Is The Brain Affected In Diabetes Mellitus?
Didi....This is a very good question because the impact of diabetes on the brain is actually overlooked. Theoretically, one can say that since diabetes affects so many organs in the body, therefore, it might affect the brain as well. Practically speaking, it has been shown that chronic hyperglycemia leads to the release of mediators that cause chronic brain inflammation, reduce blood flow and damage the cells. In fact hyperglycemia raises the risk of having dementia and depression. The chances of becoming depressed or getting dementia increases when diabetes complications develop and decreases in diabetic people with good blood sugar control. Besides, cardiovascular complications could contribute to stroke by blocking the blood flow to the brain. Another way in which diabetes can affect the brain is ketoacidosis, that occurs most likely in Type I diabetes, where the brain cannot handle the excessive amounts of ketone bodies. We must not forget that hypoglycemia, resulting from an overdose of antidiabetic drugs, leads to hypoglycemic coma. Continue reading >>
I. Review of normal lipid metabolism Triglycerides in adipose ==lipolysis==> Long-chain FAs Long-chain FAs==hepatic beta-oxidation==>Acetyl CoA Acetyl CoA==hepatic ketogenesis==>ketone bodies Ketone bodies are Beta-hydroxybutyrate and Acetoacetate Beta-OHB is oxidized to AcAc-; their relative concentrations depend on redox state of cell; Beta-OHB predominates in situation favoring reductive metabolism (e.g. decreased tissue perfusion, met. acidosis, catabolic states--like DKA!) Typical ratio Beta-OHB:AcAc- is 3:1; us. increases in DKA II. Hormonal influences on glucose and lipid metabolism Insulin In liver, increases glu uptake from portal blood; stimulates glycogenesis, inhibits glycogenolysis and gluconeogenesis In skeletal muscle, increases glu uptake from blood, stimulates protein synth, inhibits proteolysis In adipose tissue, required for glu and lipoprotein uptake from blood; stimulates lipogenesis, inhibits lipolysis Tissues which don't require insulin to transport glucose into cells: brain, renal medulla, formed blood elements Counterregulatory hormones: glucagon (major player in DKA), epi/norepi, cortisol, growth hormone (no acute effects, only over days-weeks) Glucagon: increases hepatic beta-oxidation, ketogenesis, gluconeogenesis and glycogenolysis; decreases hepatic FA synth. Epi/Norepi: increase hepatic gluconeogenesis & glycogenolysis; increases adipose lipolysis; decreases peripheral glu utilization Cortisol: major effect is decreased peripheral glu utiliz; little effect on production Growth hormone: increases hepatic gluconeogenesis and glycogenolysis; increases adipose lipolysis In high counterreg. hormone states (see above), require high levels of insulin to avoid progressive hyperglycemia and ketoacidosis--glucagon levels in DKA are 5-6 x nl* III. Pa Continue reading >>
Diabetic Ketoacidosis-associated Stroke In Children And Youth
Copyright © 2011 Jennifer Ruth Foster et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Diabetic ketoacidosis (DKA) is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia and ketonemia. Although possibly underappreciated, up to 10% of cases of intracerebral complications associated with an episode of DKA, and/or its treatment, in children and youth are due to hemorrhage or ischemic brain infarction. Systemic inflammation is present in DKA, with resultant vascular endothelial perturbation that may result in coagulopathy and increased hemorrhagic risk. Thrombotic risk during DKA is elevated by abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. DKA-associated cerebral edema may also predispose to ischemic injury and hemorrhage, though cases of stroke without concomitant cerebral edema have been identified. We review the current literature regarding the pathogenesis of stroke during an episode of DKA in children and youth. 1. Introduction Type 1 diabetes mellitus (T1DM) is a common autoimmune condition that often presents in childhood and may be complicated by episodes of diabetic ketoacidosis (DKA). DKA is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia, ketonemia, acidemia, and systemic inflammation. Compared with adults, episodes of DKA in children carry a higher risk of morbidity and mortality. This is predominantly attributable to intracerebral complications [1–5], which occur in 3–10 pediatric patients per 1000 cases of DKA . The most common Continue reading >>
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Effects Of Diabetic Ketoacidosis On Visual And Verbal Neurocognitive Function In Young Patients Presenting With New-onset Type 1 Diabetes
