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 >>
Mechanism For Leptin’s Acute Insulin-independent Effect To Reverse Diabetic Ketoacidosis
Hypercorticosteronemia drives DKA through increased lipolysis. (A–C) Plasma glucose, NEFA, and βOHB concentrations in adrenalectomized T1D rats. In all panels, unless indicated otherwise, all measurements were made at the 4-hour time point. (B) *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001 between the groups indicated; §§P < 0.01 vs. adrenalectomy plus corticosterone at time zero. (D) Anion gap. (E–I) Plasma insulin, leptin, corticosterone, ACTH, and IGF-1 concentrations. (J) Whole-body glucose turnover. (K–M) Whole-body palmitate, glycerol, and βOHB turnover. (N and O) Liver acetyl and malonyl CoA concentrations. In all panels, data are the mean ± SEM of n = 8 (control), n = 11 (adrenalectomy), n = 6 (adrenalectomy plus corticosterone), or n = 6 (adrenalectomy plus sucrose water) per group. Unless otherwise specified, *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001 vs. controls; §P < 0.05, §§P < 0.01, §§§P < 0.001, §§§§P < 0.0001 vs. adrenalectomized rats; ##P < 0.01, ###P < 0.001, ####P < 0.0001 vs. adrenalectomy plus corticosterone–treated rats. Data were compared using ANOVA with Bonferroni’s multiple comparisons test. Continue reading >>
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 >>
How Do You Cure Type 2 Diabetes Naturally With Diet?
I’m a specialist practitioner in obesity and diabetes. Type 2 diabetes can be reversed through diet. Absolutely. Firstly this is what is a normal insulin reaction looks like: Insulin is manufactured in the pancreas and secreted when your blood sugar levels rise. Blood sugar needs to be not too high and not too low. Insulin’s mechanism to remove sugar from blood is to put it into cells, like your muscles. If there is an excess after blood glucose has gone into cells it is then put in the liver and further excess becomes fat. What happens with type 2 When insulin is secreted the body’s cells have ‘‘receptors’ that accept the insulin’s key that then open the doors to the cell to let the glucose in. Sadly in type 2 the receptors become resistant to the insulin key. Therefore not enough energy gets into the cell. The body has a negative feedback system. Once the cells do not get enough energy a signal is sent back to the pancreas to manufacture even more insulin. This is a vicious cycle. Insulin keeps going up and resistance keeps getting worse. A drug, called metformin works by making cells receptive again but it has limitations and eventually other drugs are needed. This is not ideal; so how can we reverse this? Well quite simply really. The crux of this scenario is that it is the sugar spikes in the blood that are causing the high levels of insulin in the first place. Certain foods cause insulin to enter the system in a fast and high volume way and some foods hardly disturb insulin at all. The insulin index is similar to the GI system and by picking foods that cause little insulin response the type 2 diabetes begins to reverse. This is a snapshot. The lower the number the lower the insulin response Sadly many government guidelines are not beneficial and larg Continue reading >>
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How To Treat Diabetic Ketoacidosis
1 Call emergency services. Diabetic ketoacidosis can be a life-threatening condition. If you are experiencing symptoms like your blood sugar not lowering, you should immediately call emergency services or visit the emergency room. Symptoms that require you to call emergency services include severe nausea, being nauseous for four or more hours, vomiting, being unable to keep fluids down, inability to get your blood sugar levels down, or high levels of ketones in your urine. Leaving DKA untreated can lead to irreparable damage and even death. It is important to seek medical care as soon as you suspect you are having a problem. 2 Stay in the hospital. Ketoacidosis is usually treated in the hospital. You may be admitted to a regular room or treated in ICU depending on the severity of your symptoms. During the first hours you are there, the doctors will work on getting your fluids and electrolytes balanced, then they will focus on other symptoms. Most of the time, patients remain in the hospital until they are ready to return to their normal insulin regimen. The doctor will monitor you for any other conditions that may cause complications, like infection, heart attack, brain problems, sepsis, or blood clots in deep veins. 3 Increase your fluid intake. One of the first things that will be done to treat your diabetic ketoacidosis is to replace fluids. This can be in the hospital, a doctor’s office, or home. If you are receiving medical care, they will give you an IV. At home, you can drink fluids by mouth. Fluids are lost through frequent urination and must be replaced. Replacing fluids helps balance out the sugar levels in your blood. 4 Replace your electrolytes. Electrolytes, such as sodium, potassium, and chloride, are important to keep your body functioning p Continue reading >>
