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How Long Does It Take To Get Ketoacidosis?

Ask D'mine: Our Lifespan Sans Insulin?

Ask D'mine: Our Lifespan Sans Insulin?

Got questions about navigating life with diabetes? Ask D'Mine! Our weekly advice column, that is — hosted by veteran type 1,diabetes author and educator Wil Dubois. This week, Wil offers some thoughts on that universal question: "How long can I really go without insulin?" Please take a read; his findings might surprise you and even bust a myth or two. But as a precautionary reminder: this topic would fall into the category of "Don't try this at home"! {Got your own questions? Email us at [email protected]} Jake, type 1 from Minneapolis, writes: I've had diabetes for 18 years and I had someone ask me a question the other day that I didn't really have an answer to. The question was how long I would be able to survive without any insulin. I told them 3-4 days, but I don't know if this is true. Any info from a cinnamon whiskey swizzling T1? [email protected] D'Mine answers: If Tom Hanks' character in Castaway had been one of us, he would've never lived long enough to go half-crazy and end up talking to a volleyball named Wilson. OK, so that's a mixed blessing. But I guess the lesson there is: don't get washed up on a deserted island if you can avoid it. To be honest, like you, I had always pegged my zero-insulin survival time in the "couple of days" zone; but once I got to thinking about your question I realized that I didn't know how I knew that, where I learned it, or if it was even correct at all. So I set out to do some fact-checking. Now, as background for you sugar-normals, type 2s, and type 3s—in type 1s like Jake and me, if we run out of insulin hyperglycemia sets in. That leads to diabetic ketoacidosis (known as DKA by its friends), which then (untreated) leads to death. This is old news. But how fast is the process, really? Well, there are a number of variables, Continue reading >>

How To Treat Ketoacidosis

How To Treat Ketoacidosis

Immediately drink a large amount of non-caloric or low caloric fluid. Continue to drink 8 to 12 oz. every 30 minutes. Diluted Gatorade, water with Nu-Salt™ and similar fluids are good because they help restore potassium lost because of high blood sugars. Take larger-than-normal correction boluses every 3 hours until the blood sugar is below 200 mg/dl (11 mmol) and ketones are negative. It will take much more rapid insulin than normal to bring blood sugars down when ketones are present in the urine or blood. Often, one and a half to two times the normal insulin dose for a high blood sugar will be necessary. Higher insulin doses than these will be needed if there is an infection or other major stress. If nausea becomes severe or last 4 hours or more, call your physician. If vomiting starts or you can no longer drink fluids, have a friend or family member call your physician immediately, then go directly to an emergency room for treatment. Never omit your insulin, even if you cannot eat. A reduced insulin dose might be needed, but only if your blood sugar is currently low. When high blood sugars or ketoacidosis happen, it is critical that you drink lots of fluid to prevent dehydration. Take extra amounts of Humalog, Novolog or Regular insulin to bring the blood sugars down. Children with severe ketoacidosis lose 10-15 % of their previous body weight (i.e., a 60 lb. child can lose 6 to 9 lbs. of weight) due to severe dehydration. Replacement of fluids should be monitored carefully. The dehydration is caused by excess urination due to high blood sugars and is quickly worsened when vomiting starts due to the ketoacidosis. The start of vomiting requires immediate attention at an ER or hospital where IV fluid replacement can begin. If only nausea is present and it is possible Continue reading >>

Diabetic Ketoacidosis In Dogs

Diabetic Ketoacidosis In Dogs

My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

How Long Does It Take To Reach Ketosis?

How Long Does It Take To Reach Ketosis?

It only takes 1-3 days to get into ketosis. But getting in ketosis is easy, becoming keto-adapted is the tricky part. It usually takes a month to get to the first stage of becoming keto-adapted, and it takes up to 2 years to fully train your body to use ketones fully. The body is always producing at least some small level of ketones. But the ketones themselves really aren't important, it's what their levels signify (fat breakdown). Once the available blood glucose and stored glycogen is used up, the body starts breaking down triacylglycerols (the fat we all hate) to use the resulting fatty acids for energy to get gluconeogenesis going in order to stabilize blood glucose levels. The results from this oxidation of triacylglycerols are ketone bodies. all of these metabolic processes are constantly occurring all at once to some degree, just some way more than others depending on the levels of insulin and other hormones. I just am looking for the specifics like what concentration of glucose is enough to signal the fed-state (when the body stores fat,) and at what rate the body uses the blood glucose it has. The reason a key symptom of untreated diabetes is rapid weight loss is due to them not making the needed insulin. Insulin is one of the key regulators for the fed state, so therefor their body chemically always thinks it is starving, even if there is abundant blood glucose, so it's always breaking down fats for energy to synthesize new glucose from precursors and tearing down muscles for amino acids. Once they take enough insulin, the body can then enter the fed state and start storing fat and rebuilding. So what I want to know is what amount of glucose at any given time is enough to raise insulin to the level needed to signal the body to store fat. I also realize that wi Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>

