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How To Check Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis

WHAT YOU NEED TO KNOW: What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your blood sugar levels become high because your body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels. What increases my risk for DKA? Not enough insulin Poorly controlled diabetes Infection or other illness Heart attack, stroke, trauma, or surgery Certain medicines such as steroids or blood pressure medicines Illegal drugs such as cocaine Emotional stress Pregnancy What are the signs and symptoms of DKA? More thirst and more frequent urination than usual Abdominal pain, nausea, and vomiting Blurry vision Dry mouth, eyes, and skin, or your face is red and warm Fast, deep breathing, and a faster heartbeat than normal for you Weak, tired, and confused Fruity, sweet breath Mood changes and irritability How is DKA treated? DKA can be life-threatening. You must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring your blood sugar level back to normal. How can I help prevent DKA? The best way to prevent DKA is to control your diabetes. Ask your healthcare provider for more information on how to manage your diabetes. The following may help decrease your risk for DKA: Monitor your blood sugar levels closely if you have an infection, are stressed, sick, or experience trauma. Check your blood sugar levels often. You may need to check at least 3 times each day. If your blood sugar level is too high, give yourself insulin as Continue reading >>

What Is Diabetic Ketoacidosis?

What Is Diabetic Ketoacidosis?

Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 1 diabetes are at risk for a problem called diabetic ketoacidosis (DKA). It is very rare in people with type 2 diabetes. DKA happens when your body does not have enough insulin to move glucose into your cells, and your body begins to burn fat for energy. The burning of fats causes a build-up of dangerous levels of ketones in the blood. At the same time, sugar also builds up in the blood. DKA is an emergency that must be treated right away. If it is not treated right away, it can cause coma or death. What can I expect in the hospital? You will need to stay in the hospital in order to bring your blood sugar level under control and treat the cause of the DKA. Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include: Monitoring You will be checked often by the hospital staff. You may have fingersticks to check your blood sugar regularly. This may be done as often as every hour. You will learn how to check your blood sugar level in order to manage your diabetes when you go home. A heart (cardiac) monitor may Continue reading >>

Testing For Diabetic Ketoacidosis Symptoms In Dogs

Testing For Diabetic Ketoacidosis Symptoms In Dogs

Diabetic ketoacidosis is an extreme form of hyperglycemia, during which ketones build up in the bloodstream. Ketoacidosis can be fatal, so it’s essential to contact your veterinarian as soon as symptoms arise. Symptoms can include vomiting, weakness, rapid breathing and the odor of acetone on the breath. Your veterinarian will perform a variety of tests to determine if your diabetic dog is suffering from ketoacidosis, including blood testing and urine dipsticks. Your dog might need to stay at the vet for around-the-clock monitoring. Blood Testing for Ketoacidosis Your veterinarian performs a blood test to determine if your dog is suffering from diabetic ketoacidosis. He collects a small amount of blood, testing it for high circulating blood sugar levels and blood pH levels, as well as phosphorus and potassium levels. Electrolyte levels can fluctuate, so he might perform several tests over a period of time to create a record of imbalances, as well as determine which intravenous fluids would best benefit your dog. Blood tests continue until your dog shows significant improvement. Urine Dipstick Test for Ketones While caring for your pet, the vet places a catheter inside the dog to collect urine. He tests the urine with a dipstick to perform a routine urinalysis, which he's likely to repeat many times during your dog’s emergency care stay. When a urine dipstick no longer reads positive for ketones, your dog is well on his way to recovery. Around-the-Clock Monitoring and Fluid Therapy During ketoacidosis, your dog’s cells experience a severe loss of glucose. This can be dangerous, so early detection is best. If possible, get your dog into a 24-hour care facility as soon as you notice symptoms. The vet closely monitors your dog, ensuring he is treated for any infection Continue reading >>

Ketone Monitoring And Management Of Diabetic Ketoacidosis (dka)

Ketone Monitoring And Management Of Diabetic Ketoacidosis (dka)