Alcoholic Ketoacidosis Damian Baalmann, 2nd year EM resident A 45-year-old male presents to your emergency department with abdominal pain. He is conscious, lucid and as the nurses are hooking up the monitors, he explains to you that he began experiencing abdominal pain, nausea, vomiting about 2 days ago. Exam reveals a poorly groomed male with dry mucous membranes, diffusely tender abdomen with voluntary guarding. He is tachycardic, tachypneic but normotensive. A quick review of the chart reveals a prolonged history of alcohol abuse and after some questioning, the patient admits to a recent binge. Pertinent labs reveal slightly elevated anion-gap metabolic acidosis, normal glucose, ethanol level of 0, normal lipase and no ketones in the urine. What are your next steps in management? Alcoholic Ketoacidosis (AKA): What is it? Ketones are a form of energy made by the liver by free fatty acids released by adipose tissues. Normally, ketones are in small quantity (<0.1 mmol/L), but sometimes the body is forced to increase its production of these ketones. Ketones are strong acids and when they accumulate in large numbers, their presence leads to an acidosis. In alcoholics, a combination or reduced nutrient intake, hepatic oxidation of ethanol, and dehydration can lead to ketoacidosis. Alcoholics tend to rely on ethanol for their nutrient intake and when the liver metabolizes ethanol it generates NADH. This NADH further promotes ketone formation in the liver. Furthermore, ethanol promotes diuresis which leads to dehydration and subsequently impairs ketone excretion in the urine. Alcoholic Ketoacidosis: How do I recognize it? Typical history involves a chronic alcohol abuser who went on a recent binge that was terminated by severe nausea, vomiting, and abdominal pain. These folk Continue reading >>
Treatment Of Insulin-resistant Diabetic Ketoacidosis With Insulin-like Growth Factor I In An Adolescent With Insulin-dependent Diabetes
INSULIN plays a central part in the regulation of carbohydrate, fat, and protein metabolism. Severe insulin resistance, in which treatment with large doses of insulin does not result in adequate metabolic control, is uncommon. Such resistance occurs in the presence of circulating insulin or insulin-receptor antibodies,1 , 2 insulin-receptor abnormalities,3 and episodically in patients with previously typical insulin-dependent diabetes mellitus (IDDM).4 The therapeutic options in patients with severe insulin resistance have been limited, since insulin has been the only available hormone with insulin-like metabolic effects. Recombinant human insulin-like growth factor I (IGF-I), which shares considerable sequence homology as well as biologic properties with insulin,5 has recently become available and has been used in treating patients with Mendenhall's syndrome.6 We describe the use of IGF-I in the treatment of a 16-year-old girl with IDDM complicated by severe episodic insulin resistance. Administration of massive doses of insulin (more than 1000 U per hour) during these episodes failed to achieve glycemic control or reverse ketoacidosis. Treatment with IGF-I rapidly reversed the hyperglycemia and ketoacidosis, and subsequent weekly intravenous infusions of IGF-I markedly improved the degree of insulin sensitivity. The patient was a 16-year-old girl who had had IDDM since the age of 3. She was treated with twice-daily injections of regular and bovine or porcine isophane insulin suspension until the age of seven, at which time she began to receive human insulin. Her glycemic control subsequently improved. At the age of 13, she began to have increasingly frequent (two to three times monthly) episodes of severe hyperglycemia, usually without ketoacidosis. Her serum glucose Continue reading >>
The Treatment And Prevention Of Diabetic Ketoacidosis In Children And Adolescents With Type I Diabetes Mellitus.
Abstract There remain a number of important controversies in the management of pediatric DKA. From the sodium content of the hydrational fluid to the rate of fluid administration that is best able to reverse the hyperosmolar dehydration attendant with DKA with minimal morbidity and mortality, there is no universal agreement on how patients with this devastating metabolic disturbance should be treated. It is still unclear what promotes or protects patients from neurologic insult during DKA reversal. It is appropriate to begin to develop a national approach to eradicating DKA. This would require widespread public and professional education programs aimed at detecting new-onset type I patients prior to the onset of DKA. It would involve promoting diabetes screening programs aimed at detecting patients before the onset of symptomatic disease, and these would most appropriately be centered in the pediatrician's office. In the known patient, DKA still occurs as the result of intercurrent illness and nonadherence to the diabetes regimen due to patient or family chaos and dysfunction. Clearly, more strategies are needed to address these psychological and family patterns and the fact that many tenuous families have insufficient access to appropriate medical care. Those caring for children and adolescents must do all they can to prevent DKA and to treat it optimally to avert the toll this metabolic aberration takes on the pediatric diabetes population. Continue reading >>
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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 >>
How Can A Person With Multiple Diseases Be Treated?