How To Treat Diabetic Ketoacidosis In Dogs

How To Treat Diabetic Ketoacidosis In Dogs

Diabetes is a very common medical condition that arises in human beings. Pets, including dogs and cats are also as susceptible to this disease as humans. When diabetes in dogs is left unidentified or is inappropriately treated, it leads to a much serious condition known as "Diabetic Ketoacidosis" (DKA). It is a life-threatening condition and can prove fatal if left untreated. It is characterized by raised blood glucose level, presence of ketones in urine, and reduced levels of bicarbonate in the blood. Dogs suffering from this medical condition are seriously ill and develop other complications as well. Associated Symptoms Diabetic ketoacidosis in dogs produces the following symptoms - Weight loss Vomiting Depression Abdominal pain Lethargy and fatigue Loss of appetite Sudden loss of vision Increased thirst Increased frequency of urination Treatment Provided If condition of the dog is relatively stable, veterinarians administer short-acting, crystalline insulin injections at regular intervals to bring back blood glucose to normal level. Regular administration of insulin gradually controls serum glucose level and level of ketones in the dog's urine. Crystalline insulin is administered intravenously or intramuscularly on an hourly basis till the glucose level in the body is reduced to normal. Dextrose is also administered along with other fluids to prevent glucose levels from falling down far below the normal levels, after the dog is subjected to a dose of insulin. Severely ill dogs are treated in a different way as compared to relatively stable dogs. Treatment includes replacement of fluid deficit in the dog's body and maintenance of body fluid balance. Bicarbonate is administered to maintain the acid-base balance in the body. Many dogs recover fairly after being treated Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What Is It? Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when you have much less insulin than your body needs. This problem causes the blood to become acidic and the body to become dangerously dehydrated. Diabetic ketoacidosis can occur when diabetes is not treated adequately, or it can occur during times of serious sickness. To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>

Ketosis & Measuring Ketones

Ketosis & Measuring Ketones

Generally, ketone concentrations are lower in the morning and higher in the evening. Whatever time you pick to measure ketone levels, make sure to keep it consistent. Also, do not measure your ketone levels right after exercise. Ketone levels tend to be lower while your glucose levels higher so you won't get representative numbers. Keep in mind there are daily fluctuations caused by changes in hormone levels. Don't get discouraged! Another aspect that affects the level of ketones is the amount of fat in your diet. Some of you may show higher concentration of ketones after a high-fat meal. Coconut oil contains MCTs that will help you boost ketones. To easily increase your fat intake on a ketogenic diet, try fat bombs - snacks with at least 80% fat content. Ketone levels tend to be higher after extensive aerobic exercise as your body depletes glycogen stores. Exercise may help you get into ketosis faster. ketogenic "fruity" breath is not pleasant for most people. To avoid this, drink a lot of water, mint tea and make sure you eat foods rich in electrolytes. Avoid too many chewing gums and mints, as it may put you out of ketosis; there may be hidden carbs affecting your blood sugar. Increase your electrolyte intake, especially potassium. You are likely going to lose some sodium and potassium when switching to the keto diet. Finally, if you find it hard to lose weight on a ketogenic diet, there may be plenty other reasons than the level of ketone bodies: Not Losing Weight on Low-Carb Ketogenic Diet? Don’t Give Up and Read Further. Continue reading >>

's Experience With Ketoacidosis.

's Experience With Ketoacidosis.

