Advanced Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a dangerous condition characterized by a severe rise in blood sugar or hyperglycemia, depleted bodily fluids, shock, and in some cases unconsciousness. Coma and even death may occur if DKA is left untreated or if it becomes more severe due to excessive vomiting. Symptoms of DKA In the early stages of DKA, the affected individual appears flushed and breathes rapidly and deeply. This is called hyperventilation. As the condition progresses, the skin may turn pale, cool and clammy, dehydration may begin to set in and the heart rate may become rapid and breathing shallow. Nausea, vomiting and severe abdominal cramps. Blurred vision Fruity or pungent smelling breath due to the presence of acetone and ketones in the breath. Pathophysiology Although DKA can occur in patients with type 2 diabetes, it mainly develops in people with type 1 diabetes who need to take insulin for their condition. If individuals do not receive insulin, they will develop DKA. If there is a shortage of insulin, the body fails to use glucose in the blood for energy and instead fats are broken down in the liver. When these fats are broken down, acidic compounds called ketones are produced as a by-product. These ketones build up in the body and eventually cause ketoacidosis. Aside from missed or inadequate doses of insulin, another common cause of DKA is infection or illness as this can raise the level of hormones that counteract the effects of insulin. In addition, the dehydration caused by major injury or surgery can raise levels of these hormones. Diagnosis and treatment Blood tests are performed to check the sugar levels and blood pH, which is classified as acidic if it is below the usual 7.3. Unlike non-ketotic hyperosmolar coma, in DKA the blood and urine levels of keto Continue reading >>
What Are Ketone Bodies And How Are They Related To Diabetes?
What are ketones? The human body normally runs on glucose that’s produced when the body breaks down carbohydrates. But when your body doesn’t have enough glucose or insulin to use the glucose, your body starts breaking down fats for energy. Ketones are byproducts of this breakdown. Those with type 1 diabetes are especially at risk for making ketones. Ketones can make your blood acidic. Acidic blood can cause a serious condition known as diabetic ketoacidosis (DKA). Because the presence of ketones is often one of the signs that a person needs medical help, those with diabetes are often encouraged to check ketones in urine or blood regularly. Ketone levels can range from negative or none at all to very high levels. While individual testing may vary, some general results for ketone levels can be: negative: less than 0.6 millimoles per liter (mmol/L) low to moderate: between 0.6 to 1.5 mmol/L high: 1.6 to 3.0 mmol/L very high: greater than 3.0 mmol/L Call your doctor if your ketones are low to moderate, and seek emergency medical attention if your ketone levels are high to very high. What are the symptoms of ketone buildup? If you have diabetes, you need to be especially aware of the symptoms that having too many ketones in your body can cause. Examples of early symptoms of ketone buildup include: a dry mouth blood sugar levels greater than 240 milligrams per deciliter strong thirst frequent urination If you don’t get treatment, the symptoms can progress. The symptoms that occur later can include: confusion extreme fatigue flushed skin a fruity breath odor nausea vomiting stomach pain trouble breathing You should always seek immediate medical attention if your ketone levels are high. What causes ketones to build up? Ketones are the body’s alternate way of fueling. T Continue reading >>
Dehydration,*diabetic Ketoacidosis,* And Shock†‡in The Pediatric Patient
Therapy for dehydration is guided by the weight and body surface area of the patient. This state can be prevented if early signs are recognized. The recently adopted regimen for treating diabetic ketoacidosis consists of constant infusion of small doses of insulin. This regimen is easy to follow and permits close monitoring of the relationship of dose to effect. Shock is managed by oxygenation and replacement of volume deficits. Continue reading >>
What Is Diabetes?
