays a critical role in the body’s functioning: it tells cells to absorb the glucose in the blood so that the body can use it for energy. When there’s no insulin to take that glucose out of the blood, high blood sugar (hyperglycemia) results. The body will also start burning fatty acids for energy, since it can’t get that energy from glucose. To make fatty acids usable for energy, the liver has to convert them into compounds known as ketones, and these ketones make the blood more acidic. DKA results when acid levels get too high in the blood. There are other issues too, as DKA also often leads to the overproduction and release of hormones like glucagon and adrenaline Continue reading >>
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. In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each 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 univ Continue reading >>
Diabetic Ketoacidosis (dka)
Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>
Diabetic Ketoacidosis ?
I am a type 1 diabetic and I have a problem that I cant seem to figure out. I have an appointment with my doctor in about a month, because they cant get me in any earlier. But what happens is I get really sick to my stomach, my blood sugar usually drops EXTREMELY fast, I get dizzy, a headache, and I always seem to yawn a lot. I have some ideas about what it might be, like ketoacidosis. But I am not entirely sure. Do you have any ideas? I would suggest that you go to your local drug store and obtain a canister of ketosticks. Check your urine for ketone. It is a very simple test. This will tell if you have ketonuria. If this is the case it is important that you see a doctor immediately. Call you doctor and tell them what is happening and you need help very quickly. If your doctor does not see you, go to an emergency room. This is a very serious situation. Take care, Wanda QUOTE posted on the "about portions'' thread: "The presence of ketones is called "ketonuria," and further dehydration and ketone build-up can result in ketoacidosis which is a medical emergency. The bottom line is that the presence of ketones in someone with type 1 diabetes shows a dangerous lack of insulin and the immediate need for more insulin. Exercise, at this time, will only burn more fat and produce more ketones. " (+ info) diabetic ketoacidosis? if you die of diabetic ketoacidosis are there warning signs before you die and when does it alert your body? and is this something that just happens to some one or is it due to the fact of foul play by the person or someone else. how is foul pay involved. if you die at the age of 40 is it required for an autopsy to be preformed There are major warning signs if diabetic ketoacidosis (DKA). Once the DKA is advanced the diabetic will vomit everything he or s Continue reading >>
Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications
Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys f Continue reading >>
Diabetic Ketoacidosis Guidelines
Diabetic ketoacidosis is a complication of diabetes mellitus that results in blood glucose levels of more than 250 mg/dL, a serum bicarb level of less than 18 mEq/l, a blood pH level of less than 7.3, increased serum ketone levels, and clinical hydration. The main cause of diabetic ketoacidosis (DKA) is a lack of insulin in the body. Diabetic ketoacidosis can happen in any type of diabetic and in diabetics of all ages; however, it is most commonly seen in type 1 diabetics. Statistically, 14 percent of DKA occurs in people who are 70 years of age or older, 23 percent of DKA is seen in people between 51 and 70, 27 percent is seen in those 30 to 50 years of age, while 36 percent occur in people who are under 30 years of age. About one to five percent of people with DKA ultimately die from their condition. About a third of all people with DKA do not know they have diabetes before having their first bout of ketoacidosis. Typical symptoms seen in the disease include weight loss, increased thirst, increased frequency of urination, abdominal pain, shortness of breath, nausea and vomiting, and a history of a recent fever. Even though there have been many advances in the treatment of DKA, the rate of morbidity and mortality remain high. In one study involving almost 29,000 individuals with diabetes who were under the age of 20 years, the vast majority (94 percent) of individuals had no DKA episodes, 5 percent had only a single episode of DKA, while 1 percent had at least 2 episodes of DKA. The most common cause of death in DKA patients is cerebral edema. Although most people with DKA have a preexisting case of diabetes, up to 37 percent of people did not know they had diabetes when they had their first episode of the disorder. This is especially the case in young children with a Continue reading >>
Jamie On Diabetic Ketoacidosis
We lost our dear and gentle Jamie in 2009 to cancer and diabetes. Jamie and her cat Boots were long-time friends on the Feline Diabetes Message Board. Jamie will live forever in our hearts. I am copying here what she wrote about her own DKA episode. Thank you, Jamie, for one of your many legacies. What does DKA Feel Like? WARNING: Reading this story may be upsetting. The physical manifestations (and, to a lesser extent, the mental manifestations) of Diabetic Ketoacidosis, or DKA, as I have experienced and thus described, can be summed up very simply: suffering. Reading this story is reading about suffering. It's not all graphic; the bad bit begins and ends at the asterisks (***). You may want to just skip over this if you're not in a good place at the moment. "Not in a good place" might include: your kitty is newly diagnosed with feline diabetes and you are feeling overwhelmed; you have a kitty who is currently experiencing ketosis or DKA; you have lost a kitty to DKA, especially if you've lost your kitty recently; your kitty's diabetes is not under good control, and you're stressing. Please understand that in posting this story, I am not trying to cause or exacerbate pain, grief, or guilt on anyone's part. I only want people to be aware of the exceptional seriousness and danger of DKA, and how careful monitoring of our diabetic cats can help prevent suffering on their part. If, after reading this story, you find you need to talk, email me or send me a private message through the board. You may also want to visit the FDMB forums for Health, Community, and Grief where you can talk to others. Remember that everyone here understands the stress and worry that comes with having a beloved feline companion with diabetes. I tend to worry more about Boots' diabetes than I do my Continue reading >>
Diabetic Ketoacidosis: A Silent Death.
Abstract Diabetic ketoacidosis (DKA) results from severe insulin deficiency and can be diagnosed at autopsy despite no known history of the disease. Diabetic ketoacidosis may be the initial manifestation of type 1 diabetes or may result from increased insulin requirement in type 1 diabetic patients. The purpose of this study was to determine the percentage of DKA death investigated by the Office of Chief Medical Examiner that was not associated with a known history of diabetes.Cases investigated by the Office of Chief Medical Examiner during a 6-year period whose cause of death was DKA were identified using a centralized database. To determine the percentage with known history of diabetes, investigation reports were reviewed for any documentation of this history. The toxicology reports of all DKA deaths were reviewed together with histologic slides, if available, for possible microscopic changes. Concentrations of vitreous glucose, vitreous acetone, and blood acetone were used to diagnose DKA in these autopsied cases.Nearly a third of all death from DKA (32 of 92 during a 6-year period) occurred in individuals who had no known history of diabetes, emphasizing the importance of regular physicals that include a check of glucose concentration, and especially if any warning signs are present. In a case of sudden death, it is recommended that the volatile toxicology analysis at a medical examiner's office should include tests for acetone concentration, which when elevated, together with an elevated vitreous glucose, indicates DKA. Continue reading >>