The 2015 GDG updated self-monitoring and in hospital monitoring of ketones. The 2004 content that has been superseded by the 2015 update can be found in Appendix S. Management of DKA was not in the scope for the 2015 update and therefore the original recommendations and content from CG15are reproduced in this chapter. Go to: 12.1.1. Introduction Ketosis and ketonuria reflect a greater degree of insulin deficiency than hyperglycaemia alone. The presence of ketones indicates that insulin concentrations are too low not only to control blood glucose concentrations but also to prevent the breakdown of fat (lipolysis). Because ketones are acid substances, high ketone concentrations in the blood may create acidosis. Diabetic ketoacidosis (DKA) is a medical emergency and in its established state carries a 0.7–5% mortality in adults.459,476,784 High ketones in the blood are associated with high levels of fatty acids and together create insulin resistance. The patient with significant ketonaemia will require more insulin than usual to control the blood glucose. Traditionally, ketonaemia has been assessed by urine testing. This has been applied in three main settings: it is recommended as part of guidance for patient self-management of acute illness at home, when patients are advised to increase their usual corrective insulin doses in the presence of significant ketonuria; in the assessment of patients presenting to emergency services with hyperglycaemia, where presence of ketonuria may influence management decisions, including need for admission and in the management of established DKA, where resolution of ketonuria is an important indication of recovery. However, not all ketone bodies are detected by urine testing. For example, beta-hydroxybutyrate (β-OHB) is not detected wit Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Short-term high blood sugars are rarely lethal. However, for people with type 1 diabetes and some with type 2 who are not producing enough insulin, periods of high blood sugars can lead to diabetic ketoacidosis. The absence of insulin allows your blood to slowly become acidic. The body’s cells cannot survive under acidic conditions so the liver will try to help the cells that are starved for glucose and secrete glucose. When combined with dehydration, this process accelerates into a poisonous cocktail that undermines the heart, impairs the brain, and can lead to death in days. Prolonged high blood sugars can be caused by missing insulin doses, problems with an insulin pump, being sick with the flu or other illness, or eating more carbohydrates than your body has insulin to process. Who Can Develop Diabetic Ketoacidosis (DKA)? People with type 1 diabetes and type 2 diabetes can develop DKA. Most at risk however, are people with type 1 diabetes because they don’t make any insulin of their own and most people with type 2 diabetes do usually make some of their own insulin. Oftentimes DKA develops in people who have not yet been diagnosed with diabetes. Once diagnosed, people with diabetes can avoid DKA if they learn to recognize the beginning symptoms. How Do I Know If I Have Diabetic Ketoacidosis (DKA)? DKA can develop slowly or quickly. At first, it mimics the symptoms of high blood sugar: thirstiness dry mouth frequent urination You will likely have high blood sugars and ketones in your urine (more on this below). If your body still doesn’t get the insulin it needs, your blood becomes more acidic. you will likely feel tired your body might start to feel very achy like when you have a high fever. When any of the following symptoms occur, your condition has likely pr Continue reading >>

Blood Ketones

Blood Ketones

On This Site Tests: Urine Ketones (see Urinalysis - The Chemical Exam); Blood Gases; Glucose Tests Elsewhere On The Web Ask a Laboratory Scientist Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis, sometimes called DKA, is a condition caused when you have a high blood sugar level, and not enough insulin in your body to break it down to use for energy. As a result, the body starts burning its stores of fat for energy instead. This process produces by-products called ketones. As the level of ketones in the body increases, it can lead to dehydration and confusion. If not treated, people with ketoacidosis can become unconscious. DKA usually occurs in people with type 1 diabetes. It is rare in type 2 diabetes. The symptoms of diabetic ketoacidosis include high blood glucose, high levels of ketones in the urine, and: quick breathing flushed cheeks breath that smells like sweet acetone (similar nail polish remover) dehydration. DKA is a serious condition that requires immediate assessment. If someone you know has diabetes and becomes confused or unconscious, or has the symptoms listed above, call triple zero (000) for an ambulance. If you have diabetes and you find your blood sugar level is higher than it should be, it’s important that you follow the advice provided by your doctor or diabetes nurse or educator. You may also find it useful to read the advice provided in the article on hyperglycaemia (high blood sugar). Continue reading >>

Diabetic Ketoacidosis Workup

Diabetic Ketoacidosis Workup

Approach Considerations Diabetic ketoacidosis is typically characterized by hyperglycemia over 250 mg/dL, a bicarbonate level less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria. While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L. [17] In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L. Laboratory studies for diabetic ketoacidosis (DKA) should be scheduled as follows: Repeat laboratory tests are critical, including potassium, glucose, electrolytes, and, if necessary, phosphorus. Initial workup should include aggressive volume, glucose, and electrolyte management. It is important to be aware 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 >>

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 >>

Home > Our Services > Health Info Library > Helping Hands > Diabetes: Ketoacidosis (dka)

Home > Our Services > Health Info Library > Helping Hands > Diabetes: Ketoacidosis (dka)

