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Is Ketoacidosis Permanent

Hyperglycaemia‐related Complications At The Time Of Diagnosis Can Cause Permanent Neurological Disability In Children With Neonatal Diabetes

Hyperglycaemia‐related Complications At The Time Of Diagnosis Can Cause Permanent Neurological Disability In Children With Neonatal Diabetes

Go to: Abstract Children with neonatal diabetes often present with diabetic ketoacidosis and hence are at risk of cerebral oedema and subsequent long‐term neurological deficits. These complications are difficult to identify because neurological features can also occur as a result of the specific genetic aetiology causing neonatal diabetes. Case reports We report two cases of neonatal diabetes where ketoacidosis‐related cerebral oedema was the major cause of their permanent neurological disability. Case 1 (male, 18 years, compound heterozygous ABCC8 mutation) and case 2 (female, 29 years, heterozygous KCNJ11 mutation) presented with severe diabetic ketoacidosis at 6 and 16 weeks of age. Both had reduced consciousness, seizures and required intensive care for cerebral oedema. They subsequently developed spastic tetraplegia. Neurological examination in adulthood confirmed spastic tetraplegia and severe disability. Case 1 is wheelchair‐bound and needs assistance for transfers, washing and dressing, whereas case 2 requires institutional care for all activities of daily living. Both cases have first‐degree relatives with the same mutation with diabetes, who did not have ketoacidosis at diagnosis and do not have neurological disability. Ketoacidosis‐related cerebral oedema at diagnosis in neonatal diabetes can cause long‐term severe neurological disability. This will give additional neurological features to those directly caused by the genetic aetiology of the neonatal diabetes. Our cases highlight the need for increased awareness of neonatal diabetes and earlier and better initial treatment of the severe hyperglycaemia and ketoacidosis often seen at diagnosis of these children. Continue reading >>

Invokana Lawsuit

Invokana Lawsuit

The U.S. Food and Drug Administration has issued a new safety alert regarding a possible increase in the risk of leg or foot amputation after taking the antidiabetic medication, Invokana. Previous safety warnings were also issued about an increased risk of severe urinary tract infection and diabetic ketoacidosis which has required hospitalization and dialysis due to kidney failure. Invokana, a medication used to treat Type 2 diabetes, may have caused serious injury in some patients. Patients who have taken Invokana may have experienced leg, foot or toe amputation, kidney failure, heart attack or other events which were life-threatening or resulted in permanent injury. Many of these patients or their family members have filed an Invokana lawsuit against the manufacturer of Invokana, stating that the company failed to warn the public and the medical community about the potential risks of the medication. If you or a loved one required amputation, experienced kidney failure with dialysis, heart attack or other serious injuries after taking Invokana, you may be eligible for legal compensation. What is Invokana? Invokana (canagliflozin) is a newer type of anti-diabetic medication used to treat Type 2 diabetes. It is a member of the class “SGLT2 inhibitors” (sodium-glucose-co-transporter 2) medications that work to lower blood sugar by encouraging the body to release excess sugar into the urine. Normally, insulin is secreted by the body to help move sugar or glucose from the bloodstream into the cells where it can be used as energy. Type 2 diabetics are often resistant to insulin, causing the sugar to remain in the blood stream, unusable by the cells. This excess sugar is excreted into the urine but is reabsorbed by the kidneys. Over time, high blood sugar may cause perman 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 >>

Cognitive Dysfunction Associated With Diabetic Ketoacidosis In Rats

Cognitive Dysfunction Associated With Diabetic Ketoacidosis In Rats

Go to: Methods This study was conducted in accordance with the Animal Use and Care Guidelines issued by the National Institutes of Health and was approved by the Animal Use and Care Committee at University of California Davis. Four-week old Sprague Dawley rats (n=19, Charles River Laboratories, Wilmington, MA) were given an intraperitoneal injection of streptozotocin (STZ, 150 mg/kg) to induce diabetes as described previously.[26] Rats’ drinking water was replaced with water with 10% dextrose for 24-hours after STZ to prevent hypoglycemia. Urine glucose and ketoacids (acetoacetate) were measured daily using Multistix urinalysis strips (BAYER, Fisher Scientific, Santa Clara, CA). Beginning 24 hours after STZ, rats received 4 units of Novolin 70/30 insulin (Novo Nordisk, Princeton, NJ) subcutaneously daily in the evening to coincide with the rats’ nocturnal feeding behavior. Rats were randomly assigned to either the DKA group or the diabetes mellitus control group (DM). The DM group (n=8) continued to receive subcutaneous insulin to treat diabetes throughout the study. For the DKA group (n=11), subcutaneous insulin was administered for 5 days after induction of diabetes, after which insulin was withdrawn to allow DKA to develop. Ketosis developed four to five days after insulin withdrawal. Once ketosis was detected, standard rat chow was replaced with a 60% high fat diet (Research Diets, Inc., OpenSource Diets #D12492) and water was withdrawn for 15 hours to promote ketogenesis and increase dehydration. These procedures increased the similarities between human DKA and the rat DKA model as both ketosis and dehydration in humans are typically more severe than that which develops after insulin withdrawal in rats. Rats were identified as having developed DKA when urine gl Continue reading >>

