Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)
Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>
Why Diabetes Is So Dangerous
There’s a common saying in the diabetes community that diabetes won’t kill you, but it’s complications will. Still, according to the American Diabetes Association, diabetes was the 7th leading cause of death in the United States in 2010, with over 69,000 death certificates listing it as the underlying cause of death.  Add to that the common complications, like cardiovascular disease, kidney disease, and infection, and you can multiply that number by 10! Yet despite these eye-opening statistics, I still see far too many people not taking diabetes seriously. They approach it as something that’s a nuisance rather than something that can and does cause major health complications, and yes even death, if uncontrolled. “Sometimes I pretend I’m not diabetic, but that’s a dangerous game.” – Unknown Diabetes is more dangerous than most people assume, and so it becomes easy for many people with diabetes to get lax in their efforts to manage the dysfunction. A 2012 GAPP2 (Global Attitude of Patients and Physicians 2) survey found that 22% of insulin-using diabetic patients missed a basal insulin dose during a 30-day period.  There are very real dangers diabetes poses if left unchecked or mismanaged, and one of my goals today is to motivate you into taking better care of yourself or helping a loved one manage the disease better. Why is diabetes so dangerous? Because if not managed correctly, it can wreak havoc on just about every system and organ in the body. Let’s take a look at some of the biggest risks diabetic complications pose: Diabetic Ketoacidosis Diabetic Ketoacidosis is a very dangerous condition that can occur when patients neglect to take their insulin and have uncontrolled blood sugar. Since insulin is necessary to break down glucose as a sourc Continue reading >>
My Encounter With Diabetic Ketoacidosis
The Truth Behind My Encounter With Diabetic Ketoacidosis: A day like any other, can turn into a day you’ll never forget) With diabetes comes the good and the bad. When it’s good, it can be REALLY good. But when it’s bad…it can be life-threatening. I’ve certainly had my share of bad days. Trying to battle the high and the lows, and trying to stay as close to normal without losing my sanity. With having diabetes I’ve experienced many symptoms. But one day came symptoms like no other… chills – nausea – vomiting – back pain – weakness – blurred vision … and lots of ketones I had DKA (Diabetic Ketoacidosis) This was years ago, after a night of drinking with friends. Wanting to live a free, independent young adult life. Knowing, yet not knowing how destructive being the slightest bit careless could affect my diabetes. I just felt terrible. To the point where I questioned where to take insulin or not. I thought to myself … Well I don’t really plan on eating today, and I don’t want to worry about dropping “low”. I thought I was saving myself from having to fix my blood sugar. So I missed my morning dose… (Boy, was that a mistake – NEVER – would I do this again) I didn’t know at the time that insulin is needed (with or without food) Even on sick days! Without insulin in my body, my body couldn’t receive the energy to function properly. I kept close eyes on my blood sugar for a few hours that day, which was only in the mid 200’s. I thought that due to the fact I wasn’t eating, my blood sugar would come down eventually anyways. But the symptoms progressed. I couldn’t keep anything down … not even water. To be honest, DKA never came to mind. I’ve always taken my insulin. The only other time was when I was diagnosed, and was mo Continue reading >>
What Is Blood Sugar/high Blood Sugar
Diabetes is characterized by hyperglycemia, which is abnormally high levels of sugar (glucose) in the bloodstream, so everyone with type 1 and type 2 diabetes has experienced hyperglycemia. Hyperglycemia occurs when the body is not properly processing or using glucose, which is the case when insulin levels are low or nonexistent, and normally the excess amounts of glucose in the body is converted to glucogon or fat and stored for later use. Catabolic hormones such as glucagon, growth hormone, catecholamines, thyroxine and somatostatin, will increase blood sugar levels, but only insulin, which is an anabolic hormone, will decrease blood glucose levels. Since insulin is responsible for maintaining safe and healthy blood sugar levels in your body, if it is no longer present or not being produced in sufficient quantities, excess glucose will remain in your bloodstream. The excess glucose in your blood, if allowed to