Diabetic Ketoacidosis (DKA) is an acute, potentially life-threatening complication of diabetes mellitus. For the most part, DKA occurs in people with type 1 diabetes, but it can happen in folks with type 2 diabetes almost as often. DKA is the result of an inadequate amount of insulin. Insulin allows the body to use its major fuel source (glucose) for energy. Since glucose can no longer be burned, it reaches high levels in the bloodstream. This causes increased urine production and dehydration. About 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. When there is not enough insulin, the body burns fat instead. Fat breaks down into acids which in turn produce toxic acidic substances known as ketones. These build in the bloodstream causing a dangerous situation. Loss of potassium and other salts which the body needs in the excessive urination is also common. DKA is therefore a medical emergency which if untreated can result in coma and possibly death. In the early stages, it may be possible to treat DKA at home, but if it is more advanced, management should take place in a properly equipped setting such as a hospital. The keys to prevention of DKA include awareness of its warning signs along with frequent blood glucose monitoring and checking urine or blood ketone levels as needed. Causative factors The most common events that cause a person with diabetes to develop diabetic ketoacidosis are: Infection such as diarrhea, vomiting, and/or high fever (40%), Missed, inadequate, or “bad” insulin (25%), New diagnosis or previously unknown diabetes (15%). Various other causes: pregnancy, heart attack, stroke, trauma, stress, alcohol abuse, drug abuse, and surgery. Approximately 5% to 10% of cases have no identifiable cause. Signs and Symptoms Continue reading >>
Why Are Doctors In India Rude To Patients?
I think that working in a government setup as a Casualty Medical Officer makes me an authority on this subject. I am not going to deny the fact that sometimes doctors can be absolutely rude to patients and the patients are the victims. However, in many scenarios, the doctors are unnecessarily portrayed in a wrong light, when most of us are courteous, decent and well mannered.Casualty and emergency departments work on the principle of triage, where patients are classified to prioritize the grant of medical attention first to needy/ serious ones and later on to the ambulatory patients. Let me give you a few scenarios to consider before you brand doctors, particularly in government setups as rude and uncouth Scene 1- Casualty at 2 am in morning. By some luck, we had quite a few patients at 2 am in the casualty and there were only two interns to assist me. I was attending a patient who was very serious, in dire need of attention for he had consumed some poison. I had the medicine resident awoken, then got around to attend another emergency patient who came in with diabetic ketoacidosis. Here comes this cocky patient who wants me to attend him first because he was the driver of some high profile government officer. Patient- Madam, kitna time lagate ho? Samajhta nahi kya aapko, mere pet me dard hai. Pehle mujhe check karo. ( Madam, how long are you taking. Don't you understand, I have pain in abdomen, examine me first) Me- Ek serious patient hai bhaiyya, ruk jaiye jara, aapko bhi dekhti hu. ( I have a serious patient to attend, please wait for me to finish and I will examine you as well) After I finished examining him, I told him to go over to the nurse's desk to get the prescribed drugs and an injectable drug to ease the pain and asked to him to come the following morning in Continue reading >>
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Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>
Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes throu Continue reading >>
A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>
Must Read Articles Related To Diabetic Ketoacidosis
A A A Diabetic Ketoacidosis (cont.) Fluid replacement and insulin administration intravenously (IV) are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely - not at an excessive rate or total volume due to the risk of brain swelling (cerebral edema). Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte. Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus - a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body's cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia (low blood sugar). People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit. Some people with mild acidosis with modest fluid and electrolyte losses, and who can reliably drink fluid and follow medical instructions can be safely treated and sent home. Follow-up must be available with a health care practitioner. Individuals with diabetes who are vomiting should be admitted to the hospital or urgent care center for further observation and treatment. In cases of mild dehydration with borderline diabetic ketoacidosis, you may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner. Whether you are released to go home or monitored in the hospital, it is important th Continue reading >>
Why Do We Throw Up When We Are Hung-over?
1. The Body’s Reaction to Toxins An area of the brain, known as the vomiting center, alerts your body at once if any toxic substance enters your system. The vomiting center can be triggered by signals received from different parts of the body, such as the stomach, intestines, the balancing system and the blood stream. Alcohol ingestion is one of the triggers that can result in activation of the vomiting center. If the toxic level of alcohol is reached, the vomiting center will try to expel the excessive alcohol by making you throw up. 2. Gastroparesis Why do you throw up after drinking? Maybe the reason is gastroparesis. Alcohol intake causes the slowdown of the digestion in stomach (gastroparesis), which will lead to delayed stomach emptying. Since the digestion is slow, the proteins remaining in stomach will start to rot. The by-products of rotting are quite toxic and can trigger vomiting. 3. Alcohol Poisoning Alcohol poisoning is a potentially life-threatening result of alcohol drinking. Drinking excessive amounts of alcohol over a short span of time can exert adverse effects on gag reflex respiration, heart rate and body temperature. Coma and even death can occur if prompt treatment is not given. Except from vomiting, the signs and symptoms of alcohol poisoning also include delirium, seizures, low breathing rate (less than 8 breathes in a minute), pale or blue skin, cold extremities and fainting. 4. Alcoholic Ketoacidosis Why do you throw up after drinking? Alcoholic ketoacidosis may be one of the culprits. The cells need glucose and insulin to function well. Alcohol intake may cause the pancreas to cease the production of insulin. Then cells will start burning fats to obtain energy, which will generate by-products called ketones. Ketones are acidic in nature and Continue reading >>
Diabetic Ketoacidosis: Evaluation And Treatment
Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>
With What Diet Can I Lose A Lot Of Weight Fast?
