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How Ketoacidosis Cause Coma

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. It could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too. It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones and, if the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you miss a meal, you're sick or stressed, or you have an insulin reaction. DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration. Test your ketones when your blood sugar is over 240 mg/dL or you have symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot. You can check your levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work, if you have any of the symptoms below and your ketones aren't normal, or if you have more than one symptom. You've been throwing up for more than 2 hours. You feel queasy or your belly hurts. Your breath smells fruity. You're tired, confused, or woozy. You're having a hard time breathing. Continue reading >>

Diabetic Coma

Diabetic Coma

A diabetic coma is a life-threatening diabetes complication that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you lapse into a diabetic coma, you're alive — but you can't awaken or respond purposefully to sights, sounds or other types of stimulation. Left untreated, a diabetic coma can be fatal. The prospect of a diabetic coma is scary, but fortunately you can take steps to help prevent it. Start by following your diabetes treatment plan. Before developing a diabetic coma, you'll usually experience signs and symptoms of high blood sugar or low blood sugar. High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst Frequent urination Fatigue Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth A rapid heartbeat Low blood sugar (hypoglycemia) Signs and symptoms of a low blood sugar level may include: Shakiness or nervousness Anxiety Fatigue Weakness Sweating Hunger Nausea Dizziness or light-headedness Difficulty speaking Confusion Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness and won't have the warning signs that signal a drop in blood sugar. If you experience any symptoms of high or low blood sugar, test your blood sugar and follow your diabetes treatment plan based on the test results. If you don't start to feel better quickly, or you start to feel worse, call for emergency help. When to see a doctor A diabetic coma is a medical emergency. If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency number. If you're with som Continue reading >>

Diabetic Coma

Diabetic Coma

The three types of diabetic coma include diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. Diabetic coma is a medical emergency and needs prompt medical treatment. Uncontrolled blood glucose levels may lead to hyperglycaemia or hypoglycaemia. Low or persistently high blood glucose levels mean your diabetes treatment needs to be adjusted. Speak to your doctor or registered diabetes healthcare professional. Prevention is always the best strategy. If it is a while since you have had diabetes education, make an appointment with your diabetes educator for a review. On this page: Diabetes mellitus is a condition characterised by high blood glucose (sugar) levels. Uncontrolled diabetes may lead to a diabetic coma or unconsciousness. The three types of coma associated with diabetes are diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. Diabetic ketoacidosis coma Diabetic ketoacidosis typically occurs in people with type 1 diabetes, which was previously known as juvenile diabetes or insulin dependent diabetes mellitus (IDDM), though it can occasionally occur in type 2 diabetes. This type of coma is triggered by the build-up of chemicals called ketones. Ketones are strongly acidic and cause the blood to become too acidic. When there is not enough insulin circulating, the body cannot use glucose for energy. Instead, fat is broken down and then converted to ketones in the liver. The ketones can build up excessively when insulin levels remain too low. Common causes of ketoacidosis include a missed dose of insulin or an acute infection in a person with type 1 diabetes. Ketoacidosis may be the first sign that a person has developed type 1 diabetes. Symptoms of ketoacidosis Symptoms of ketoacidosis are: extreme thirst lethargy frequent urination ( Continue reading >>

Diabetic Coma

Diabetic Coma

Print Overview A diabetic coma is a life-threatening diabetes complication that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you lapse into a diabetic coma, you're alive — but you can't awaken or respond purposefully to sights, sounds or other types of stimulation. Left untreated, a diabetic coma can be fatal. The prospect of a diabetic coma is scary, but fortunately you can take steps to help prevent it. Start by following your diabetes treatment plan. Symptoms Before developing a diabetic coma, you'll usually experience signs and symptoms of high blood sugar or low blood sugar. High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst Frequent urination Fatigue Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth A rapid heartbeat Low blood sugar (hypoglycemia) Signs and symptoms of a low blood sugar level may include: Shakiness or nervousness Anxiety Fatigue Weakness Sweating Hunger Nausea Dizziness or light-headedness Difficulty speaking Confusion Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness and won't have the warning signs that signal a drop in blood sugar. If you experience any symptoms of high or low blood sugar, test your blood sugar and follow your diabetes treatment plan based on the test results. If you don't start to feel better quickly, or you start to feel worse, call for emergency help. When to see a doctor A diabetic coma is a medical emergency. If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency nu Continue reading >>

