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How Does Ketoacidosis Kill You

How To Lower Your Blood Sugar When It's Really High

How To Lower Your Blood Sugar When It's Really High

​This article is written for type 2 diabetics who need help coming down from a very high blood sugar during a single, isolated high blood sugar event. If you want to try an stabilize your baseline, consider signing up for my Baseline Blood Sugar Challenge course. ​THIS ARTICLE IS NOT A SUBSTITUTE FOR REAL MEDICAL ADVICE. If you're a type 2 diabetic and your blood sugar is high right now (greater than 300mg/dL for at least 6 hours), the first thing you should do is call your doctor. So, if you haven't called anyone for help yet, please stop reading this article and call your doctor. If your doctor is able to help, then you need not read on. Also, if you are having symptoms of Diabetic Ketoacidosis, stop reading this article and go to the hospital immediately. Diabetic Ketoacidosis can kill you if left untreated. But. If you're in a situation where your blood sugar has been high for an extended period of time, you could perhaps consider taking the following steps to solve your blood sugar problem. Disclaimer: This is friendly, non-medical advice from a random diabetic person you don't even know, which is a very (very) poor substitute for real, actual medical advice. Use at your own risk. First, you should try and lower your blood sugar without injectable insulin by completing the following steps: 1. Check your blood sugar. Write down the time and your blood sugar level. 2. Drink water (this doesn't actually lower blood sugar, but it helps flush sugar and ketones from your body, if you have them). Continue drinking water, but please don't make yourself sick. 3. Move. As in, walk. Walk around the block or walk in place or haul your ass up and down the stairs for 30-60 minutes. Walking helps your cells become less insulin resistant, which is what you need right now. Do N Continue reading >>

Ketosis: What Is Ketosis?

Ketosis: What Is Ketosis?

Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

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 >>

What Is Blood Sugar/high Blood Sugar

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 >>

Diabetic Ketoacidosis And Diabetic Nonketotic Diabetes

Diabetic Ketoacidosis And Diabetic Nonketotic Diabetes

Sort What are 9 clinicopathic abnormalities associated with diabetic ketoacidosis? Hyperglycemia and glycosuria Hyperketonemia and ketonuria Hypobicarbonatemia Elevated liver enzymes Hypokalemia Leukoctosis Anemia Hyponatremia Hypophosphatemia Continue reading >>

Pumper's Voice

Pumper's Voice

Pumping Pitfalls Avoiding and dealing with pump-related problems For anyone who uses an insulin pump, there are bound to be occasional problems. For some, problems may be as rare as a Chicago Cubs’ World Series victory; for others they may occur as often as a Hollywood scandal. Insulin pumps, being mechanical devices, are subject to mishaps that can result in interruptions or irregularities in insulin delivery or action. When too little insulin is being infused into your body, high blood sugar will occur. When absorption is inconsistent, highs and lows can occur. And if no insulin is being delivered, diabetic ketoacidosis (DKA) can occur in just a few hours. Fending Off DKA DKA is a serious condition that will make you very ill and can kill you. The primary cause of DKA is a lack of working insulin in the body, accompanied by dehydration. When you are using an insulin pump, there is no long-acting insulin present in your body. Any interruption in insulin delivery can result in a sharp rise in blood sugar and ketone production can start as soon as three hours after the last bit of insulin was infused. The most important step in preventing ketoacidosis is early detection of the problem. You accomplish this by checking for ketones with any unusually high blood sugar levels. Everyone on a pump should be prepared to test for ketones and you can do this by way of a urine dipstick (ketostix or ketodiastix) or a fingerstick blood sample (Precion Xtra meter from Abbott). Positive ketones are indicated by either of the following: • Urine testing that indicates small, moderate or large levels of ketones (³15 mg/dl) • Blood testing that indicates the presence of b-Hydroxybutyrate (³.6 mmol/l) If your ketone test shows negative or trace amounts, your high blood sugar is prob Continue reading >>

My Encounter With Diabetic Ketoacidosis

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 >>

Diabetic Ketoacidosis (dka) Myths

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 >>

First Aid For People With Diabetes

First Aid For People With Diabetes

The prevalence of diabetes increased 382% from 1988 to 2014. According to the National Diabetes Statistics Report, this growth correlates with the upsurge of visits to the emergency room from people in a life-threatening diabetic crisis. As the condition continues to rise so does the likelihood of providing first aid for someone with diabetes. Understanding Diabetes First-aid providers have important choices to make before providing care to a diabetic. The best way to effectively manage a diabetic emergency is through understanding the mechanisms behind the medical condition. Every cell in the body requires glucose as a foundation of energy. People with diabetes, though needing glucose, have an inability to process, or metabolize, it efficiently because the pancreas is either producing too little insulin or none at all—either way, glucose can accumulate to dangerously high levels. A healthy pancreas regulates the production of insulin proportionate to the amount of glucose in the blood. Classification of Diabetes Type 1 diabetes is primarily an autoimmune condition manifesting in children and young adults. These people do not produce insulin; they require routine injections of insulin to aid in glucose metabolism. Without insulin injections type 1 diabetics cannot use the sugar in their blood for energy. People with Type 2 diabetes produce small amounts of insulin, or they cannot properly use the insulin hormone, also known as insulin resistance. This condition usually develops later in life. Many people with type 2 diabetes use diet, exercise, and other non-insulin medications. Some Type 2 diabetics however, may require supplemental insulin. What is a Diabetic Emergency? With six million people using insulin in the United States, the incidence of too much or too litt Continue reading >>