Go to: Abstract To evaluate the effects of diabetic ketoacidosis (DKA) on neurocognitive functions in children and adolescents presenting with new-onset type 1 diabetes. Newly diagnosed patients were divided into two groups: those with DKA and those without DKA (non-DKA). Following metabolic stabilization, the patients took a mini-mental status exam prior to undergoing a baseline battery of cognitive tests that evaluated visual and verbal cognitive tasks. Follow-up testing was performed 8-12 weeks after diagnosis. Patients completed an IQ test at follow-up. Results: There was no statistical difference between the DKA and non-DKA groups neither in alertness at baseline testing nor in an IQ test at follow-up. The DKA group had significantly lower baseline scores than the non-DKA group for the visual cognitive tasks of design recognition, design memory and the composite visual memory index (VMI). At follow-up, Design Recognition remained statistically lower in the DKA group, but the design memory and the VMI tasks returned to statistical parity between the two groups. No significant differences were found in verbal cognitive tasks at baseline or follow-up between the two groups. Direct correlations were present for the admission CO2 and the visual cognitive tasks of VMI, design memory and design recognition. Direct correlations were also present for admission pH and VMI, design memory and picture memory. Pediatric patients presenting with newly diagnosed type 1 diabetes and severe but uncomplicated DKA showed a definite trend for lower cognitive functioning when compared to the age-matched patients without DKA. Keywords: diabetic ketoacidosis, Cognition, dehydration, neuroinflammation Neurocognitive tasks. Mean (standard deviation) and median (range) of standard scores of Continue reading >>
Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>
How Does Ketoacidosis Affect The Human Brain?
Diabetic Ketoacidosis (DKA) is the body’s emergency reaction to glucose starvation in the absence of insulin. It is a disastrous reaction — in general, it makes things worse rather than better, and starts a vicious cycle of blood acidity, rising blood glucose, dehydration, and blood hyperosmolality (high concentration of dissolved stuff) that can be hard to break. One of the hardest-hit organs in DKA is the brain, due to the dehydration and acidic blood entering that sensitive organ. Severe DKA may lead to brain swelling (edema) which is life-threatening. But recent studies have shown that even a short, apparently fully-recovered stint of DKA leads to measurable brain injury. Diabetic Ketoacidosis (DKA) is a life–threatening consequence of diabetes. DKA occurs when there is a lack of insulin in the body causing hyperglycemia. As a result of the inability of glucose to enter the cells, the body must find other means to obtain energy. As such, fat breakdown occurs resulting in the accumulation of fatty acids. The fatty acids are metabolized to ketones that cause the blood to become acidotic (pH less than7.3). Because glucose remains in the blood, there is an increase in thirst and drinking to eliminate the solute load of glucose, which also results in increased urination (polyuria and polydipsia). Thus, the combination of increased serum acidity, weight loss, polyuria, and polydipsia may lead to extreme dehydration, coma, or brain damage. Without a doubt, the most severe acute complication of DKA is cerebral edema. Many cases of new onset type 1 diabetes present DKA (15-70 percent depending on age and geographic region, according to multiple studies), hence the importance of an early diagnosis of diabetes in order to avoid potential consequences. Much research is be Continue reading >>
Diabetic Coma: Causes, What Happens When You Go Into A Diabetic Coma?
What is Diabetic Coma and What Happens When You go Into a Diabetic Coma? Diabetic coma is a fatal complication that leads to unconsciousness. Any diabetic person with extremely high (hyperglycemia) or low (hypoglycemia) level of blood sugar can be affected by diabetic coma. A person who has slipped into diabetic coma will not be able to respond to any physical stimulation except for being alive. Diabetic coma can cause death when left untreated or not properly treated on time. There are very less chances of hopes in case of diabetic coma. However one can control his or her health conditions to avoid occurrence of diabetic coma. One should follow their diabetes management plan strictly to avoid a turn towards diabetic coma. Diabetic coma is of three types, ketoacidosis coma, hyperosmolar coma and hypoglycemic coma. Emergency medical facility is required in case of a diabetic coma Hyperglycaemia or hypoglycaemia is caused by huge rate of fluctuation in