Diabetic Coma

Diabetic Coma

Diabetic coma is a medical emergency in which a person with diabetes loses consciousness because of one of the acute complications of diabetes: Advanced ketoacidosis from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic state, in which extreme hyperglycemia and dehydration alone are enough to cause unconsciousness. Coma is a profound state of unconsciousness and a person in coma does not respond normally to pain or light, does not take any voluntary action, and does not exhibit the normal sleep-wake cycles. It may be a result of several conditions including including intoxication, metabolic abnormalities, central nervous system diseases, acute neurologic injuries such as stroke, and hypoxia. In some cases, it is deliberately induced by administering pharmaceutical agents with a view to preserve higher brain function following another form of brain trauma. Diabetic coma is a condition which may result as a severe complication of diabetes and may take three major forms of complications as indicated above, namely, hyperglycemia (high blood sugar), Diabetic ketoacidosis, and Hyperosmolar nonketotic state. In some case, even hypoglycemia (low blood sugar) may also trigger diabetic coma. Diabetic coma is largely preventable if proper medications as prescribed is taken along with having a healthy diet and maintaining a suitable lifestyle. At the same time, the blood sugar level should be monitored closely to indicate potential problems. Diabetic coma does not strike suddenly - it is preceded by a number warning signs and symptoms. In case of high blood sugar (hyperglycemia the person affected may experience one or more of these signs - frequent urination and increased thirst, dry mouth, vomiting and nausea, and shortness of b Continue reading >>

Ketoacidosis And Hyperosmolar Coma

Ketoacidosis And Hyperosmolar Coma

There are two acute conditions that can develop from the combination of high blood sugars and dehydration. The first is called diabetic ketoacidosis, or DKA. It occurs in people who make virtually no insulin on their own (either type 1 diabetics or type 2 diabetics who have lost nearly all beta cell activity). Very low serum insulin levels, combined with the insulin resistance caused by high blood sugars and dehydration, result in the virtual absence of insulin-mediated glucose transport to the tissues of the body. In the absence of adequate insulin, the body metabolizes stored fats to produce the energy that tissues require to remain alive. A by-product of fat metabolism is the production of substances called ketones and ketoacids. One of the ketones, acetone, is familiar as the major component of nail polish remover. Ketones may be detected in the urine by using a dipstick such as Ketostix (see Chapter 3, “Your Diabetic Tool Kit”). Ketones may also be detected on the breath as the aroma of an organic solvent, which is why unconscious diabetics are often mistaken for passed-out drunks. Ketones and ketoacids are toxic in large amounts. More important, your kidneys will try to eliminate them with even more urine, thereby causing further dehydration. Some of the hallmarks of severe ketoacidosis are large amounts of ketones in the urine, extreme thirst, dry mouth, nausea, frequent urination, deep labored breathing, and high blood sugar (usually over 350 mg/dl). The other acute complication of high blood sugar and dehydration, hyperosmolar coma, is a potentially more severe condition, and occurs in people whose beta cells still make some insulin. (“Hyperosmolar” refers to high concentrations of glucose, sodium, and chloride in the blood due to inadequate water to di Continue reading >>

What Is The Difference Between Insulin Shock & A Diabetic Coma?

What Is The Difference Between Insulin Shock & A Diabetic Coma?

Nearly 26 million Americans had diabetes in 2010, and many were not being adequately treated, according to the Centers for Disease Control and Prevention. Most people have heard about the long-term complications of poorly controlled diabetes, such as kidney failure, cardiovascular disease and blindness. People with diabetes can also develop acute complications. If your blood glucose gets too high due to inadequate treatment, or falls too low due to overly aggressive treatment, you could suddenly lose consciousness. Insulin shock, diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome are all potential causes of diabetic coma. Insulin Shock Insulin is a hormone your pancreas normally produces in response to rising glucose levels. Many people with diabetes must take insulin to prevent their blood glucose from rising too high. If you take more insulin than your body needs, you could suddenly develop hypoglycemia, or low blood glucose. People who take insulin and exercise without eating or drink too much alcohol are particularly susceptible to hypoglycemia. Insulin shock, which is a form of diabetic coma, may occur if your blood glucose falls too low to support your brain’s metabolic demands -- usually below 50 mg/dL. Seizures may occur before the onset of coma. Diabetic Ketoacidosis Just as a low blood glucose level can trigger unconsciousness, extremely high blood glucose levels can alter brain function and lead to coma. Diabetic ketoacidosis, which usually affects people with type 1 diabetes, happens when you don’t have enough insulin in your system. DKA may be the initial manifestation of newly developed diabetes, or it may result from a skipped insulin dose in a person who has already been diagnosed with diabetes. Infections and alcohol abuse can also trigge Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

The Facts Diabetic ketoacidosis (DKA) is a condition that may occur in people who have diabetes, most often in those who have type 1 (insulin-dependent) diabetes. It involves the buildup of toxic substances called ketones that make the blood too acidic. High ketone levels can be readily managed, but if they aren't detected and treated in time, a person can eventually slip into a fatal coma. DKA can occur in people who are newly diagnosed with type 1 diabetes and have had ketones building up in their blood prior to the start of treatment. It can also occur in people already diagnosed with type 1 diabetes that have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. Although much less common, DKA can occasionally occur in people with type 2 diabetes under extreme physiologic stress. Causes With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL) while insulin levels are very low. Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able Continue reading >>