Will There Ever Be A Cure For Diabetes? Why Or Why Not?

Will There Ever Be A Cure For Diabetes? Why Or Why Not?

For More tips,read more about diabetes Diabetes Full Control- Live a Better Life What is type 1 diabetes? Around 400,000 people in Germany are producing cells of the pancreas and destroys them. As a result, it comes within a few days to weeks for lack of insulin production. Type 1 diabetes often occurs as early as childhood and adolescence. The hormone insulin is responsible for the locks of dietary sugar from the blood into the cells that need it for energy. In insulin deficiency, the glucose in the blood accumulates - the blood sugar level rises. This can damage permanently the blood vessels, nerves and numerous organs. Patients with type 1 diabetes need throughout their lives several times daily insulin injections to prevent acute metabolic disorders and related diseases due to high blood sugar levels. What is the difference between Type 1 diabetes and Type 2? In contrast to type 1 diabetes is the type 2 diabetes, below the estimated about seven million people in Germany suffer, not the consequence of a lack of insulin, but an insulin resistance. This means that the cells no longer speak adequately to insulin, so that the hormone can not smuggle the sugar into the cells. The blood sugar level rises. To compensate, the pancreas initially produces larger amounts of insulin. Also no longer sufficient to overcome the insulin resistance, a type 2 diabetes develops. The main causes of type 2 diabetes are genetic predisposition, obesity and lack of exercise. While the type 1 diabetes is more likely in recent years, a type 2 diabetes often develops at an advanced age in patients. Training: What to know patients Typically, a person with Type 1 diabetes leads his therapy in everyday life through their own, as long as no problems or complaints arise. In children take parents th Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Figure 3. Timeline in DKA management. GCS:Glascow Coma Scale, CBC:Complete Blood Counting, ECG:Electrocardiogram, HR:Heart Rate, BP:Blood Pressure, BUN:Blood Urea Nitrogen, Cr: Creatinine, WBC:White Blood Cell, CRP:C-reactive protein, CE:Cerebral edema (adapted from reference 165) Figure 4. A 15 years old male patient firstly diagnosed T1DM with DKA infected by rhino-orbita-cerebral mucormycozis (Picture from the reference [218]) 1. Introduction A chronic autoimmune destruction of the pancreatic beta cells results in decreasing endogenous insulin secretion and the clinical manifestation of type 1 diabetes mellitus (T1DM). The clinical onset of the disease is often acute in children and adolescents and diabetic ketoacidosis (DKA) is present in 20-74% of the patients [1-7]. DKA is a serious condition that requiring immediate intervention. Even with appropriate intervention, DKA is associated with significant morbidity and possible mortality in diabetic patients in the pediatric age group [8]. Young age and female sex have been associated with an increased frequency of DKA [3,9]. The triad of uncontrolled hyperglycemia, metabolic acidosis and increased total body ketone concentration characterizes DKA [10]. In addition to possible acute complications, it may also influence the later outcome of diabetes [11]. 2. Epidemiology Worldwide, an estimated 65 000 children under 15 years old develop T1DM each year, and the global incidence in children continues to increase at a rate of 3% a year [12,13]. The current incidence in the UK is around 26/100 000 per year [14]. Patterson et al. were aimed to establish 15-year incidence trends for childhood T1DM in European centres with EURODIAB study. 29 311 new cases of T1DM were diagnosed in children before their 15th birthday during a 1 Continue reading >>