Diabetic Ketoacidosis In Cats

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 >>

Confusing Ketosis With Ketoacidosis

Confusing Ketosis With Ketoacidosis

Confusing Ketosis with Ketoacidosis Confusing Ketosis with Ketoacidosis – Nutrition professionals often say low-carb diets, and a very low-glycemic diet like that of the Roman Diet, cause ketoacidosis, a medical emergency that can kill you. This is completely false. They are confusing the words “ketosis” and “ketoacidosis” – which are vastly different. Ketosis does happen on low-carb diets and when following the Roman Diet, ahich is very low-glycemic and low in insulin demand. When the body is not getting the usual amount of carbohydrates typical in the western lifestyle, it releases fats from the fat tissues, which go to the liver and are turned into ketone bodies. Ketones are molecules that can cross the blood-brain barrier and provide energy for the brain when it isn’t receiving enough glucose. This is the body’s natural response to low-carb or very low-glycemic intake. This is NOT to be confused with ketoacidosis, which is something that only happens in uncontrolled diabetes, mainly uncontrolled type 1 diabetes. It involves the bloodstream being flooded with both glucose and ketone bodies in extremely large amounts. Ketoacidosis is dangerous, that is true. But that simply has nothing to do with low-carb or very low-glycemic diets. It has to do with better management of blood glucose levels, primarily with type 1 diabetes. In nutritional ketosis, or keto-adaptation, as long as sufficient insulin is present, there is no such risk of ketoacidosis. Interestingly enough, nutritional ketosis can actually help make blood sugar control more manageable! The metabolic state of ketosis has been proven to be therapeutic in many ways. It can help with epilepsy, brain cancer and type 2 diabetes, to name a few. (1-3) Stories of type 1 diabetics following ketogenic Continue reading >>

Is Ketosis Dangerous?

Is Ketosis Dangerous?

Duck Dodgers October 14, 2014 Peter, An article by Per Wikholm was published in this month’s LCHF Magasinet, where Per demonstrates that the Inuit could not have been in ketosis given that the scientific literature is abundantly clear, over and over again, that the Inuit consumed too much protein, and more importantly, Per debunks Stefansson’s claims for high fat with writing from his own books—Stef admitted in the pemmican recipes that Arctic caribou was too lean to make pemmican that supported ketosis. The most popular LCHF bloggers in Sweden, Andreas Eenfeldt/Diet Doctor and Annika Dahlquist have reluctantly agreed with Per’s findings—admitting that the Inuit were likely not ketogenic from their diet. I’ve put together a comprehensive review of the scientific literature regarding the Inuit, encompassing over two dozen studies, spanning 150 years, with references from explorers, including Stefansson. In the comments section of that post, Per gives a brief overview of how he was able to prove Stefansson’s observations on high fat intake were flawed. The post is a review of all the available literature that I could find (over two dozen studies). But, the literature certainly does not in any way support ketosis from the Inuit diet due to such high protein consumption. As Per (and Stefansson) points out, the caribou is too lean and as the many quotes show, the Inuit were saving their blubber and fat for the long dark Winter to power their oil lamps and heat their igloos. Again and again, we see that in the literature, as even Stefansson admits this. As far as glycogen is concerned, their glycogen intake is probably not worth scrutinizing given the well-documented high protein consumption in every published study. It really is besides the point. But, interest Continue reading >>

When You Need To Go To The Emergency Room With High Blood Sugars

When You Need To Go To The Emergency Room With High Blood Sugars

My uncle, like all his family, was a bit of a cheapskate. He hated to spend money unless it was absolutely necessary. He was thin and active, having only recently given up a career as a singer and dancer performing weekly on a nationally televised variety show. So when he felt unwell one weekend night, he turned down his wife's suggestion that she drive him to the emergency room and told her he'd wait til Monday when he could see his family doctor. Why waste all that money on an ER visit that was probably unnecessary? As it turned out, he didn't need to see his doctor on Monday. He died that night. He was a few years younger than I am now and the fatal heart attack he experienced was the first symptom he had of our family's odd form of inherited diabetes. But this is why, even though I've inherited the family "cheap" gene, if there's any possibility something dangerous is going on, I head for the ER. Usually it is a waste of money. I was in a small car accident a few weeks ago that left me with nerve pain running up and down my arms and legs. I sat for four hours at our local ER, saw the doctor for five minutes, and was sent home. The diagnosis, whiplash. The treatment, wait and see if it gets worse. The bill? Over $900. I went to the ER because I'd called my family doctor's office and they told me to. Whiplash usually resolves on its own, but occasionally it can cause swelling in your neck that can kill you. I'm not equipped to judge what kind I had, and unlike my uncle, I wasn't about to gamble. So with this in mind, you can understand my reaction when a stranger contacted me recently, after reading my web page, and told me that his blood sugar, which had been normal until very recently, was testing in the 500s on his meter except when his meter wasn't able to give hi Continue reading >>

Why Isnt Ketoacidosis A Problem For Lc And Vlc Paleo-eaters?

Why Isnt Ketoacidosis A Problem For Lc And Vlc Paleo-eaters?

I'm sitting in a lecture about nutrition and metabolism for people with diabetes. The instructor keeps insisting that if you are metabolizing ketones for any length of time, it will result in ketoacidosis, and eventually kill you. I've not heard anything about LC and VLC paleo eaters having problems with ketoacidosis, but I'm not sure how we avoid it while primarily metabolizing ketone bodies. I understand that people with diabetes have more issues to work with, and are metabolically deranged, but how do people with normal metabolisms avoid acidosis issues? Can anyone please shed some light on this for me? I googled around and haven't found explanation. Continue reading >>

How Dka Happens And What To Do About It

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 >>

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