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 >>
Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)
Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>
Risks Of Diabetic Ketoacidosis
People suffering from diabetes could develop diabetic ketoacidosis. This serious complication develops from extremely low level or absence of insulin in the body. Usually type 1 diabetes patients have the greatest risk of developing diabetic ketoacidosis. If left untreated this health disorder could lead to severe health problems and in the worst case, it can even cause death. Diabetic ketoacidosis causes Sugar is the primarily fuel source of your body. Insulin helps the body cells to absorb the sugar. If the insulin level is low, the cells and tissues of your body will not be able to absorb the sugar. To sustain the body functions, your body will now look for an alternate source of energy. Your body will now increase secretion of hormones that break down fat to release energy. In this process of increased fat metabolism, toxins, known as ketones, are produced in the body. Rise in these toxic acids cause severe damage to the organs of the body. If diabetics on insulin treatment miss their insulin medications, the insulin level will drop, triggering diabetic ketoacidosis. Due to an ailment if your body produces excess hormones, such as adrenaline, these hormones will inhibit the activity of insulin, leading to diabetic ketoacidosis. This health disorder could also develop from alcoholism and drug abuse. Stress, trauma, stroke, heart attack, high fever and surgery could increase the risk of developing diabetic ketoacidosis. People suffering from any form of diabetes – type 1 diabetes, type 2 diabetes or gestational diabetes could develop diabetic ketoacidosis any time. However, people with type 1 diabetes, who are below 19, have the greatest risk of developing this health problem. Diabetic ketoacidosis symptoms The symptoms of diabetic ketoacidosis develop rapidly. You 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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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 Ketoacidosis Causes, Symptoms, Treatment, And Complications
Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys filter some of the glucose (suga 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 >>
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 >>
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 >>
Can I Expect Diabetes Patients Have Normal Life?
Sympler, Your Health Buddy says, After diabetes diagnosis, many type 1 and type 2 diabetics worry about their life expectancy. Death is never a pleasant subject but it's human nature to want to know 'how long can I expect to live'. There is no hard and fast answer to the question of ‘how long can I expect to live’ as a number of factors influence one’s life expectancy. How soon diabetes was diagnosed, the progress of diabetic complications and whether one has other existing conditions will all contribute to one’s life expectancy - regardless of whether the person in question has type 1 or type 2 diabetes. People with type 1 diabetes have traditionally lived shorter lives, with life expectancy having been quoted as being reduced by over 20 years. However, improvement in diabetes care in recent decades indicates that people with type 1 diabetes are now living significantly longer. According to the experts, people with type 1 diabetes born after 1965 had a life expectancy of 69 years. What causes a shorter life expectancy in diabetics? Higher blood sugars over a period of time allow diabetic complications to set in, such as: Diabetic retinopathy Kidney disease Cardiovascular disease (heart disease) Higher blood sugars can often be accompanied by associated conditions such as: Higher blood pressure High cholesterol Both help to contribute to poor circulation and further the damage to organs such as the heart, kidneys, eyes and nerves in particular. In some cases, short term complications such as hypoglycemia and diabetic ketoacidosis can also be fatal. What can a diabetic patient do to help increase his/her life expectancy? Maintaining good blood glucose control is a key way to prolong the length of your life. Keeping blood sugar levels within the recommended blood Continue reading >>
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis, or DKA, is a serious health problem that can happen to a person with diabetes. It happens when chemicals called ketones build up in the blood. Normally, the cells of your body take in and use glucose as a source of energy. Glucose moves through the body in the bloodstream. Insulin is a hormone that helps your cells take in the glucose from the blood. If you have diabetes, your cells can’t take in and use this glucose in a normal way. This may be because your body doesn’t make enough insulin. Or it may be because your cells don’t respond to it normally. As a result, glucose builds up in your bloodstream and doesn’t reach your cells. Without glucose to use, the cells in your body burn fat instead of glucose for energy. When cells burn fat, they make ketones. High levels of ketones can poison the body. High levels of glucose can also build up in your blood and cause other symptoms. Ketoacidosis also changes the amount of other substances in your blood. These include electrolytes, such as sodium, potassium, and bicarbonate. This can lead to other problems. Ketoacidosis happens most often in a person with type 1 diabetes. This is a condition where the body does not make enough insulin. In rare cases, ketoacidosis can happen in a person with type 2 diabetes. It can happen when they are under stress, like when they are sick, or when they have taken certain medicines that change how their bodies handle glucose. Diabetic ketoacidosis is pretty common. It is more common in younger people. Women have it more often than men do. What causes diabetic ketoacidosis? High levels of ketones and glucose in your blood can cause ketoacidosis. This might happen if you: Don’t know you have diabetes, and your body is breaking down too much fat Know you have dia 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 >>
Type 2 Diabetes: Ketoacidosis
What is ketoacidosis, and how do you treat it? Ketoacidosis -- also known as diabetic ketoacidosis, or DKA -- occurs when harmfully high levels of ketones build up in the blood. Ketones are an acid produced when there's a shortage of insulin in the blood and the body is forced to break down fat, rather than glucose, for energy. Ketones can spill over into the urine when the body doesn't have enough insulin, and the effects can be deadly. The symptoms of ketoacidosis Blood sugar level higher than 300 milligrams per deciliter (mg/dL) Difficulty breathing, rapid breath, or shortness of breath Breath that smells fruity A very dry mouth Nausea and vomiting Difficulty concentrating Extreme fatigue, drowsiness, or weakness Rapid heartbeat and low blood pressure How to treat ketoacidosis Ketoacidosis is an emergency condition that requires immediate attention. Call 911 or take the person you're caring for to the nearest hospital. How to prevent ketoacidosis Make sure the person you're caring for drinks plenty of water so he stays hydrated and can flush the ketones out of his system. Check for ketones by doing a simple urine test. Test strips are available over the counter. Tell him to refrain from exercise if his blood glucose is 250 mg/dL or higher and ketones are present in his urine. Remind him to check his blood glucose often and to immediately report any sky-high readings to his main diabetes care provider. Sarah Henry has covered health stories for most of her more than two decades as a writer, from her ten-year stint at the award-winning Center for Investigative Reporting to her staff writer position with Hippocrates magazine to her most recent Web work for online sites, including WebMD, Babycenter. See full bio Continue reading >>
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 >>
Ketoacidosis Diabetic Ketoacidosis (DK) occurs when a person with diabetes becomes dehydrated during a state of relative insulin deficiency, associated with high blood levels of sugar and organic acids called ketones. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. DK is a serious condition that can lead to diabetic coma or even death if left untreated. DK is associated with significant disturbances of the body’s chemistry, which can resolve with proper therapy. In Diabetic Ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). As the body produces stress response hormones unopposed by insulin due to the insulin deficiency, the body begins to consume its own muscle, fat and liver cells into glucose 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. Ketones are acids that build up in the blood and appear in the urine when your body doesn’t have enough insulin. They are a warning sign that your diabetes is out of control or that you are getting sick. High levels of ketones can poison the body. Ketoacidosis may happen to anyone with diabetes and individuals with Type I need to take extra precautionary measures. But you can help prevent DK by learning the warning signs and checking your urine and blood regularly. Ketoacidosis usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following: Thirst or a very dry mouth Frequent urination High blood glucose (sugar) levels High levels of ket Continue reading >>