5 Common Signs Of Diabetic Ketoacidosis Or Dka

5 Common Signs Of Diabetic Ketoacidosis Or Dka

One of the quickest ways for a person with diabetes to get themselves placed in the emergency room is through a DKA incident. DKA or diabetic ketoacidosis is a condition when your body over produces ketones which can adjust your bloods pH leading to toxicity in the blood or even death. Sometimes, DKA can literally sneak up on you, but most of the time there are underlying symptoms that can be called out before your body sinks too far into DKA. Let’s take a look at some of these signs to help you catch yourself in DKA in order to prevent one of those emergency room visits. If your blood sugar goes over 300 this can happen to pump users if their tubing is somehow kinked without them noticing. so make sure to keep an eye on your sugars because it may not be a miscalculation of bolus but DKA Combination of illness as well as sudden high blood sugar together sometimes when you’re sick your body requires more insulin that is not usually provided due to your physical condition, this can lead to DKA so make sure to check for ketones when you’re sick. Having difficult time breathing when your blood becomes more acidic one way your body tries to bring your pH back to normal is by getting rid of carbon dioxide through the respiratory system. When you hyperventilate you breathe out more CO2 which after a while can make your blood more basic. Very dry mouth and thirstier than usual your body goes into DKA due to the lack of insulin in the system. This means that there is a high amount of sugar in the system and one way for your body to return the balance of molecules in the body is through urine. The problem with this is you also lose a lot of fluid in the process, hence dry mouth and thirst. Fruity smelling breathe this is always a sure sign of DKA, if someone tells you that Continue reading >>

If You Throw Up Within 30 Minutes Of Eating, How Many Calories Do You Lose Of The Food You Ate?

If You Throw Up Within 30 Minutes Of Eating, How Many Calories Do You Lose Of The Food You Ate?

Most everything but the simple sugars and some of the protein. By that time, you'd only absorb a portion of the water-soluble vitamins and minerals. The interesting part of this scenario is that the least nutritious and most unhealthful calories (namely the simple sugars) would be absorbed first. If this happened too often, it would not only result in weight loss, but ketoacidosis and malnutrition that would lead to permanent neurological and muscular damage, and eventually to organ failure. For this reason, if a person is having a difficult time holding down food for more than a few days, they really need to seek medical attention. If they were in good health and could hold down water, they could survive a month or two in such a state, but permanent physical damage would occur much quicker. Also, if a person suffers some condition where this happens periodically but infrequently, they still need to seek medical attention. Unfortunately, digestive juices will erode the mucosa of the esophagus and cause scarring. This sort of reflux is a leading cause of throat cancer. If you know someone that has this problem, they require medical attention. Continue reading >>

Steroid Induced Diabetic Ketoacidosis (dka) In A 13 Year Old Female With Renal Disorder

Steroid Induced Diabetic Ketoacidosis (dka) In A 13 Year Old Female With Renal Disorder

1Department of Paediatrics and Child Health, Faculty of Clinical Sciences, College of Health Sciences, University of Port Harcourt, Nigeria 2University of Port Harcourt Teaching Hospital, Nigeria *Corresponding Author: Department of Paediatrics University of Port Harcourt Teaching Hospital Port Harcourt, Rivers State, Nigeria E-mail: [email protected] Citation: Jaja T, Anochie IC, Eke FU (2012) Steroid Induced Diabetic Ketoacidosis (DKA) in a 13 year Old Female with Renal Disorder. Pediatr Therapeut 2:109. doi:10.4172/2161-0665.1000109 Copyright: © 2012 Jaja T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Pediatrics & Therapeutics Abstract Background: Diabetic ketoacidosis (DKA) is a common complication of poorly controlled diabetes mellitus in children and a rare complication of steroid therapy. Patients on steroid therapy may develop hyperglycemia as a complication, but presentation with DKA is rather unusual. Aim: To highlight a rare clinical entity of DKA induced by prednisolone in a 13 year old female on treatment for nephrotic syndrome. Case report: NC was a 13 year old female who presented with first episode of generalized body swelling, oliguria, massive proteinuria and hypercholesterolenaemia with normal renal function. She was not a known diabetic and had no family history of diabetes mellitus. She was started on prednisolone at 20 mg three times daily for nephrotic syndrome. Two weeks after commencement of prednisolone, she developed DKA with blood glucose of 31.1 mmol/l, glycosuria and ketonuria. She received intravenous in Continue reading >>

I Want To Quit Drinking And Smoking Altogether. However, As A Freshman In College, It's Hard Because Of The Constant Influence. Why Should I Quit?

I Want To Quit Drinking And Smoking Altogether. However, As A Freshman In College, It's Hard Because Of The Constant Influence. Why Should I Quit?