Look, almost any diet will make you lose weight. But what are you going to do when you’re finished with them? If you’re like most people, you’ll fall back on your old habits—the same ones that made you fat in the first place. That’s why most diets end in failure. It’s not that they’re ineffective—although some are complete rubbish; it’s that they’re a temporary answer to a semi-permanent problem. Here’s what you need to find out: what’s the healthiest form of food consumption you can enjoy for the rest of your life? Maybe you like veganism? Or paleo, or keto, or whatever. Perhaps you don’t end up in any diet camp and instead create your own habits. That’s great too. But here’s what matters for right now: if you want to lose weight, then you must consume food at a caloric deficit. This means eating less calories than you burn. I lost eighty pounds a number of years ago. About fifty to sixty pounds of that came without any exercise; I simply ate at a caloric deficit and tracked everything on MyFitnessPal—an online food journal with a mobile app. Similar stories can be found daily on forums like Reddit’s /r/loseit. You can literally achieve this eating junk food. (although I don’t recommend it!) A professor at Kansas State University lost 27lbs in 2 months eating Twinkies, chips, Oreos, and other junk. More recently, I lost 6lbs after eating exclusively at gas stations for 30 days. I traveled across 9 states and visited more than 200 stores—all in an effort to prove that you can “eat out” and still be healthy. But to be fair, the convenience store industry is working hard to make healthful food available on-the-go. Finding fruit, veggies, and good made-to-order options was easier than I thought it would be. So here’s the point: d Continue reading >>
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Ketosis Vs. Ketoacidosis: What You Should Know
Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>
Management Of Adult Diabetic Ketoacidosis
Go to: Abstract Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management. Keywords: DKA treatment, insulin, prevention, ESKD Go to: Introduction In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1 The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars. Omission of insulin is the most common precipitant of DKA.2,3 Infections, acute medical illnesses involving the cardiovascular system (myocardial infarction, stroke) and gastrointestinal tract (bleeding, pancreatitis), diseases of the endocrine axis (acromegaly, Cushing’s syndrome), and stress of recent surgical procedures can contribute to the development of DKA by causing dehydration, increase in insulin counter-regulatory hor Continue reading >>
What The Heck Is Ketoacidosis?
By Gary Scheiner MS, CDE 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 can kill you. The primary cause of DKA is a lack of working insulin in the body. Let me explain. Normal Fuel Metabolism 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. As you can tell, 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 (see figure below). Abnormal Fuel Metabolism What would happen if you had no insulin? I’m not talking about a minor under-dosage; I’m talking about having none whatsoever. A number of things would start to go wrong. 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, leads to th Continue reading >>
Is A Ketogenic Diet Effective?
The short answer to your question, is yes, a ketogenic diet is safe and effective for most people. Of course, as with any major change in diet or exercise, you should consult with your doctor so that he or she can help you understand whether this diet is safe for YOU. And especially if you are a Type 1 diabetic, I would be concerned about you starting keto without being under close supervision by a doctor because you could go into ketoacidosis which is a dangerous condition. (Ketoacidosis is different than ketosis, which is a safe metabolic condition that your body enters when you cut carbs and raise your fat levels. It’s important not to confuse the two because while ketoacidosis is very dangerous, ketosis is healthy and is actually the goal for most people on the keto diet. Check out this research for the science behind ketosis vs. ketoacidosis.) Basically, a ketogenic diet is very low carb, moderate protein, and high fat. On keto, you should start out eating less than 20 net carbs per day - which is usually what everyone focuses on. But you also need to focus on your protein and fat levels. Women should eat between 50 and 75 grams of protein per day and men should stay between 100–125 grams of protein per day. And then for the fun part of keto - the FAT - your fat should be between a 1:1 and 1:2 ratio of protein to fat. Which means that if I eat 50 grams of protein a day, I should be eating between 50 and 100 grams of fat per day. And this is the yummy kind of fat - saturated fat is great on keto. So eat that bacon and slather on the butter because eating all that fat will help you lose weight and get healthy - as long as you have cut the carbs. And the fat helps you feel full so you won’t get hungry as often and you won’t feel deprived. And don’t worry tha Continue reading >>
The Scary Experience Of Diabetic Ketoacidosis
Today, we’re excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company’s philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it. Throughout this past year, I’ve had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much. In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.) Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. – and I thought it was 11:00 a.m. The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walke Continue reading >>
How Does Diabetic Ketoacidosis Cause Vomiting?
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. 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 to function as well. A higher level of ketones also affects levels of sugar and electrolytes in the body. As ketones accumulate in the blood, more ketones will be passed in the urine, taking sodium and potassium salts out with them. Over time, levels of sodium and potassium salts in the body become depleted, which can cause nausea and vomiting. The result is a vicious cycle. The most important prevention strategies are to monitor blood glucose levels routinely, keep blood glucose levels controlled (e.g., Continue reading >>