Signs Treatment Zama's experience Diabetic ketoacidosis is caused by a lack of insulin or an insufficient amount of insulin. Since the lack of insulin means that glucose in not able to be used, the body searches for a new source of energy. In this condition, the diabetic breaks down body fat (lipolysis) to use as energy. During lipolysis, waste products called ketones are produced. Ketones are eliminated in the urine and through the lungs. Under normal conditions, the body can tolerate and eliminate ketones. But in diabetic ketoacidosis, fats are being broken down at such a high rate that the body can not eliminate the ketones fast enough and they build up in the blood. In high amounts, ketones are toxic to the body. They cause the acid-base balance to change and serious electrolyte and fluid imbalances result. Some of the signs of ketoacidosis include polyuria polydipsia lethargy anorexia weakness vomiting dehydration There will probably be ketones in the urine (ketonuria) The breath may have a sweet chemical smell similar to nail polish remover. However, some owners have said that even during documented ketoacidosis, their pet's breath did NOT have any unusual odor. Treatment Mildly ketoacidotic animals can be alert and well hydrated. After your pet is stabilized, your pet can return home and be treated with proper diabetes management techniques including insulin therapy, diet, and exercise. "Sick" ketoacidotic animals require intensive medical management in the vet hospital. This is a life-threatening emergency that requires complex medical management and monitoring. It may take several days for the animal to be out of danger. Treatment involves injections of regular insulin, intravenous fluids, electrolytes, and frequent monitoring of blood glucose, blood chemistry, Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic acidosis is a life-threatening condition that can occur in people with type 1 diabetes. Less commonly, it can also occur with type 2 diabetes. Term watch Ketones: breakdown products from the use of fat stores for energy. Ketoacidosis: another name for diabetic acidosis. It happens when a lack of insulin leads to: Diabetic acidosis requires immediate hospitalisation for urgent treatment with fluids and intravenous insulin. It can usually be avoided through proper treatment of Type 1 diabetes. However, ketoacidosis can also occur with well-controlled diabetes if you get a severe infection or other serious illness, such as a heart attack or stroke, which can cause vomiting and resistance to the normal dose of injected insulin. What causes diabetic acidosis? The condition is caused by a lack of insulin, most commonly when doses are missed. While insulin's main function is to lower the blood sugar level, it also reduces the burning of body fat. If the insulin level drops significantly, the body will start burning fat uncontrollably while blood sugar levels rise. Glucose will then begin to show up in your urine, along with ketone bodies from fat breakdown that turn the body acidic. The body attempts to reduce the level of acid by increasing the rate and depth of breathing. This blows off carbon dioxide in the breath, which tends to correct the acidosis temporarily (known as acidotic breathing). At the same time, the high secretion of glucose into the urine causes large quantities of water and salts to be lost, putting the body at serious risk of dehydration. Eventually, over-breathing becomes inadequate to control the acidosis. What are the symptoms? Since diabetic acidosis is most often linked with high blood sugar levels, symptoms are the same as those for diabetes Continue reading >>

Symptoms Of Diabetic Ketoacidosis: What You Need To Know

Symptoms Of Diabetic Ketoacidosis: What You Need To Know

Diabetes can be hard to manage, but not properly controlling the disease can have dangerous and potentially deadly consequences. Ketoacidosis is one of them. This condition happens in people who don’t have enough insulin in their body, perhaps because they have not taken some of their insulin shots. The U.S. National Library of Medicine explains that when insulin is lacking, and the body cannot use ingested sugar as a fuel source, it starts to break down fat, which releases acids called ketones into the bloodstream. In large numbers, those ketones are poisonous and can cause deep, rapid breathing, dry skin and mouth, frequent thirst, a flushed face, headache, nausea, stomach pain, muscle stiffness, muscle aches, frequent urination, difficulty concentrating and fruity-smelling breath. If left untreated, the condition can be fatal, in part because it can eventually cause fluid to build up in the brain and for the heart and kidneys to stop working. There are ways to tell whether you have the condition or are approaching it, the Mayo Clinic says. A routine blood sugar test like the kind diabetics take all the time will show high blood sugar, and there are tests to measure the ketone levels in urine. The American Diabetes Association says that experts usually recommend using a urine test strip to check for ketones when blood glucose levels reach higher than 240 milligrams per deciliter. And when sick with a cold or flu, a person should “check for ketones every four to six hours” to be safe. That’s because infections or other illnesses can increase hormones like adrenaline and cortisol in the body, which then counter the work of insulin — “pneumonia and urinary tract infections are common culprits,” the Mayo Clinic warns. In addition to missed insulin shots and Continue reading >>

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