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 >>
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 >>
Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal. Ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat and proteins in response to a perceived need for respiratory substrate. Prolonged alcoholism may lead to alcoholic ketoacidosis. Ketoacidosis can be smelled on a person's breath. This is due to acetone, a direct by-product of the spontaneous decomposition of acetoacetic acid. It is often described as smelling like fruit or nail polish remover. Ketosis may also give off an odor, but the odor is usually more subtle due to lower concentrations of acetone. Treatment consists most simply of correcting blood sugar and insulin levels, which will halt ketone production. If the severity of the case warrants more aggressive measures, intravenous sodium bicarbonate infusion can be given to raise blood pH back to an acceptable range. However, serious caution must be exercised with IV sodium bicarbonate to avoid the risk of equally life-threatening hypernatremia. Cause Three common causes of ketoacidosis are alcohol, starvation, and diabetes, resulting in alcoholic ketoacidosis, starvation ketoacidosis, and diabetic ketoacidosis respectively. In diabetic ketoacidosis, a high concentration of ketone bodies is usually accomp Continue reading >>
Diabetic Coma Recovery: What You Need To Know
In people with diabetes, a diabetic coma occurs when severe levels of either high or low uncontrolled blood sugar are not corrected. If treated quickly, a person will make a rapid recovery from a diabetic coma. However, diabetic coma can be fatal or result in brain damage. It is important for people with diabetes to control their blood sugars and know what to do when their blood sugar levels are not within their target range. The severe symptoms of uncontrolled blood sugar that can come before a diabetic coma include vomiting, difficulty breathing, confusion, weakness, and dizziness. Recovery from diabetic coma If a diabetic coma is not treated within a couple of hours of it developing, it can cause irreversible brain damage. If no treatment is received, a diabetic coma will be fatal. In addition, having blood sugar levels that continue to be too low or too high can be bad for long-term health. This remains true even if they do not develop into diabetic coma. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range. Doing so will also reduce the risk of associated complications and diabetic coma. What is diabetes? Diabetes is a long-term condition in which the body is unable to control the level of a sugar called glucose in the blood. Diabetes is caused by either a lack of insulin, the body's inability to use insulin correctly, or both. In people who don't have diabetes, insulin usually ensures that excess glucose is removed from the bloodstream. It does this by stimulating cells to absorb the glucose they need for energy from the blood. Insulin also causes any remaining glucose to be stored in the liver as a substance called glycogen. The production of insul Continue reading >>
What Causes Diabetic Ketoacidosis?
As a type 1 diabetic I am quite familiar (unfortunately) with the signs and symptoms of diabetic ketoacidosis. Diabetic ketoacidosis (DKA) results from associated with too little insulin (and usually high blood sugars as well) which leads to the product of organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body’s chemistry, which resolve with proper therapy. (And let’s clear up early that DKA and nutritional ketosis experienced in low-carb diets are two extremely different things…but more on that in a different article!) Diabetic ketoacidosis usually occurs in people with type 1 diabetes mellitus, but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. What Causes Ketoacidosis? People with type 1 diabetes do not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When glucose is not available, fat is broken down instead. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Blood glucose levels rise (usually higher than 300 mg/dL) because the liver makes glucose to try to combat the problem. However, the cells cannot pull in that glucose without insulin. Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin, or surgery can lead to diabetic ketoacidosis in people with type Continue reading >>
Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>
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. 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 >>
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 >>
Neurological Consequences Of Diabetic Ketoacidosis At Initial Presentation Of Type 1 Diabetes In A Prospective Cohort Study Of Children
OBJECTIVE To investigate the impact of new-onset diabetic ketoacidosis (DKA) during childhood on brain morphology and function. RESEARCH DESIGN AND METHODS Patients aged 6–18 years with and without DKA at diagnosis were studied at four time points: <48 h, 5 days, 28 days, and 6 months postdiagnosis. Patients underwent magnetic resonance imaging (MRI) and spectroscopy with cognitive assessment at each time point. Relationships between clinical characteristics at presentation and MRI and neurologic outcomes were examined using multiple linear regression, repeated-measures, and ANCOVA analyses. RESULTS Thirty-six DKA and 59 non-DKA patients were recruited between 2004 and 2009. With DKA, cerebral white matter showed the greatest alterations with increased total white matter volume and higher mean diffusivity in the frontal, temporal, and parietal white matter. Total white matter volume decreased over the first 6 months. For gray matter in DKA patients, total volume was lower at baseline and increased over 6 months. Lower levels of N-acetylaspartate were noted at baseline in the frontal gray matter and basal ganglia. Mental state scores were lower at baseline and at 5 days. Of note, although changes in total and regional brain volumes over the first 5 days resolved, they were associated with poorer delayed memory recall and poorer sustained and divided attention at 6 months. Age at time of presentation and pH level were predictors of neuroimaging and functional outcomes. CONCLUSIONS DKA at type 1 diabetes diagnosis results in morphologic and functional brain changes. These changes are associated with adverse neurocognitive outcomes in the medium term. The incidence of childhood-onset type 1 diabetes varies from 0.1 to 57.6 per 100,000 and is increasing worldwide (1). Long Continue reading >>
Diabetes Care Tasks At School: What Key Personnel Need To Know
* Goal: Optimal Student Health and Learning Ketone Monitoring is a vital piece of a comprehensive plan. * This training component is one of thirteen components created specifically for school nurses and non-medical school personnel who perform diabetes care tasks at school. These components are: â€¢ Diabetes Basics â€¢ Diabetes Medical Management Plan â€¢ Hypoglycemia â€¢ Hyperglycemia â€¢ Blood Glucose Monitoring â€¢ Glucagon Administration â€¢ Insulin Basics â€¢ Insulin by Syringe and Vial â€¢ Insulin by Pen â€¢ Insulin by Pump â€¢ Ketones â€¢ Nutrition and Physical Activity â€¢ Legal Considerations This unit is about Ketones. * Learning Objectives Participants will be able to understand: What ketones are Why ketones are monitored When ketones should be monitored When to contact school nurse, parent/guardian, health care provider Participants will be able to demonstrate: How to perform a ketone test * The subject of this unit is ketone monitoring in the school setting. Participants will be able to understand: What ketones are Why ketones are monitored When ketones should be monitored When to contact school nurse, parent/guardian, health care provider Participants will be able to demonstrate: How to perform a ketone test * What Are Ketones? Acids that result when the body does not have enough insulin and uses fats for energy May occur when insulin is not given, during illness or extreme bodily stress, or with dehydration Can cause abdominal pain, nausea, and vomiting Without sufficient insulin ketones continue to build up in the blood and result in diabetic ketoacidosis (DKA) * Ketones are acids that result when the body does not have enough insulin and uses fats for energy. Ketones may be observed when insulin is not Continue reading >>
What Is The Difference Between Ketogenic Diet And Starvation?
