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Hyperglycemia Ketoacidosis Symptoms

Hyperglycemia (high Blood Sugar)

Hyperglycemia (high Blood Sugar)

Hyperglycemia facts Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes. Other conditions that can cause hyperglycemia are pancreatitis, Cushing's syndrome, unusual hormone-secreting tumors, pancreatic cancer, certain medications, and severe illnesses. The main symptoms of hyperglycemia are increased thirst and a frequent need to urinate. Severely elevated glucose levels can result in a medical emergency like diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemic hyperosmolar state). Insulin is the treatment of choice for people with type 1 diabetes and for life-threatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Hyperglycemia due to medical conditions other than diabetes is generally treated by treating the underlying condition responsible for the elevated glucose. Continue reading >>

Hyperglycemia

Hyperglycemia

University of California San Francisco, Fresno, California Edited By: David A. Wald Temple University School of Medicine Philadelphia, Pennsylvania Objectives The objectives of this module will be to: Review the classic presentation of a patient with hyperglycemia, including DKA and HHS. Review the diagnostic work up of the hyperglycemic patient. Review the principles of managing a patient with hyperglycemia. Hyperglycemia complicating diabetes ranges from the asymptomatic and benign in patients with mild to moderate uncomplicated hyperglycemia to the life-threatening (i.e. diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). DKA and HHS represent a spectrum of complications from diabetes and differ mainly in the level of hyperglycemia, extent of dehydration and presence and degree of ketoacidosis. Each condition revolves around insulin deficiency, either absolute or relative. DKA and HHS are the most serious, acute metabolic complications of diabetes. Generally DKA occurs in younger patients (<65 y/o) with Type 1 diabetes and usually evolves rapidly over 24 hours. HHS usually occurs in older patients (>65 y/o) with poorly controlled Type 2 diabetes and evolves over several days. Both disease entities originate from a reduction in insulin and an increase in counter-regulatory stress hormones. In the emergency department hyperglycemia is most often seen as a complication of diabetes (both types 1 and 2). Hyperglycemia is defined as: Fasting Blood Glucose (for 8 hrs) > 90 – 130 mg/dL Postprandial Blood Glucose > 180 mg/dL Initial Actions and Primary Survey In these patients, a thorough history and physical examination should be performed with a focus on trying to identify a precipitating cause of the hyperglycemia. In patients with an incidental findin Continue reading >>

Diabetes - Diabetic Ketoacidosis & Hyperosmolar Hyperglycemia Syndrome

Diabetes - Diabetic Ketoacidosis & Hyperosmolar Hyperglycemia Syndrome

Sort Hyperglycemia: Causes type of glucose level caused by 1) too much food, 2) too little diabetic medications, 3) inactivity, 4) emotional/physical stress, 5) poor absorption of insulin 6) illness 7) corticosteroids **counterregulatory hormones released when stress, illness persist Hyperglycemia: Manifestations manifests as 1) polyuria: osmotic diuresis (glucose in renal tubules cannot be reabsorbed; consequent hyperosmolarity and osmotic pressure results in more water in tubules) 2) polyphagia followed by lack of appetite, 3) polydipsia: hyperosmolarity of blood causes thirst as cells release more water into circulation 4) weakness/fatigue, 5) blurred vision, 6) glycosuria, 7) nausea/vomiting, 8) abdominal cramping 9) dry, warm, itchy skin Hyperglycemia: Treatment 1) exercise **do NOT exercise if BG 250 mg/dL (stress hormones released) and ketones (Type 1); do NOT exercise if >300 mg/dL (Type 2) 2) drink water 3) eat less CHO at meals **contact HCP if BG >250 mg/dL two-three times in one week During illness: 1) do NOT stop taking medication 2) check BG more frequently 3) clear liquids until no more nausea Hypoglycemia: Manifestations MILD: sweating, tremor, tachycardia, palpitation, nervousness, hunger MODERATE: poor concentration, numb lips/tongue, HA, light-headedness, slurred speech, irrational/combative behavior, visual disturbances SEVER: disorientation, loss of consciousness, difficult to arouse, seizures, coma **Can mimic alcohol intoxication. ***use of beta blockers interferes with recognizing the symptoms Hypoglycemia: Treatment RULE of 15: 1) check blood glucose for levels < 70 mg/dL 2) ingestion of 15-20g of a simple (fast-acting) carbohydrate: glucose tablets, 4 oz of juice, 1 T of honey, 4-6 oz soda ***NO CANDY BARS/COOKIES: treatment with fats s/b avoid Continue reading >>

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Hyperglycemia And What To Do About It