Peer pressure to join negative activities like smoking, drugs, drinking etc., is something every young man faces. The weak and feeble succumb while the strong and productive youngsters look for peer pressure on useful activities like debating clubs, public speaking, sports, running, community service etc., Many achievements (irony!) are possible. You can reach the heaven or hell sooner than many others. You can keep away many friends. You can annoy your spouse who may ask you to enjoy outdoor smoking. You can imbibe thousands of strange chemical molecules in the most micro size. You can leave your kids to grow up independently without interfering in their lives. You can use multiple machines to breathe at the later stages. You can use many ash trays which can alternate as crystal art pieces. You can outspend non-smokers on air-purifiers, exhaust fans, perfumes, mouth fresheners etc., You can set a great example to kids and youngsters to follow your “cool” personality. You can make a great contribution to Doctors and Pharma companies to bolster their bottom-line. And here is a successful method I used to quit smoking, Continue reading >>

A Seven Weeks Old Baby With Diabetic Ketoacidosis: A Case Report

A Seven Weeks Old Baby With Diabetic Ketoacidosis: A Case Report

Key clinical message Diabetes mellitus is rare during infancy, however, it should be suspected in infants presenting with features consistent with sepsis and hyperglycemia. This is crucial in initiating the treatment of diabetes ketoacidosis which if delayed may result in significant morbidity and death. Background Neonatal diabetes mellitus (NDM) is a rare endocrinological disorder, which affects children in the first 6 months of life, with estimated incidence of 1/90,000 to 1/210,000 live births [1, 2]. Two forms of this condition have been identified, transient and permanent neonatal diabetes mellitus (TNDM and PNDM). TNDM is a genetically mediated disorder of insulin production that remits in the postnatal period and is commonly associated with intrauterine growth retardation, it accounts for 50–60% of the cases of neonatal diabetes [3]. PNDM, a less common form that results from abnormal pancreatic development, increased apoptosis, and necrosis with cellular dysfunction and causing lifelong insulin dependency [4]. Patients develop inadequate insulin production necessitating exogenous insulin therapy, which if not well balanced results in several complications including diabetic ketoacidosis. We report the case of 7 weeks old boy with diabetic ketoacidosis that required 10 days of intensive care management. Case Report A 7-week-old baby was referred to the emergency department (ED) of Muhimbili National Hospital (MNH), Dar es Salaam because of presumed severe pneumonia and septicemia. He presented at the ED with history of fever and difficulty in breathing for 3 days, fever was of high grade with no report of convulsion. Difficulty in breathing was noted concurrently with fever and was not accompanied by cough, however, it was noted to cause difficulty in breastfe Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Diabetic Ketoacidosis With Acute Necrotizing Pancreatitis As First Presentation In Latent Autoimmune Diabetes In Adult

Diabetic Ketoacidosis With Acute Necrotizing Pancreatitis As First Presentation In Latent Autoimmune Diabetes In Adult

Stella Pak, David Cha, Omeed Jazayeri-Moghaddas, Dexter Nye, Jillian Costello, John-Phillip Markovic, Jim Kim Abstract This case describes delayed diagnosis of acute necrotizing pancreatitis in the setting of diabetic ketoacidosis (DKA) as the first presentation of late onset autoimmune diabetes of adulthood (LADA). Possible presentation of DKA with LADA and acute pancreatitis (AP) are explored in this paper, with an emphasis on early diagnosis of pancreatitis for appropriate management. This case is a critical reminder that although DKA can non-specifically elevate pancreatic enzymes, LADA and AP can present concurrently, and pancreatic pathology should still be considered in the differential. J Med Cases. 2017;8(11):356-358 doi: Full Text: HTML PDF Continue reading >>

Permanent Neonatal Diabetes Mellitus Manifesting As Diabetic Ketoacidosis

Permanent Neonatal Diabetes Mellitus Manifesting As Diabetic Ketoacidosis

Abstract Neonatal diabetes mellitus (NDM) is a very rare disease defined as hyperglycemia that occurs during the first month of life, requires insulin treatment, and lasts more than 2 weeks. There are 2 types of NDM: permanent neonatal diabetes mellitus (PNDM) and transient neonatal diabetes mellitus (TNDM). We report a case of PNDM in a 3-day-old female infant. This full-term neonate was born small for gestational age. Respiratory distress, poor activity, hypothermia, poor feeding, dehydration, and ketoacidosis were noted at the age of 3 days. After insulin therapy and fluid replacement, her condition became stable. Glucagon test done at the age of 26 days showed serum C-peptide level to be low for her age. During the first year of life she had catch-up growth, but insulin therapy was still required. Serum C-peptide level was undetectable at the age of 15 months. The course of this case indicates the importance of a high index of suspicion for patients with PNDM in order to correct metabolic derangement as early as possible and facilitate normal growth and development under insulin therapy. Continue reading >>

What You Should Know About Diabetic Ketoacidosis

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 >>

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