Diabetic Ketoacidosis (KEY toe as i DOE sis), also known as DKA, is a serious complication of diabetes. When the cells in the body cannot use glucose for energy, there is a buildup of acids called “ketones” in the blood. For the cells to use glucose for energy both glucose and insulin need to be in the blood. Insulin acts like a key to unlock the cell door. It allows glucose in to be used for energy. When cells do not have glucose to use for energy: The body starts to use fat for energy. Ketones are made when fat is used for energy. Ketones are present in the blood and in the urine. Ketones cause the blood to become more acidic. If untreated, this leads to DKA and life-threatening problems. Cause Not enough insulin: Missing doses of insulin Infection, illness or injury (which causes the body to need more insulin) Insulin doses too small If using insulin pump, interruption in delivery of insulin Signs of DKA and When to Test for Ketones You may or may not feel any different when you begin to have ketones. The only way to know is by checking the urine or blood for the presence of ketones. Check for ketones if blood glucose is higher than 300 mg/dl. Check for ketones when ill (fever, flu or vomiting) even if blood glucose is not higher than 300 mg/dl. Warning Signs of DKA Fast breathing Fruity smell to the breath Hard to wake up Feeling sick to the stomach (nausea), belly pain, or vomiting How to Check Urine for Ketones Step 1: Check the expiration date on the bottle. Note that ketone strips expire 6 months after opening bottle. Step 2: Collect urine in a cup. Dip the ketone strip into the cup. Remove it from the urine. Step 3: Wait 15 seconds. Step 4: Match the color on the ketone strip to the colors on the bottle. You can also check blood for ketones. Your health car Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when your body produces high levels of acids called ketones in the blood. Diabetic ketoacidosis can be life threatening. This situation can happen very quickly. If you have diabetes, learn the warning signs of diabetic ketoacidosis and know when to seek emergency care (below). Contact your doctor or diabetes nurse without delay if: your urine or blood ketone levels are high your ketone levels are not coming down once you have started treating yourself you are feeling very unwell (drowsy, rapid breathing, pain in your abdomen or nausea and vomiting) you are unable to look after yourself you don't know how much extra insulin to take you are unable to drink fluids you have a temperature or an obvious sickness that is not improving What is diabetic ketoacidosis? Diabetic ketoacidosis is a condition which can affect people with diabetes, usually type 1 diabetes. It happens when your body does not have enough insulin to help it use sugar for energy. Instead, your body starts burning fat for energy, which releases ketones. A build-up of ketones in your body causes it to become acidic. This is why it is called 'ketoacidosis'. Because diabetic ketoacidosis upsets the chemical balance in the body, and can quickly make you sick, it requires immediate medical attention. Left untreated, diabetic ketoacidosis can be fatal. If picked up early, it can be treated with extra insulin, glucose and fluid. What causes diabetic ketoacidosis? Diabetic ketoacidosis is triggered by low insulin levels. This is most commonly caused by: Missed doses of insulin Insulin therapy not being given correctly which may be because of problems with your insulin pen, insulin cartridge or insulin pump An illness or hormonal change 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

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 And Detection Of Ketoacidosis

Symptoms And Detection Of Ketoacidosis

Symptoms These symptoms are due to the ketone poisoning and should never be ignored. As soon as a person begins to vomit or has difficulty breathing, immediate treatment in an emergency room is required to prevent coma and possible death. Early Signs, Symptoms: Late Signs, Symptoms: very tired and sleepy weakness great thirst frequent urination dry skin and tongue leg cramps fruity odor to the breath* upset stomach* nausea* vomiting* shortness of breath sunken eyeballs very high blood sugars rapid pulse rapid breathing low blood pressure unresponsiveness, coma * these are more specific for ketoacidosis than hyperosmolar syndrome Everyone with diabetes needs to know how to recognize and treat ketoacidosis. Ketones travel from the blood into the urine and can be detected in the urine with ketone test strips available at any pharmacy. Ketone strips should always be kept on hand, but stored in a dry area and replaced as soon as they become outdated. Measurement of Ketones in the urine is very important for diabetics with infections or on insulin pump therapy due to the fact it gives more information than glucose tests alone. Check the urine for ketones whenever a blood sugar reading is 300 mg/dl or higher, if a fruity odor is detected in the breath, if abdominal pain is present, if nausea or vomiting is occurring, or if you are breathing rapidly and short of breath. If a moderate or large amount of ketones are detected on the test strip, ketoacidosis is present and immediate treatment is required. Symptoms for hyperglycemic hyperosmolar syndrome are linked to dehydration rather than acidosis, so a fruity odor to the breath and stomach upset are less likely. How To Detect Ketones During any illness, especially when it is severe and any time the stomach becomes upset, ketone Continue reading >>

Lab Values And Dka

Lab Values And Dka

Changes in laboratory values often give us clues to what is happening with our patients. I came across the following resource this morning and thought it was worth sharing. Here’s a handy table to help you identify diabetic ketoacidosis (DKA). The following equation can be used to calculate an anion gap: Anion gap = Na+(mEq/L) – [Cl-(mEq/L) + HCO3-(mEq/L)] You have an important role when caring for a patient with DKA. Thorough physical assessments, careful monitoring of laboratory values, and critical thinking are essential to avoid complications of this complex disorder. Have you cared for a patient with DKA? What are the common presenting signs and symptoms? Reference Donahey, E., Folse, S., Weant, K. (2012). Management of Diabetic Ketoacidosis. Advanced Emergency Nursing Journal, 34(3). Continue reading >>

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