My current understanding compels me to formulate the following brief answer: If both type 1 (an autoimmune) and type 2 (a lifestyle) diabetes are pulled together, I’d describe them with the unifying name ‘fuel partitioning disease of insulin’. Now, that’s not to say that type 1 diabetes does not have a strong lifestyle component as well… You may rightfully ask what I mean by ‘fuel partitioning disease’? Understanding the physiological role of insulin in the body leads you to this conclusion. The general role of insulin was perfectly described by George Cahill in his Banting Memorial Lecture way back in 1971: “Insulin serves as the body's signal for the fed or fasted state. High insulin levels, the “fed” signal, initiate tissue uptake and storage of fuels. Low insulin levels, the “fasted” signal, initiate mobilization of stored fuels from tissue stores, the rate being proportional to the lowness of the insulin. Certain metabolic states such as obesity or trauma alter the concentration of insulin at which no net transfer of fuel occurs, resulting in insulin resistance or hyper-sensitivity.” Our understanding has been refined to some extent since then, but the basics are well described. In fact, where our knowledge has improved the most is the mechanisms underlying the impaired action of insulin. As it seems now, as soon as (especially superficial, below the waistline) subcutaneous fat depots fail to take up and store lipids (fat) in an appropriate (insulin sensitive) way, these lipids get deposited in less appropriate places. First, in deeper subcutaneous, then visceral, epicardial, etc. adipose depots, and if those become full as well, fat starts flooding all insulin sensitive organs, such as the liver, the pancreas, and the endothelium (the inn Continue reading >>
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How To Treat Ketoacidosis
Immediately drink a large amount of non-caloric or low caloric fluid. Continue to drink 8 to 12 oz. every 30 minutes. Diluted Gatorade, water with Nu-Salt™ and similar fluids are good because they help restore potassium lost because of high blood sugars. Take larger-than-normal correction boluses every 3 hours until the blood sugar is below 200 mg/dl (11 mmol) and ketones are negative. It will take much more rapid insulin than normal to bring blood sugars down when ketones are present in the urine or blood. Often, one and a half to two times the normal insulin dose for a high blood sugar will be necessary. Higher insulin doses than these will be needed if there is an infection or other major stress. If nausea becomes severe or last 4 hours or more, call your physician. If vomiting starts or you can no longer drink fluids, have a friend or family member call your physician immediately, then go directly to an emergency room for treatment. Never omit your insulin, even if you cannot eat. A reduced insulin dose might be needed, but only if your blood sugar is currently low. When high blood sugars or ketoacidosis happen, it is critical that you drink lots of fluid to prevent dehydration. Take extra amounts of Humalog, Novolog or Regular insulin to bring the blood sugars down. Children with severe ketoacidosis lose 10-15 % of their previous body weight (i.e., a 60 lb. child can lose 6 to 9 lbs. of weight) due to severe dehydration. Replacement of fluids should be monitored carefully. The dehydration is caused by excess urination due to high blood sugars and is quickly worsened when vomiting starts due to the ketoacidosis. The start of vomiting requires immediate attention at an ER or hospital where IV fluid replacement can begin. If only nausea is present and it is possible Continue reading >>
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 >>
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 >>
Diabetic Ketoacidosis (DKA) is an acute, potentially life-threatening complication of diabetes mellitus. For the most part, DKA occurs in people with type 1 diabetes, but it can happen in folks with type 2 diabetes almost as often. DKA is the result of an inadequate amount of insulin. Insulin allows the body to use its major fuel source (glucose) for energy. Since glucose can no longer be burned, it reaches high levels in the bloodstream. This causes increased urine production and dehydration. About 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. When there is not enough insulin, the body burns fat instead. Fat breaks down into acids which in turn produce toxic acidic substances known as ketones. These build in the bloodstream causing a dangerous situation. Loss of potassium and other salts which the body needs in the excessive urination is also common. DKA is therefore a medical emergency which if untreated can result in coma and possibly death. In the early stages, it may be possible to treat DKA at home, but if it is more advanced, management should take place in a properly equipped setting such as a hospital. The keys to prevention of DKA include awareness of its warning signs along with frequent blood glucose monitoring and checking urine or blood ketone levels as needed. Causative factors The most common events that cause a person with diabetes to develop diabetic ketoacidosis are: Infection such as diarrhea, vomiting, and/or high fever (40%), Missed, inadequate, or “bad” insulin (25%), New diagnosis or previously unknown diabetes (15%). Various other causes: pregnancy, heart attack, stroke, trauma, stress, alcohol abuse, drug abuse, and surgery. Approximately 5% to 10% of cases have no identifiable cause. Signs and Symptoms 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 >>
Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>
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 >>
Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, And Preventable Safety Concern With Sglt2 Inhibitors
