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 >>
Mother Of 22-year-old Who Died From Diabetic Ketoacidosis Speaks Out
In the aftermath of her son's tragic death, Lyndall Hauver urges caregivers: People with type 1 diabetes who develop flu-like symptoms should head straight to the hospital. Will Hauver was feeling under the weather with aches, an upset stomach, and fever, but still had enough energy for varsity lacrosse practice at Rollins College in Florida the last day of January in 2015. It appeared he got the flu that already struck others on campus. The next day, a Sunday, the 22-year-old felt a bit better and visited his fraternity, rounding up some freshman pledges to clean his house. He went to bed early to rest up for an upcoming lacrosse trip. Monday morning, Will's roommate found him on the floor, passed out. By that afternoon, he had died. Will, who had type 1 diabetes, died from diabetic ketoacidosis (or DKA)1 a serious, acute complication of diabetes that results from too little insulin and can be brought on by the flu.2 When a person develops DKA it's the result of dangerously high levels of blood acids in the body called ketones. Ketones alter the chemical balance of blood in the body.3 After Will's death, his grief-stricken mom, Lyndall Hauver, of Towson, Maryland, decided to share Will's story in the hope that others will learn from her family's tragic loss. "As soon as you get a fever or have a sign of the flu or a stomach virus go to the hospital," Lyndall says. "It causes your blood sugar to go crazy, to go up and down and that wreaks havoc on your fluids and heart and everything else." "You have to be vigilant," she continues. "It's easy to get complacent when things are going well." She adds: "This was a fluke occurrence, bad luck, and I can't change it. It breaks my heart every minute." The Longest Hour Days before Will's death, the parents of some of Will's team 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 >>
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 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 >>
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 >>
Coroner: Death Of Johnson & Johnson Heiress Casey Johnson By Diabetic Ketoacidosis
Troubled socialite Casey Johnson died of natural causes linked to diabetes, while Hollywood starlet Brittany Murphy's death was tied to her use of prescription drugs. Autopsy results on the two women were released Thursday by the Los Angeles County Coroner, answering questions that swirled about both women's sudden and tragic deaths. Johnson, 30, the Johnson & Johnson heiress who battled drug and alcohol woes, died as a result of her diabetic condition, the autopsy showed. The cause of death was listed as diabetic ketoacidosis - a lethal condition condition caused by lack of insulin and sky-high blood sugar. The death was attributed to natural causes. Johnson was diagnosed with juvenile diabetes as a child. The daughter of Jets owner Woody Johnson was found dead in a West Hollywood home by a maid on Jan. 5. Shortly before her death, Johnson announced her engagement to bisexual reality TV star Tila Tequila. Murphy, 32, the star of "8 Mile" and "Clueless," was suffering from pneumonia when she collapsed and died in the shower of her California home on Dec. 21, 2009, the autopsy showed. While the illness was cited as her primary cause of death, the autopsy found "multiple drug intoxication" - all prescription medications, said coroner's spokesman Craig Harvey. Her death was ruled accidental, he said, and a full autopsy report was expected in two weeks. Continue reading >>
Children With Type 1 Diabetes At Risk For Life-threatening Diabetic Ketoacidosis
Two weeks before a family vacation last spring, 10-year-old Hailey Evans started to drink a lot more water. Her parents didn’t think much of it, given that Hailey had just joined a running team at her school in Northern Virginia and was exercising more. Not long after landing in Bolivia, where one of Hailey’s grandparents lives, she complained of a stomachache and nausea. Altitude sickness, her parents figured. Then Hailey took a sudden turn for the worse. Hospitalized the next day, she was diagnosed with Type 1 diabetes within an hour. A few hours after that, she was in coma caused by swelling in her brain and severe dehydration. The next morning, April 20th, Hailey died, two weeks shy of her 11th birthday. Hailey’s devastated parents, Vanessa and Derrick Evans, now have joined a growing chorus of voices determined to raise awareness of Type 1 diabetes and push for more regular blood sugar testing. While Type 1 diabetes is the second most common chronic illness of childhood—trailing only asthma—it can mimic other common ailments and often is missed until it has taken a potentially deadly turn. “We had no idea,” Vanessa Evans says. “I wish I would have known, because maybe taking her to the doctor sooner would have saved her life. I would have never thought this could happen to anyone, much less us, yet here we are, left without our beautiful daughter. I don’t wish this pain on anyone. As we learned the hard way, with this disease, every minute, every hour, every day counts.” Cases of Type 1 diabetes are increasing worldwide, particularly in young children. Warning signs can include extreme thirst, frequent urination, a fruity breath odor and blurred vision, as well as generalized symptoms such as fatigue, nausea, stomachache, appetite changes and we 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 >>
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 >>
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 >>
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 >>
The Scary Experience Of Diabetic Ketoacidosis
Today, we’re excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company’s philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it. Throughout this past year, I’ve had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much. In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.) Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. – and I thought it was 11:00 a.m. The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walke Continue reading >>
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: 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 >>