the blood sugar level leading to diabetic coma. Whenever there is any extreme fluctuation in the glucose level of the blood, the same has to be reported to the doctor immediately. Never forget that "prevention is better than cure". Make yourself more aware on diabetes and learn the likely consequences of the disease to keep yourself alert. Frequently Asked Questions (F.A.Q's) on Diabetic Coma A person can fall in to diabetic coma while suffering from Diabetic ketoacidosis (DKA). The person will not remain conscious in this sleep-like state. This state which can be caused by hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose), can remain for long time or sometimes lead to death. "Ketones" are generated in the human body when it uses body fat for energy. Ketones are also generated when there is minimum insu Continue reading >>
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 >>
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 >>
High Alert: The Emergency Complications Of Diabetes
Diabetes has become such a chronic long-term condition that it’s easy to forget about the serious acute complications that can arise, which can lead to a coma or death if not treated. There are only two types of emergencies – having very high glucose and having a very low glucose. The warning signs of an looming coma range from a mild headache to hallucinations.. If not identified or treated both types of emergencies can lead to serious irreversible complications including brain damage, kidney failure and death. When your glucose is very very high The fundamental issue in diabetes is raised blood glucose levels. Medically this is called hyperglycaemia. When glucose rises very rapidly or to very high levels, it can result in a diabetic ketoacidotic coma or a hyperglycaemic coma. Diabetic ketoacidotic coma This happens in type 1 diabetes and the high risk people include children and teens. A person can go into a ketoacidotic coma within a few hours. A person in a ketoacidotic crisis presents with: a complete lack of insulin in the body very high glucose levels dehydration break down of muscle abnormal potassium, sodium and other electrolyte levels. Causes of ketoacidotic crisis or coma A person who hasn’t been diagnosed with diabetes as yet Missing an insulin dose Illness such as gastroenteritis, nausea and vomiting Not adjusting insulin when glucose is high What to look out for if you suspect you may be going into a ketoacidotic crisis or coma Shortness of breath Fruity smelling breath Nausea and vomiting Severe fatigue Abdominal pain and headache Thirst Passing urine more often. Danger signs to watch out for Slurred speech Blurred vision Reduced concentration Coma. What you must do if yoususpect you may be going into a ketoacidotic crisis or coma Get to a casualty Continue reading >>
How Does Gut Bacteria Influence The Brain?
How does gut bacteria influence the brain? Bacteria in the human body outnumber our own cells 10:1. Most of those bacteria reside in the gut. Research shows that when the balance between healthy bacteria and disease-causing bacteria is changed (in the gut of rodents), they became more bold or more anxious. In a 2011 study of the "microbiome-gut-brain axis," published in Gastroenterology mice that are breed to be timid, were given an antibiotic. They became bold and adventurous and reverted back to their previous timid selves once the antibiotic was stopped. Mice that were raised in sterile environments (no bacteria), had more stress hormones. When fecal samples from healthy mice were implanted, they became normal in their stress response, but only if the implant took place prior to being weaned. Also in another study, mice that were fed probiotics were more resilient to getting depression. Further gut bacteria research on rodents shows that the gut bacteria influence neural development, brain chemistry and many other behavioral phenomena, including emotional behavior, pain perception and the stress system response. The human gut, is often referred to as the "second brain,", and it is the only organ to have its own independent nervous system embedded in the gut wall. Although the gut bacteria affect our brain (via the immune system and , the brain also affects gut bacteria. Stress alters the bacteria balance and can leave the host open to infections, and other problems, and mood disorders such as anxiety and depression. This is due to the vast number of neurochemicals the gut bacteria produce, for example they produce about 90% of our seratonin (a neurotransmitter responsible for making us feel happy. Research on infant monkeys whose mothers got startled by loud noises d Continue reading >>
What Happens To The Human Brain When It Gets Old?