I really must track down how the unscientific drivel that the ketogenic diet is some sort of a starvation response got started. The only link between starvation and the ketogenic diet is the production of ketones in the body. I know certain Quora gurus posit such crap repeatedly but it’s not true. Ketones as a natural process in the body The body produces ketones naturally. It’s likely a protective mechanism due to the evolutionary instability of the food supply. Most of the time ketone levels are quite low. However, anytime the food supply gets interrupted, even short times like at night during sleep, the body starts to produce ketones. Ketones and fat metabolism Ketones are made in the liver from fat. One of the reasons people measure ketone levels in the body is that they are a marker for increased fat utilization in the body. There are two fuel partitioning schemes in the human body. The body can utilize glucose and glycogen or the body can utilize fats (dietary and body) and ketones. There are some overlaps in the utilization of these schemes but when foods that are easily broken down into glucose are withdrawn the body will start to burn fats and ketones as sources of energy. Ketones and starvation The similarity between starvation and the ketogenic diet is that both involve higher levels of circulating ketones in the body. This makes sense since in both situations foods that are easily broken down into glucose have been withdrawn. In both situations, levels of blood glucose and glycogen stores are lower and the body must fuel with other substances. Some tissues in the body are perfectly happy (and in many ways) prefer utilizing fats as fuels. However, some tissues need levels of glucose. These tissues when faced with lower glucose intake in the diet must rely Continue reading >>
What Are The Most Important Things To Know Before Writing A Character Who Has Diabetes?
Writing as a type 1 diabetic ( not to be taken as medical opinion or advice): Whilst one would need to be careful of copyright: the scenes in the movie ‘Panic Room’ where Jodie Foster’s character as a mother of daughter played by Kirsten Stewart, shows the tension created when they fortify themselves in a panic room after criminals break into the house. The daughter who is diabetic has taken her insulin but has little food and is slipping into a state of low blood sugar.(hypoglycaemia or ‘hypo’). The best acted hypoglycaemic episode I have ever seen was by Julia Roberts in ‘Steel Magnolias’ - which opens with her playing the soon-to-be married daughter - someone who has had a long history of diabetes. In my 50 years as a diabetic the following has happened to me or are thoughts that I have had: ( and are not copyrighted !) we were carrying canoes down a mountain to the river below for a week long canoe trip through inhospitable terrain - the drum carrying my insulin and syringes/needles rolled down the mountain and was not found til the next day. Fortunately I had distributed spare kits to others before the descent. ( the glass vials containing the insulin were padded and put in an aluminium container. They survived the roll down the mountain intact inside the plastic drum. The drum did not fare quite as well). I once suffered from a severe hypo and needed some mouth to mouth resuscitation by my wife. Severe hypoglycaemia can cause brain damage. I became hypo once when body surfing but managed to stagger out onto the beach. i was in a hiking party with two of us being type 1 diabetics - the other diabetic was rather unstable with his control and sadly drowned in a waist-high river crossing during the trip. Exact reason for the accident unknown. An acquaint Continue reading >>
Diabetes With Ketone Bodies In Cats
Diabetes Mellitus with Ketoacidosis in Cats The term “ketoacidosis” refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies.” Meanwhile, diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. Typically, the type of condition affects older cats; in addition, female cats are more prone diabetes with ketoacidosis than males. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the cat's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your cat’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azotemia), low sodium levels Continue reading >>
What Are The Long Term Possible Side Effects Of Ketogenic Diet? Say, If One Chooses To Be On It For Rest Of His/her Life?
There is not enough research on long term use of Ketogenic diet. The current available data on is based on 12 years of Ketogenic living which suggest there is no side effects on continuing keto diet for a longer period of time. Although there is no major side effects of living a Ketogenic lifestyle for rest of your life, however there are certain things which you might need to monitor over a period of time. I'll list down few possible side effects: Vitamins or Minerals deficiency which may occur if you eat less veggies. Clogged artiries if you are eating too much of saturated fat especially red meat. It will increase your bad cholesterol levels which may lead to heart disease. Some people can go from long term state to ketoacidosis. In this state the blood becomes acidic and the person who get this condition tend to be people history of Diabetes or alcoholism. Osteoporosis due to low calcium intake. Kidney problems / stones if water intake is low. If you follow the Ketogenic diet for a long term, make sure you are monitored for red flags you are experiencing during the state permanently. That can help to avoid becoming very sick. Having said that, there are many people and cultures that go into ketosis and stay there for years and years without any negative effects. I hope this helps. Akshay, Certified Nutrition Specialist Continue reading >>
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 >>