continually increase without treatment, will not only eventually cause serious complications, it can even kill you! Normal range blood sugar levels The standard unit for measuring blood glucose levels around the world is millimoles per liter (mmol/L), but in the U.S. blood glucose levels are measured in milligrams per deciliter (mg/dL). Blood sugar levels are usually at their lowest in the morning and are commonly known as "fasting blood sugar levels" and should be tested first thing upon waking, before breakfast. In people without diabetes the normal range of blood glucose levels eight to twelve hours after their last meal is between 70 to 100 mg/dL (3.8 to 5.5 mmol/L). Glucose levels rise by a few grams after meals for about an hour or two, so it is usually tested two hours after the end of the meal. In those without diabetes, the normal blood sugar levels aft Continue reading >>
Undiagnosed Type 1 Diabetes Kills – Please Share
In 2014, 1 in 6 children diagnosed with Type 1 diabetes were admitted to hospital with a potentially life-threatening condition called diabetic ketoacidosis (DKA) which can occur if a Type 1 diabetes diagnosis is delayed. The purpose of Diabetes Ireland’s Type 1 Diabetes Awareness Campaign is two-fold. The first is to encourage GPs to consider Type 1 diabetes first, as a potential diagnosis when a child presents feeling generally unwell by performing a simple finger prick glucose test to lead to prompt diagnosis. A delay in diagnosis usually means repeated visits to the GP and can result in diabetes ketoacidosis (DKA) which is potentially fatal. And secondly, to raise awareness among the general population of Type 1 Diabetes signs and symptoms (The 4T’s; Toilet, Thirsty, Tired and Thinner) which can attack completely at random. I was diagnosed with type 1 diabetes when I was 20 years old, I have no family history and my lifestyle was quite healthy. I cycled to college and I ate relatively healthy for a student with no money. *** A healthy lifestyle or not having a family history of diabetes does not protect you from Type 1 Diabetes. Sometimes, there is no rhyme or reason. The following are just a few of the tragic stories that have made news headlines; – 2015 Kycie Terry in Utah – 2013 in North Carolina, 14-month-old Reegan died as a result of her diabetes going undetected. You might be fooled into thinking that we are protected in Ireland and that these cases only happen in other countries. But, seriously, how can we be different? If this post has stirred something in you and you want to do something to create more awareness of Type 1 Diabetes, please share this post or share the facebook post from Diabetes Ireland‘s Facebook page to whatever social media pla Continue reading >>
Ketoacidosis - What?
Ketoacidosis. I'm sure if you have a diabetic dog, or are diabetic yourself, you've heard of this disease. Diabetic ketoacidosis develops when there is not enough insulin, which normally helps sugar move into cells to be used as energy. Without insulin, the body begins to breaks down fat as an alternate energy source. Breaking down fat in this way produces toxins called ketones, leading to diabetic ketoacidosis. Ketoacidosis can kill. Seriously. Signs include excessive thirst (indicative of high blood sugar), frequent urination (obviously if you are drinking a lot, you will pee a lot!), nausea and vomiting, abdominal pain, loss of appetite, weakness or fatigue, shortness of breath, fruity-scented breath (yes, really!), and confusion. Buzz started throwing up Saturday night around midnight and continued for the next 12 hours. It was really frightening - at first it was his dinner, then clear fluid, then yellow fluid, then there was blood. Around noon on Sunday, he fell asleep and stayed asleep for 4 straight hours. When he woke up, we fed him a small (very small, actually) amount of his low-residue wet food with some boiled chicken and once we knew he could hold that down, we let him have some water. We had already given him some subcutaneous fluids, so he was only slightly dehydrated, but he just had this insatiable thirst that we actually had to take the water away or we were afraid his gut would explode. We finally got in touch with the vet (why do our dogs always seem to get sick on a Sunday, the ONE day that neither of our vets work!?!) who figured out it was ketoacidosis (or maybe even a pancreatitis attack - but most likely ketoacidosis because his blood sugar has been very hard to control the past few weeks, with it being unsually high all. the. time.). There's n Continue reading >>
How Does Diabetic Ketoacidosis Kill You
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Can Diabetes Kill You?