The other Quora participants have focused on the decline that happens with age. While it’s true that nothing last forever, neither brain nor reign, there is some good news about brain aging. Perhaps the most striking brain research today is the strong evidence we now have that exercise may forestall some kinds of mental decline. It may even restore memory. Myriad animal studies have shown that, among other brain benefits, aerobic exercise increases capillary development in the brain, meaning more blood supply, more nutrients and - a big requirement for brain health - more oxygen. The preeminent exercise and brain-health researcher in humans is Arthur Kramer at the University of Illinois at Urbana-Champaign. In a dozen studies over the past few years, Kramer and his colleagues have proved two critical findings: Fit people have sharper brains, and people who are out of shape, but then get into shape, sharpen up their brains. This second finding is vital. There’s no question that working out makes you smarter, and it does so, Kramer notes, at all stages of life. Just as important, exercise staves off heart disease, obesity, diabetes and other maladies that increase the risk of brain problems as we age. A confirmation of the benefits of aerobic conditioning for brain aging was presented in a cross sectional study. “Aerobic Fitness Reduces Brain Tissue Loss in Aging Humans”, Colcombe and Kramer, 2003. Aerobic fitness of 55 highly educated, cognitively normal persons (aged 55–79 years) was assessed by estimating VO2max . Brain integrity was assessed by MRI scans using VBM methodology. The analysis showed a typical pattern of age related differences: reduced brain tissue density in association with cortical regions (prefrontal, superior and inferior parietal, and inf Continue reading >>
Type 1 Diabetes Diagnosis May Come With Brain Changes In Kids, Including Memory Loss
Diabetes is the seventh leading cause of the death in the United States. A new study reveals another disturbing detail. Researchers found that type 1 diabetes in children can cause brain loss, affecting memory and attention cognition. Diabetic ketoacidosis (DKA) is a harmful complication of Type 1 Diabetes that can gradually alter brain matter in newly diagnosed children. "Children and adolescents diagnosed with type 1 diabetes with diabetic ketoacidosis have evidence of brain gray matter shrinkage and white matter swelling," the study's lead author Dr. Fergus Cameron, head of diabetes services at Royal Children's Hospital in Victoria, Australia, told HealthDay. The recent study includes 36 children and teens with DKA and 59 without it. MRIs were taken over the course of six months. Those with DKA experienced a decrease in gray matter volume along with swelling of white matter. There was also evidence of memory loss and reduced sustained and divided attention. Symptoms tended to develop over time, raising a big concern for parents who might not notice any differences in their child right away. "Any decrement in attention or memory in children is a concern as children are acquiring new knowledge and learning new skills all the time," Cameron said. Cameron and his team found that 20 to 30 percent of children newly diagnosed with type 1 diabetes had DKA. According to the CDC, from 2002 to 2003, 15,000 youth in the United States were newly diagnosed with type 1 diabetes each year. "DKA still kills people, so we need to do better. We need better tools. And we need to educate doctors more on the symptoms of type 1 diabetes," Cameron said. The Juvenile Diabetes Research Foundation reports that type 1 diabetes is on the rise. Each year, 30,000 U.S. adults and children are diagn Continue reading >>
Diabetic Ketoacidosis: A Serious Complication
A balanced body chemistry is crucial for a healthy human body. A sudden drop in pH can cause significant damage to organ systems and even death. This lesson takes a closer look at a condition in which the pH of the body is severely compromised called diabetic ketoacidosis. Definition Diabetic ketoacidosis, sometimes abbreviated as DKA, is a condition in which a high amount of acid in the body is caused by a high concentration of ketone bodies. That definition might sound complicated, but it's really not. Acidosis itself is the state of too many hydrogen ions, and therefore too much acid, in the blood. A pH in the blood leaving the heart of 7.35 or less indicates acidosis. Ketones are the biochemicals produced when fat is broken down and used for energy. While a healthy body makes a very low level of ketones and is able to use them for energy, when ketone levels become too high, they make the body's fluids very acidic. Let's talk about the three Ws of ketoacidosis: who, when, and why. Type one diabetics are the group at the greatest risk for ketoacidosis, although the condition can occur in other groups of people, such as alcoholics. Ketoacidosis usually occurs in type one diabetics either before diagnosis or when they are subjected to a metabolic stress, such as a severe infection. Although it is possible for type two diabetics to develop ketoacidosis, it doesn't happen as frequently. To understand why diabetic ketoacidosis occurs, let's quickly review what causes diabetes. Diabetics suffer from a lack of insulin, the protein hormone responsible for enabling glucose to get into cells. This inability to get glucose into cells means that the body is forced to turn elsewhere to get energy, and that source is fat. As anyone who exercises or eats a low-calorie diet knows, fa Continue reading >>
How Does Napping Affect The Brain?
Whenever I am preparing for a class lecture I like to take short naps in between my preparations - just as long as I have an alarm clock or coffee to wake me up (see coffee naps). It never occurred to me a few years back that the nap might be beneficial beyond simply resting and re-energizing my brain. But a study has shown that naps, in this case a 90 minute snooze, can help consolidate memories and promote long-term retention. In the study, participants began learning a complex thumb-tapping sequence. The participants were then divided into two groups: one took a nap and the other did not. When tested later that evening, the group that took a nap during the afternoon remembered more of the thumb-tapping sequence than the group that hadn't napped. This suggests that while napping, the brain was working to strengthen and consolidate the newly forming memories. With that in mind, a Power Naps (varies between 20-90 minutes) can be helpful for those who lack a good night’s sleep or want to perform better on their next exam. Or in my case, my class lectures... References: Naps May Boost Memory Continue reading >>