Lets see. They are giving you the U.S. Government recommendations. Low fat diet, cholesterol lowering medication, exercise. Gets 20% worse every year. Sounds like what was happening with Dr. Davis’s patients when he started practicing. The Wheat Belly lifestyle BEGAN with heart health | Dr. William Davis Cholesterol in the diet doesn’t make it into the blood stream. Cholesterol in the bloodstream is manufactured by the body to heal the arteries. If the levels are high you have damaged arteries. You reduce artery damage by eating less carbs. This will also help the diabetes and obesity. Once the weight starts to go down the blood pressure will decrease. See your MD to adjust the BP medication dose. Eating wheat can damage the lining of the intestine, which leads to leaky gut syndrome, which leads to asthma and allergies and autoimmune diseases (include rheumatic arthritis and not osteoarthritis.. Stop eating wheat, the lining of the intestine will heal, the asthma, allergies, and autoimmune diseases will decrease. In the comments he mentions 15 net grams of carbs (grams carbs minus grams fiber) per 6 hour meal period. He recommends not taking / stopping cholesterol medications. Your MD probably will argue for the cholesterol medications and their low fat diet. As a diabetic, he might faint due to low blood sugar, progressing into Diabetic Ketoacidosis. So gradually reduce his carb intake and be ready with a high sugar drink for rescue then maintain a higher carb intake. When he starts the diet, he may experience what is low carb flu for 10 to 14 days. How to survive wheat withdrawal | Dr. William Davis My experiences is that I was getting electric shocks in my upper right arm muscle. High carbohydrate intake had created diabetic neuropathy, eating low carb reversed i Continue reading >>
Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency. Three different types of diabetic coma are identified: Severe low blood sugar in a diabetic person Diabetic ketoacidosis (usually type 1) advanced enough to result in unconsciousness from a combination of a severely increased blood sugar level, dehydration and shock, and exhaustion Hyperosmolar nonketotic coma (usually type 2) in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness. In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that they have diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify them as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered. An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia. Types Severe hypoglycemia People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough to reverse by eating or drinking carbohydrates, but blood glucose occasionally can fall fast enough and low enough to produce unconsciousness before hypoglycemia can be recognized and reversed. Hypoglycemia can be severe enough to cause un Continue reading >>
What Are The Advantages Of Eating A High-fat Diet For Weight Loss, Rather Than Simply Fasting?
You can actually do both and lose weight very effectively, in addition to gaining many other health benefits. As someone else mentioned, the ketogenic diet actually is not a fad diet but has research to prove its effectiveness, and I personally have seen its benefits. Many also incorporate intermittent fasting with keto, but it’s not a requirement. I do recommend watching some of Dr. Jason Fung’s videos on fasting for really interesting information on how fasting intermittently can be very healthy in a lot of ways. So if you’re not familiar, the keto diet has the optimum ratios of macronutrients: fat, protein, and carbohydrates. There has been a great deal of debate in recent years on what those ratios should be, and it does vary from person to person. However, research is showing that what we were led to believe in the past, that eating fat makes you fat, is dead wrong. Eating a diet high in fat, moderate in protein, and very low in carbohydrates, such as the ketogenic diet (or commonly known as “keto”), puts your body into a state of ketosis, a natural metabolic state in which your body is no longer using glucose as its main source of fuel, and instead it begins using ketones to get its energy. Ketones are produced when your body is burning fat because no glucose is available. It is important not to confuse ketosis, a completely harmless and normal metabolic state, with ketoacidosis, a dangerous condition that occurs mostly in type 1 diabetics when they create high levels of both glucose and ketones at the same time. On the ketogenic plan, blood glucose usually drops, so this is not a danger for most people. However, if you are a type 1 diabetic, check with your doctor before switching to the ketogenic way of eating. So being in ketosis simply means that you Continue reading >>
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What Are The Causes And Symptoms Of Diabetic Ketoacidosis?