Diabetic ketoacidosis is no ifs ands or buts apparently the most basic issues of diabetes. signs can find you shockingly, moving closer in unequivocally 24 hours or an incredible arrangement significantly less. without diabetic ketoacidosis cure, you will fall straightforwardly into a condition of numbness and pass on. “reliably that the grown-up isn’t managed is one other minute nearer to failing miserably,” says Joel Zonszein, MD, educator of medicines at Albert Einstein foundation of remedy in colossal apple city. Diabetic ketoacidosis happens when your body doesn’t make middle of the road insulin. Diabetic ketoacidosis by and large effects people with class 1 diabetes, everything considered there’s besides class 2 diabetes ketoacidosis. without insulin, sugar can’t be secured in your cells for use as imperativeness and functions as much as your blood in its place. Your fabricate needs to go to a decrease afresh up control structure: fats. inside the strategies for isolating fat for control, your body releases unsaturated fats and acids suggested as ketones. Ketones are a choice number of imperativeness for the physical make-up, and fundamentally having them in your blood isn’t essentially unseemly. That is generally known as ketosis, and it might apparently flip up once you go on a low-carb eating regimen and even consequent to fasting in a lone day. “when I put individuals on a controlled suppers plan, I can get a gage of how energetically they’re looking for after it by strategy for the proximity of ketones inside the pee,” says Gerald Bernstein, MD, an endocrinologist and facilitator of the Friedman Diabetes programming at Lenox Hill restorative establishment in ny city. associated: The Ketogenic eating up routine must be would becould genuine Continue reading >>
Transcript: Dr. Joseph Aloi On Treating Diabetic Ketoacidosis With Glucommander Software
This interview is also available as a video: click here to view. Dr. Joseph Aloi, Wake Forest Baptist Medical Center, Winston-Salem, NC. Steve: This is Steve Freed with Diabetes in Control and we’re here at AACE 2016 and we have with us a special guest who’s been working on some unique projects that we’d like to share with you. Maybe you can start off and tell us a little bit about your background, where you’re at and what kind of practice you have. Dr. Aloi: I’ve been in academic medicine for the last 25 years. I worked in three hospital systems. I started at the University of Virginia and then migrated to Eastern Virginia Medical School, which a lot of the data we’re presenting came through that relationship. And most recently I’m now at Wake Forest where I’m chief of the endocrine section there. But I’ve been working in the area of in-patient glycemic management for about the last 10 years. Steve: Because I noticed on one of your posters that you’re using this new software, fairly new software, to help treat diabetic ketoacidosis. Dr. Aloi: Correct. Steve: How does that work? Dr. Aloi: Patients coming in with diabetic ketoacidosis generally are treated with IV insulin. That’s standard of care. There are some other models for that. And what we were doing at Eastern Virginia Medical School was looking at treating patients coming in with Glucommander, which is a computer dosing algorithm for IV insulin and we had good experience with using Glucommander both in decreasing length of stay and decreasing rates of hypoglycemia. So we had a small group of information and then we combined that with looking at other medical centers. We partnered with Emory, Atlantic Diabetic Consultants, Sentara Healthcare system and then we were able to pull out almost 2, Continue reading >>