Hyperglycemia And What To Do About It

This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail [email protected] Both hypoglycemia and hyperglycemia are true medical emergencies. As we discussed last month, hypoglycemia often has a rapid onset and can impact any patient whose body is not provided an adequate glucose supply. While anyone can experience hypoglycemia, it is most common in patients who have been diagnosed with diabetes and whose natural insulin does not function normally. Patients with diabetes also risk developing hyperglycemia, a complex and dangerous metabolic derangement that can be fatal without proper care. The American Diabetes Association says that in 2011 there were a staggering 25 million patients with diabetes and 79 million with pre-diabetes across the United States. This month’s CE article explores the consequences of hyperglycemia on the body and the life-threatening emergencies it can cause. Diabetic Disease Progression Recall that insulin secretion is stimulated by eating. Insulin secretion is not stimulated between meals, and a decline in the body’s blood glucose levels inhibits the pancreatic islets’ insulin secretion and stimulates the secretion of glucagon, which allows glucose levels to remain in a normal range. Figure 1 demonstrates the relationship between blood glucose levels and the pancreas. With the exception of very few organs, such as the brain and the kidneys, the body’s tissues require insulin for glucose to pass through the cell walls. For patients with diabetes mellitus (DM), either thei Continue reading >>

Diabetic Ketoacidosis & Hyperosmolar Hyperglycemic State

Diabetic Ketoacidosis & Hyperosmolar Hyperglycemic State

Diabetic ketoacidosis is characterized by having blood glucose >13.9 mmol/L, arterial pH <7.3 in adults or venous pH <7.3 in pediatrics, bicarbonate <15 mEg/L, moderate ketonuria or ketonemia and anion gap >14. Hyperosmolar Hyperglycemic state in adults is described as having blood glucose >33.3 mmol/L, arterial pH >7.3, bicarbonate >15 mEq/L, mild ketonuria or ketonemia, effective serum osmolality >320 mOsm/kg and variable anion gap. While hyperosmolar Hyperglycemic state in pediatric patients have blood glucose >33.3 mmol/L, venous pH >7.3, bicarbonate >15 mEq/L and altered mental status or severe dehydration. Continue reading >>

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Treatment

Diabetic Ketoacidosis And Hyperosmolar Hyperglycemic State In Adults: Treatment

INTRODUCTION Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also known as hyperosmotic hyperglycemic nonketotic state [HHNK]) are two of the most serious acute complications of diabetes. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. The treatment of DKA and HHS in adults will be reviewed here. The epidemiology, pathogenesis, clinical features, evaluation, and diagnosis of these disorders are discussed separately. DKA in children is also reviewed separately. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis".) Continue reading >>

High Blood Sugar Emergencies

High Blood Sugar Emergencies

Blood sugar levels that are too high (hyperglycemia) can quickly turn into a diabetic emergency without quick and appropriate treatment. The best way to avoid dangerously high blood sugar levels is to self-test to stay in tune with your body, and to stay attuned to the symptoms and risk factors for hyperglycemia. Extremely high blood sugar levels can lead to one of two conditions—diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS; also called hyperglycemic hyperosmolar nonketotic coma). Although both syndromes can occur in either type 1 or type 2 diabetes, DKA is more common in type 1, and HHNS is more common in type 2. Diabetic Ketoacidosis (DKA) Ketoacidosis (or DKA) occurs when blood sugars become elevated (over 249 mg/dl, or 13.9 mmol/l) over a period of time and the body begins to burn fat for energy, resulting in ketone bodies in the blood or urine (a phenomenon called ketosis). A variety of factors can cause hyperglycemia (high blood glucose), including failure to take medication or insulin, stress, dietary changes without medication adjustments, eating disorders, and illness or injury. This last cause is important, because if illness brings on DKA, it may slip by unnoticed, since its symptoms can mimic the flu (aches, vomiting, etc.). In fact, people with type 1 diabetes are often seeking help for the flu-like symptoms of DKA when they first receive their diagnosis. Symptoms of diabetic ketoacidosis may include: fruity (acetone) breath nausea and/or vomiting abdominal pain dry, warm skin confusion fatigue breathing problems excessive thirst frequent urination in extreme cases, loss of consciousness DKA is a medical emergency, and requires prompt and immediate treatment. A simple over-the-counter urine dipstick test (e.g., Keto Continue reading >>

Hyperglycemia: When Your Blood Glucose Level Goes Too High

Hyperglycemia: When Your Blood Glucose Level Goes Too High

Hyperglycemia means high (hyper) glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells rely on glucose for energy. Hyperglycemia is a defining characteristic of diabetes—when the blood glucose level is too high because the body isn't properly using or doesn't make the hormone insulin. You get glucose from the foods you eat. Carbohydrates, such as fruit, milk, potatoes, bread, and rice, are the biggest source of glucose in a typical diet. Your body breaks down carbohydrates into glucose, and then transports the glucose to the cells via the bloodstream. Body Needs Insulin However, in order to use the glucose, your body needs insulin. This is a hormone produced by the pancreas. Insulin helps transport glucose into the cells, particularly the muscle cells. People with type 1 diabetes no longer make insulin to help their bodies use glucose, so they have to take insulin, which is injected under the skin. People with type 2 diabetes may have enough insulin, but their body doesn't use it well; they're insulin resistant. Some people with type 2 diabetes may not produce enough insulin. People with diabetes may become hyperglycemic if they don't keep their blood glucose level under control (by using insulin, medications, and appropriate meal planning). For example, if someone with type 1 diabetes doesn't take enough insulin before eating, the glucose their body makes from that food can build up in their blood and lead to hyperglycemia. Your endocrinologist will tell you what your target blood glucose levels are. Your levels may be different from what is usually considered as normal because of age, pregnancy, and/or other factors. Fasting hyperglycemia is defined as when you don't eat for at least eight hours. Recommended range without diabet Continue reading >>