The Case At Hand Recently, the U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication that warns of an increased risk of diabetic ketoacidosis (DKA) with uncharacteristically mild to moderate glucose elevations (euglycemic DKA [euDKA]) associated with the use of all the approved sodium–glucose cotransporter 2 (SGLT2) inhibitors (1). This Communication was based on 20 clinical cases requiring hospitalization captured between March 2013 and June 2014 in the FDA Adverse Event Reporting System database. The scarce clinical data provided suggested that most of the DKA cases were reported in patients with type 2 diabetes (T2D), for whom this class of agents is indicated; most likely, however, they were insulin-treated patients, some with type 1 diabetes (T1D). The FDA also identified potential triggering factors such as intercurrent illness, reduced food and fluid intake, reduced insulin doses, and history of alcohol intake. The following month, at the request of the European Commission, the European Medicines Agency (EMA) announced on 12 June 2015 that the Pharmacovigilance Risk Assessment Committee has started a review of all of the three approved SGLT2 inhibitors (canagliflozin, dapagliflozin, and empagliflozin) to evaluate the risk of DKA in T2D (2). The EMA announcement claimed that as of May 2015 a total of 101 cases of DKA have been reported worldwide in EudraVigilance in T2D patients treated with SGLT2 inhibitors, with an estimated exposure over 0.5 million patient-years. No clinical details were provided except for the mention that “all cases were serious and some required hospitalisation. Although [DKA] is usually accompanied by high blood sugar levels, in a number of these reports blood sugar levels were only moderately increased” (2). Wit Continue reading >>
Diabetes With Ketone Bodies In Dogs
Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA. Diabetes with ketone bodies is also described in veterinary terms as diabetic ketoacidosis or DKA. It is a severe complication of diabetes mellitus. Excess ketone bodies result in acidosis and electrolyte abnormalities, which can lead to a crisis situation for your dog. If left in an untreated state, this condition can and will be fatal. Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below: Change in appetite (either increase or decrease) Increased thirst Frequent urination Vomiting Abdominal pain Mental dullness Coughing Fatigue or weakness Weight loss Sometimes sweet smelling breath is evident Slow, deep respiration. There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease. While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA: Fasting Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerba Continue reading >>
Managing Diabetes Complicated By Ketoacidosis
Go to site For Pet Owners Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus that has to be aggressively treated. Diagnosis The diagnosis is based on the presence of ketonuria with signs of systemic illness. Management guidelines Goals of treatment include the correction of fluid deficits, acid-base balance and electrolyte balance, reduction of blood glucose and ketonuria, and beginning insulin therapy and treatment of concurrent diseases. Many protocols for treatment exist but rapid-acting insulin (regular) must be administered first, as decreases in the hyperglycemia must be achieved quickly. When blood sugar levels are lowered and maintained at 200−250 mg/dL for 4−10 hours, then Vetsulin® (porcine insulin zinc suspension) can be used. Evaluation of treatment When evaluating the regulation of insulin therapy, it is important to consider several areas including the evaluation of glycemia, urine monitoring, routine rechecks and glycated protein evaluations. Evaluation of the glycemia Creating a blood glucose curve is the most accurate way to evaluate glycemia in order to adjust the dose of Vetsulin. Indications for creating a blood glucose curve are: First, to establish insulin dose, dosing interval, and insulin type when beginning regulation. Second, to evaluate regulation especially if problems occur. Third, when rebound hyperglycemia (Somogyi effect) is suspected. Contraindications for creating a blood glucose curve are: Concurrent administration of drugs affecting glycemia. Presence of a known infection or disease. Stressed animal. The procedure is as follows: The most accurate way to assess response to management is by generating a blood glucose curve. Ideally, the first sample should be taken just prior to feeding Continue reading >>
Feline Diabetic Ketoacidosis
Fall 2008 Ketoacidosis is a metabolic imbalance that is most commonly seen as a sequel to unmanaged or poorly regulated diabetes mellitus. It is caused by the breakdown of fat and protein in a compensatory effort for the need of more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product in the form of ketones. As ketones build up in the blood stream, pH and electrolyte imbalances proceed. This condition is a potentially life-threatening emergency that requires immediate medical attention. Diabetes mellitus is a common endocrine disease in geriatric felines. It is caused by a dysfunction in the beta cells of the exocrine pancreas resulting in an absolute or relative deficiency of insulin. Insulin has been called the cells' gatekeeper. It attaches to the surface of cells and permits glucose, the cells' primary energy source, to enter from the blood. A lack of insulin results in a build up of glucose in the blood, physiologically causing a state of cellular starvation. In response to this condition the body begins to increase the mobilization of protein and fat storage. Fatty acids are released from adipose tissue, which are then oxidized by the liver. Normally, these fatty acids are formed into triglycerides. However, without insulin, these fatty acids are converted into ketone bodies, which cannot be utilized by the body. Together with the increased production and decreased utilization an abnormally high concentration of ketone bodies develop. These fixed acids are buffered by bicarbonate; however, the excessive amounts overwhelm and deplete the bicarbonate leading to an increase in arterial hydrogen ion concentration and a decrease in serum bicarbonate. This increase in hydrogen ions lowers the body's pH, leading to a metabolic ac Continue reading >>