Diabetic Ketoacidosis (dka) Myths
Recently, I was asked to give a lecture to both my residents and nurses at the University of Texas Health Science Center at San Antonio (UTHSCSA) on some common DKA myths. Now this topic was originally covered by my good friend Anand Swaminathan on multiple platforms and I did ask his permission to create this blogpost with the idea of improving patient care and wanted to express full disclosure of that fact. I specifically covered four common myths that I still see people doing in regards to DKA management: We should get ABGs instead of VBGs After Intravenous Fluids (IVF), Insulin is the Next Step Once pH <7.1, Patients Need Bicarbonate Therapy We Should Bolus Insulin before starting the infusion DKA Myths Case: 25 y/o female with PMH of Type I DM who presents via EMS with AMS. Per EMS report, the patient ran out of her insulin 3 days ago….. Vital Signs: BP 86/52 HR 136 RR 30 O2Sat 97% on room air Temp 99.1 Accucheck: CRITICAL HIGH EMS was not able to establish IV access, so decided to just bring her to the ED due to how sick she looks. Your nurses are on point today and get you two large bore 18G IVs and start to draw blood work to send to the lab. You state I need a blood gas, and the nurse turns to you and asks do you need an ABG or VBG? Myth #1: We should get ABGs instead of VBGs in DKA So you do a literature review and come across two studies that specifically look at ABG vs VBG in an ED population: Study #1: Kelly AM et al. Review Article – Can Venous Blood Gas Analysis Replace Arterial in Emergency Medical Care. Emery Med Australas 2010; 22: 493 – 498. PMID: 21143397 For pH, 3 studies of patients with DKA (265 patients) were reviewed showing a weighted mean difference of 0.02 pH units. Only one study, which was the largest study (200 patients) reported 95% Continue reading >>
Can Diabetes Kill You?
Here’s what you need to know about the life-threatening diabetes complication called diabetic ketoacidosis. Diabetic ketoacidosis is one of the most serious complications of diabetes. Symptoms can take you by surprise, coming on in just 24 hours or less. Without diabetic ketoacidosis treatment, you will fall into a coma and die. “Every minute that the person is not treated is [another] minute closer to death,” says Joel Zonszein, MD, professor of medicine at Albert Einstein College of Medicine in New York City. Diabetic ketoacidosis occurs when your body doesn’t produce enough insulin. (Diabetic ketoacidosis most often affects people with type 1 diabetes, but there is also type 2 diabetes ketoacidosis.) Without insulin, sugar can’t be stored in your cells to be used as energy and builds up in your blood instead. Your body has to go to a back-up energy system: fat. In the process of breaking down fat for energy, your body releases fatty acids and acids called ketones. Ketones are an alternative form of energy for the body, and just having them in your blood isn’t necessarily harmful. That’s called ketosis, and it can happen when you go on a low-carb diet or even after fasting overnight. “When I put people on a restricted diet, I can get an estimate of how vigorously they’re pursuing it by the presence of ketones in the urine,” says Gerald Bernstein, MD, an endocrinologist and coordinator of the Friedman Diabetes Program at Lenox Hill Hospital in New York City. RELATED: The Ketogenic Diet Might Be the Next Big Weight Loss Trend, But Should You Try It? But too many ketones are a problem. “In individuals with diabetes who have no or low insulin production, there is an overproduction of ketones, and the kidneys can’t get rid of them fast enough,” sa Continue reading >>
Can You Die From Diabetes Type 2 And How To Prevent It?