Euglycemic Diabetic Ketoacidosis, A Misleading Presentation Of Diabetic Ketoacidosis

Euglycemic Diabetic Ketoacidosis, A Misleading Presentation Of Diabetic Ketoacidosis

Go to: Introduction Hyperglycemia and ketosis in diabetic ketoacidosis (DKA) are the result of insulin deficiency and an increase in the counterregulatory hormones glucagon, catecholamines, cortisol, and growth hormone. Three processes are mainly responsible for hyperglycemia: increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization by peripheral tissues. This might also be augmented by transient insulin resistance due to hormone imbalance, as well as elevated free fatty acids.[1] DKA is most commonly precipitated by infections. Other factors include discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and illicit drug use. The diagnostic criteria of DKA, established by the American Diabetic Association, consists of a plasma glucose of >250 mg/dL, positive urinary or serum ketones, arterial pH of <7.3, serum bicarbonate <18 mEq/L, and a high anion gap. The key diagnostic feature of DKA is elevated circulating total blood ketone concentration. Hyperglycemia is also a key diagnostic criterion of DKA; however, a wide range of plasma glucose levels can be present on admission. Continue reading >>

Diabetic Ketoacidosis: Evaluation And Treatment

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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

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

Understanding And Treating Diabetic Ketoacidosis

Understanding And Treating Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>

Hyperglycemic Crises

Hyperglycemic Crises

What They Are and How to Avoid Them One type results in about 100,000 hospitalizations a year with a mortality rate of under 5%. The other is thought to cause fewer hospitalizations, yet the mortality rate is about 15%. Severe hyperglycemic conditions, known as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), involve very serious imbalances in blood chemistry and usually require that a person be hospitalized until normal blood chemistry is restored. Because they can occur in anyone with diabetes, everyone should know what causes them, how to prevent them, how they are treated, and when to seek medical attention. The body in balance Glucose metabolism is a complex balancing act. In people who don’t have diabetes, a number of interconnected processes help the body to use glucose and keep blood glucose levels in the normal range. The body constantly balances glucose extracted from foods and produced by the liver with glucose utilization by the body’s tissues. When there is ample glucose in the bloodstream, the liver converts some of it into glycogen for storage. When the body needs more energy, such as during a prolonged period of fasting or activity, the liver converts stored glycogen back into glucose so that it can be used by the body’s tissues. The liver also can create glucose from amino acids and fats. Insulin lowers blood glucose levels both by slowing down the liver’s glucose production and by helping the body’s tissues to use glucose for energy. If the blood glucose level goes too low, other hormones, called counterregulatory hormones, work against the action of insulin to raise blood glucose levels. These hormones include glucagon, epinephrine, growth hormone, and cortisol. All work by prodding the liver to release glucose and by Continue reading >>

What You Should Know About Recovery From Diabetic Coma

What You Should Know About Recovery From Diabetic Coma

A diabetic coma occurs when a person with diabetes loses consciousness. It can occur in people with type 1 or type 2 diabetes. A diabetic coma occurs when blood sugar levels become either too low or too high. The cells in your body require glucose to function. High blood sugar, or hyperglycemia, can make you feel lightheaded and lose consciousness. Low blood sugar, or hypoglycemia, can cause dehydration to the point where you may lose consciousness. Usually, you can prevent hyperglycemia or hypoglycemia from progressing to a diabetic coma. If a diabetic coma occurs, it’s likely that your doctor can balance your blood glucose levels and restore your consciousness and health quickly if they can respond to your condition in a timely manner. You can also slip into a diabetic coma if you develop diabetic ketoacidosis. Diabetic ketoacidosis (DKA) is a buildup of chemicals called ketones in your blood. Hypoglycemia The symptoms of hypoglycemia may include: headache fatigue dizziness confusion heart palpitations shakiness Hyperglycemia If you have hyperglycemia, you may experience noticeably increased thirst and you may urinate more frequently. A blood test would also reveal higher levels of glucose in your blood stream. A urine test can also show that your glucose levels are too high. DKA causes high levels of blood glucose. The symptoms also include increased thirst and a frequent need to urinate. Other symptoms of elevated ketone levels include: feeling tired having an upset stomach having flushed or dry skin If you have more severe diabetic coma symptoms, call 911. Severe symptoms may include: vomiting difficulty breathing confusion weakness dizziness A diabetic coma is a medical emergency. It can lead to brain damage or death if you don’t get treatment. Treating hyperg Continue reading >>

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