An Overview Diabetic ketoacidosis (DKA) is considered to be one of the most severe metabolic imbalance associated with type 1 diabetes mellitus. Type 1 diabetes mellitus is also known as insulin dependent diabetes mellitus, wherein a patient depends upon external sources of insulin as its body is unable to make it as per the body’s requirement. DKA is seen very commonly in about 35% to 40% of young diabetic patients including small children and teenagers when diagnosed with type 1 diabetes. Patients who are not suffering with type 1 form of diabetes could also fall under the risk of acquiring DKA condition due to various other reasons. Every diabetic patient irrespective of the type of diabetes, can develop DKA, when facing any other form of illness. Diabetic ketoacidosis is often a serious condition that may require immediate hospitalization for the patient. Approximately, 160,000 hospital admissions per year in the United States occur in this regard. Unfortunately DKA is seen to show maximum complication in young adults including teenagers and of course the elderly patients. Complication arising out diabetic ketoacidosis also accounts for a number of deaths in the US for children and young patients suffering from diabetes. The biggest challenge in the management of this condition comes with the lack of awareness of the unmanaged diabetes in patients that is not taken very seriously event today. What is Diabetic Ketoacidosis? Diabetic ketoacidosis is a life threatening complication associated with diabetes. This condition arises when the body produces excess quantities of ketoacids. The risk of developing ketoacidosis is greater in people with Type 1 diabetes. The condition develops when the amount of insulin produced by the body is insufficient. As insulin levels dr Continue reading >>
What Is The Treatments For Ketoacidosis?
Management of diabetic ketoacidos Time: 0–60 mins 1. Commence 0.9% sodium chloride If systolic BP > 90 mmHg, give 1 L over 60 mins If systolic BP < 90 mmHg, give 500 mL over 10–15 mins, then re-assess. If BP remains < 90 mmHg, seek senior review 2. Commence insulin treatment 50 U human soluble insulin in 50 mL 0.9% sodium chloride infused intravenously at 0.1 U/kg body weight/hr Continue with SC basal insulin analogue if usually taken by patient 3. Perform further investigations: see text 4. Establish monitoring schedule Hourly capillary blood glucose and ketone testing Venous bicarbonate and potassium after 1 and 2 hrs, then every 2 hrs Plasma electrolytes every 4 hrs Clinical monitoring of O2 saturation, pulse, BP, respiratory rate and urine output every hour 5. Treat any precipitating cause Time: 60 mins to 12 hrs • IV infusion of 0.9% sodium chloride with potassium chloride added as indicated below 1 L over 2 hrs 1 L over 2 hrs 1 L over 4 hrs 1 L over 4 hrs 1 L over 6 hrs • Add 10% glucose 125 mL/hr IV when glucose < 14 mmol/L • Be more cautious with fluid replacement in elderly, young people, pregnant patients and those with renal or heart failure. If plasma sodium is > 155 mmol/L, 0.45% sodium chloride may be used. • Adjust potassium chloride infusion Plasma potassium (mmol/L) Potassium replacement (mmol/L of infusion) > 5.5 Nil 3.5–5.5 40 < 3.5 Senior review – additional potassium required Time: 12–24 hrs • Ketonaemia and acidosis should have resolved (blood ketones < 0.3 mmol/L, venous bicarbonate > 18 mmol/L). Request senior review if not improving • If patient is not eating and drinking Continue IV insulin infusion at lower rate of 2–3 U/kg/hr Continue IV fluid replacement and biochemical monitoring • If ketoacidosis has resolved and Continue reading >>
What Is Ketoacidosis? A Comprehensive Guide
Ketoacidosis is lethal. It is responsible for over 100,000 hospital admissions per year in the US with a mortality rate of around 5%. In other words, ketoacidosis is to blame for about 5,000 deaths per year. The cause? A deadly combination of uncontrolled hyperglycemia, metabolic acidosis, and increased ketone body levels in the blood (more on this deadly combination later). Luckily, this lethal triad rarely affects individuals who don’t have diabetes. However, the majority (80%) of cases of diabetic ketoacidosis occur in people with a known history of diabetes mellitus (any form of diabetes). Ketoacidosis vs. Diabetic Ketoacidosis — What’s The Difference? At this point, you may have noticed that I used ketoacidosis and diabetic ketoacidosis interchangeably. This is because it is difficult for the body to get into a state of ketoacidosis without the blood sugar control issues that are common in people with diabetes. Hence, the term diabetic ketoacidosis. (However, there is another form of ketoacidosis called alcoholic ketoacidosis. This occurs in alcoholics who had a recent alcohol binge during a period of time when they didn’t eat enough.) Ketoacidosis tends to occur the most in people who have type 1 diabetes. Somewhere between 5 and 8 of every 1,000 people with type 1 diabetes develops diabetic ketoacidosis each year. Type 2 diabetics also run the risk of ketoacidosis under stressful situations, but it is much rarer because type 2 diabetics have some remaining insulin production (type 1 diabetics do not). If you are not part of the 422 million people worldwide that have diabetes, your risk of getting ketoacidosis is negligible. You would have to put yourself through years of stress, inactivity, and unhealthy eating habits before you experience ketoacidosis. ( Continue reading >>