Can you Die from Diabetes Type 2 and How to Prevent It? Diabetes is a serious disease that is usually life-long. According to the World Health Organization, diabetes mellitus type 2 is a form of a metabolic disease that is characterized by elevated blood glucose levels. Type 2 diabetes is around 20 times more common than type 1 diabetes, and around 90% of all diabetic people can be assigned to the type 2 category. Diabetic ketoacidosis is a complication of diabetes that is a serious complication. Can diabetes kill you? If you have this complication, it is potentially life-threatening. Diabetic ketoacidosis develops when the boy produces high levels of ketones (blood acids). When you cannot produce adequate insulin, the body breaks down fat to use as fuel. That breakdown eventually leads to a buildup of ketones, which leads to ketoacidosis. Causes and Symptoms of Diabetic Ketoacidosis Insulin is a necessary hormone that comes from a pancreatic gland. This hormone lowers the sugar level in the bloodstream. Glucose comes from food and your liver. When levels of glucose are high, there is a risk for diabetic ketoacidosis. Experts believe that genetics, lifestyle, and environment contribute to the development of diabetes type 2. The symptoms and signs of dying from diabetes and diabetic ketoacidosis are the first indications of having this disease for many people. They include: Frequent urination Nausea and vomiting Abdominal pain Shortness of breath Excessive thirst Weakness/fatigue Confusion Prevention of Type 2 Diabetes Positive antibody tests in older people suggest that type 2 diabetes is not a uniform condition and that in around 10% of cases, an autoimmune disease may be the cause of diabetes. While you can’t change your genes, you can do some things to prevent type Continue reading >>
Beware The Perils Of Severe Hypoglycemia
Over 80 years ago, famed diabetologist Elliot Joslin said about the treatment of patients with type 1 diabetes: “Ketoacidosis may kill a patient, but frequent hypoglycemic reactions will ruin him.” Unfortunately, hypoglycemia continues to be the most difficult problem facing most patients, families, and caregivers who deal with the management of type 1 diabetes on a daily basis. Frequent hypoglycemia episodes not only can “ruin,” or adversely impact the quality of life for patients, but also, when severe, can cause seizures, coma, and even death. A Tragic Case Recently, our group published a case report in the journal Endocrine Practice describing a tragic death from hypoglycemia that occurred while the patient slept in his own bed. Our patient, a 23-year-old man with type 1 diabetes who had a history of recurrent severe hypoglycemia, was using an older model insulin pump and wearing a separate, non-real-time continuous glucose monitoring (CGM) system. He was given the CGM in 2005 for the purpose of tracking his nocturnal (nighttime) blood glucose values and making further insulin pump adjustments. After he was pronounced dead in the emergency room, our diabetes nurse removed the pump and CGM to help us understand what happened. His insulin pump was found to have been working correctly. What we learned was that after supper, he had a heavy workout at a gym, followed by a late snack. Between 8 pm and midnight, he “stacked” five boluses of insulin, totaling 7.35 units (33% of his basal dose), in an attempt to keep his glucose values in “tight” control. The downloaded sensor demonstrated that his glucose values fell from about 200 mg/dL at midnight to under 50 mg/dL by 2:00 am, and to under 30 mg/dL by 5:00 am – three hours before he was found by his pare 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 In Cats
Diabetic ketoacidosis requires urgent veterinary treatment. With ketoacidosis, the lack of insulin causes the body to burn fat and muscle creating ketones. The kidneys are unable to filter all of the ketones from the blood. As a result, these ketones build up in the bloodstream, turning the blood extremely acidic. This is a dangerous stage of diabetes that causes blood chemical and blood sugar imbalances, and also impairs brain function. Left untreated, diabetic ketoacidosis can lead to diabetic coma and death. Understanding Diabetes Mellitus Diabetes mellitus is more commonly referred to as diabetes. With this disease, the feline's pancreas fails to properly regulate the flow of insulin within the body. Without the proper levels of insulin, the cat eats more, but fats and protein break down into energy, so the cat loses weight. Sugar levels within the blood skyrocket and are released in the urine. Cats often require insulin injections to maintain healthy blood sugar levels. With non-insulin dependent diabetes, diet, weight loss and exercise may be enough to keep blood sugar levels down. If a cat's blood sugar levels are properly monitored, a cat with diabetes is unlikely to face any serious health issues. If diabetic ketoacidosis does occur, call your vet immediately. Signs of Diabetic Ketoacidosis The most common signs of ketoacidosis in cats are excessive thirst and frequent urination. However, you should also watch for: Breath smells of nail polish remover/acetone Excessive appetite Vision changes/blindness Vomiting Weakness Weight loss Ketoacidosis can occur with an infection or illness. It can also happen if the insulin amounts need altering. Your vet will find a cause and create a new treatment plan you will follow at home. Diagnosis and Treatment When you bring Continue reading >>