Diabetic Coma Causes

Diabetic Coma Causes

Diabetics with prolonged blood-sugar extremes (either too high or too low blood-sugar level) may lead to a diabetic coma. Causes of Diabetes coma Many condition diabetes conditions lead to the cause of diabetes coma. They are: Diabetic ketoacidosis (DKA) - If the muscle cells become energy starved, and the body may respond by breaking down stored fats. Breaking down of fats produces a toxic acid known as ketones and this breakdown is called as ketoacidosis. If it left untreated, DKA can lead to a diabetic coma. DKA is most common among diabetes type 1, but can also affect the type 2 diabetes or gestational diabetes. Diabetic hyperosmolar syndrome - If the blood-sugar level rises to 600 milligrams per deciliter (mg/dL), or 33 millimoles per liter (mmol/L) it is called as diabetic hyperosmolar syndrome. Such a high level of glucose in blood makes the blood thicker like syrup. This excess sugar level is removed from the blood through the urine, which remove tremendous amounts of fluid from the body causing dehydration. If it left untreated diabetic hyperosomolar syndrome can lead to dangerous dehydration and coma. Hyperosmolar syndrome is more common among type 2 diabetes. Hypoglycemia - Brain needs glucose to function properly. An extreme low blood-sugar level may lead to pass out. Hypoglycemia can be caused by large quantityof insulin or too little of food or vigorous exercise or drinking lot of alcohol. Anyone who has diabetes is at risk of a diabetic coma. Type 1 is more at risk of a diabetic coma caused by: Low blood-sugar (hypoglycemia), and DKA Type 2 is more at risk of a diabetic coma caused by: hyperosmolar syndrome. Diabetic coma risk factors. Some factors can increase the risk of diabetic coma they include: Insulin delivery system problems - If on an insulin pum Continue reading >>

Cranberry Sparkler

Cranberry Sparkler

A state of profound unconsciousness from which a person cannot be aroused. It may be the result of trauma, a brain tumor, loss of blood supply to the brain (as from cerebrovascular disease), a toxic metabolic condition, or encephalitis (brain inflammation) from an infectious disease. In people with diabetes, two conditions associated with very high blood glucose may cause coma; these are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Severe hypoglycemia, or very low blood glucose, may also lead to coma. It’s important for all people with diabetes to learn to recognize these conditions and respond accordingly. Diabetic ketoacidosis is a serious imbalance in blood chemistry causing about 100,000 hospitalizations each year, with a mortality rate of under 5%. It typically occurs when a person has high blood sugar and insufficient insulin to handle it. Without adequate insulin, the body breaks down fat cells for energy, flooding the bloodstream with metabolic by-products called ketoacids. Meanwhile, the kidneys begin filtering large amounts of glucose from the blood and producing large amounts of urine. As the person urinates more frequently, the body becomes dehydrated and loses important minerals called electrolytes. If not treated, these serious imbalances can eventually lead to coma and death. Hyperosmolar hyperglycemic state most commonly affects elderly people. Like DKA, HHS starts with high blood glucose and insulin deficiency and causes people to urinate frequently and become dehydrated. HHS also impairs the ability of the kidneys to filter glucose from the bloodstream, making the blood glucose level rise even higher. Because of the extreme dehydration, HHS can be life-threatening, with a mortality rate of 15%, and can be even more difficul Continue reading >>

Diabetic Coma: Causes, What Happens When You Go Into A Diabetic Coma?

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 >>

Diabetic Coma Causes

Diabetic Coma Causes

Diabetes also called diabetes mellitus is a life-long health condition that is caused by the problems in insulin hormone production in the body. Diabetes may cause health problems like blurred vision, kidney disease, weak immune system and also a life threatening condition diabetic coma. Diabetic coma may be caused by extremely high and extremely low blood sugar levels even blood sugar level may be higher than 600 mg/dL. These extreme high and low blood sugar levels may be caused by these conditions ; Diabetic ketoacidosis Diabetic ketoacidosis (DKA) occurs in type-1 diabetes if your muscles needs energy and can’t find enough insulin to use glucose and uses body fatty acids to produce energy. Ketones are produced as a result of this process and ketones are harmful for our body. Diabetic ketoacidosis is a life theratening condition. Diabetic hyperosmolar syndrome Diabetic hyperosmolar syndrome occurs if your blood sugar level is higher than 600 mg/dL. Also it can be caused by extreme dehydration.This very high sugar amount causes your blood to become more concentrated and thick. Body tries to remove this high sugar by urine and loses more water. Diabetic hyperosmolar syndrome must be treated as soon as possible. Hypoglycemia ( severe) Severe hypoglycemia ( low blood sugar) may be caused by too much insulin intake, drinking too much alcohol, strenous exercies. Hypoglycemia may cause loss of consciousness and diabetic coma. Diseases and surgery Some kind of diseases, surgery or trauma may cause hyperglycemia and diabetic ketoacidosis. This may be a reason of diabetic coma. Drugs Some kind of drugs may cause hyperglycemia and diabetic coma. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

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 >>

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