What Is It? Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when you have much less insulin than your body needs. This problem causes the blood to become acidic and the body to become dangerously dehydrated. Diabetic ketoacidosis can occur when diabetes is not treated adequately, or it can occur during times of serious sickness. To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>
> Hyperglycemia And Diabetic Ketoacidosis
When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>
What is diabetic ketoacidosis? Diabetic ketoacidosis is a complication of diabetes that occurs when compounds called ketones build up in the bloodstream. Ketones are produced when the body breaks down fats instead of sugars, which happens when the body does not produce enough insulin to process sugar properly. Ketoacidosis generally develops in people with type 1 diabetes, a chronic condition in which the pancreas produces too little or no insulin. It can also happen, although uncommonly, in those with type 2 diabetes, a chronic condition in which your body is either resistant to insulin or your pancreas does not produce enough insulin. Symptoms worsen over time as the body attempts to use fat instead of sugar for energy. Blood sugar levels generally increase dramatically during the development of diabetic ketoacidosis, as the liver attempts to compensate for the lack of sugar-derived energy. Diabetic ketoacidosis can lead to rapid breathing, flushing, fruity-smelling breath, nausea, vomiting, pain, fatigue, headache, and muscle stiffness. In severe cases, ketoacidosis can lead to a slowing of mental activity that can progress to a coma. The consequences of ketoacidosis can be severe, even life threatening, but modern treatments are usually very effective at preventing serious complications if treatment is obtained early. Seek immediate medical care (call 911) for serious symptoms of ketoacidosis, such as decreased consciousness, difficulty breathing, mental stupor, or unexplained fruity-smelling breath. Seek prompt medical care for any symptoms of diabetes or high blood glucose levels, as early treatment is critical for preventing life-threatening complications. Continue reading >>
The Facts Diabetic ketoacidosis (DKA) is a condition that may occur in people who have diabetes, most often in those who have type 1 (insulin-dependent) diabetes. It involves the buildup of toxic substances called ketones that make the blood too acidic. High ketone levels can be readily managed, but if they aren't detected and treated in time, a person can eventually slip into a fatal coma. DKA can occur in people who are newly diagnosed with type 1 diabetes and have had ketones building up in their blood prior to the start of treatment. It can also occur in people already diagnosed with type 1 diabetes that have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. Although much less common, DKA can occasionally occur in people with type 2 diabetes under extreme physiologic stress. Causes With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin in order to take in glucose from the blood. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 22 mmol/L (400 mg/dL) while insulin levels are very low. Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able Continue reading >>
What Is It Like To Go On A Ketogenic Diet?
It's do-able. Some people love it and some people hate it. Personally, I find that nutritional ketosis is almost ideal for me, whereas "normal" eating with lots of carbs in my diet leads to feelings of non-satiety, drowsiness, mood swings, insulin spikes, bloating, and sometimes nausea. A ketogenic diet consists of 70-80% calories from fat, 15-25% calories from protein, and 0-5% calories from net carbohydrates (carbs). You must restrict your daily net carbs to 20-40g daily. (total grams carbs) - (grams fiber) = (net grams carbs) Your transition period depends on a few factors: how strictly you limit your carbohydrate intake, how much energy you expend day-to-day, and how much energy in the form of glucose and glycogen you have stored in your body currently. My transition period takes 3 days. Day 1: This is an easy day. Your blood is still filled with circulating glucose, and any deficit will be taken from the glycogen in your liver to be converted to glucose. You may feel hunger pangs by the afternoon, and a small dip in insulin, which will feel normal to you because this is what happens every day on a normal diet and you are used to it. Day 2: This is an easy day, too. Your body is happily pulling glycogen from your liver, converting it to glucose, and all is well. Any small amount of carbs that you consume are burned away, nothing is being stored. You may feel the typical afternoon slowdown and hunger, as on day 1. Day 3: Hard day. Your body has been (or is nearly) depleted of glucose and glycogen. The small amount of carbs that you consume are not enough to fuel your brain. You have a feeling of satiety from all the fat you are consuming, but you may feel achy, have headaches, and feel sluggish. Your body is alerting you to the lack of glucose and glycogen. It will t Continue reading >>
What Can Happen To My Body If My Sugar Is Higher Than 600 For Many Hours?
Dangerously high blood sugar levels cause ketoacidosis. A blood sugar level over 600 for many hours is considered extremely dangerous and should be treated at a hospital. Hyperglycemia is the medical term for elevated blood sugar levels. According to the American Diabetes Association, blood sugars more than 240 can cause ketoacidosis – a condition where the body starts using fat for energy. Ketoacidosis can lead to coma and death. Video of the Day Ketones And High Blood Sugar When blood sugar levels are high for prolonged periods of time and the body starts using fat for energy, toxic ketones are produced. The presence of ketones can be measured in the urine. They are the acid byproduct of fat breakdown. Diabetes is the most common cause of high blood sugar levels. Hyperglycemia can also be caused by acute pancreatitis. Early symptoms include frequent urination that leads to dehydration and excessive thirst. Blood sugar more than 600 for many hours could then lead to difficulty breathing, weakness, confusion and decreased level of consciousness. Blood sugar levels become dangerously high when the body does not have enough insulin, which is produced in the pancreas. When ketones develop in the body, the liver produces more glucose to correct the problem, but without insulin, blood sugar levels continue to rise. For patients diagnosed with diabetes, ketoacidosis can develop from missed insulin doses, not enough insulin, infection, trauma or other acute illness. Prolonged high blood sugar levels can cause swelling in the brain – cerebral edema. Children are more susceptible, but adult cases have been documented, according to Elliot J. Crane, MD, Departments of Pediatrics and Anesthesiology, Stanford University Medical Center. Other complications include organ damage fr Continue reading >>
Renal Function And Effects Of Partial Rehydration During Diabetic Ketoacidosis
Although diabetic ketoacidosis is characterized by increased renal excretion of glucose, ketone bodies, and nitrogenous compounds, there are few quantitative studies pertaining to renal function during this state. Therefore, renal function was studied in 10 adult patients in moderate to severe diabetic ketoacidosis before insulin administration. Admission plasma concentrations were: glucose 21.4 (9.2–39.4) mM or 386 (166–710) mg/dl, acetoacetate 3.0 (1.3–7.4) mM, beta-hydroxybutyrate 7.9 (2.9–15.2) mM, acetone 4.4 (1.3–8.9) mM, and HCO3 12.8 (9.5–17.8) mM. Arterial blood pH was 7.28 (7.21–7.38). Partial rehydration was achieved with 0.45% saline. Inulin was used to measure GFR. Renal clearance of acetoacetate, beta-hydroxybutyrate, acetone, glucose, and urinary excretion of nitrogenous compounds were determined. Partial rehydration reduced plasma glucose concentration, primarily because of renal excretion, amounting to 384 ± 73 μmol/min or 69 ± 13 mg/min. Partial rehydration had no effect on plasma ketone bodies, on bicarbonate or urea concentrations, or on arterial pH. Partial rehydration had no effect on ketone body or nitrogenous compound excretory rates. Reabsorptive rates of acetoacetate, beta-hydroxybutyrate, acetone, and glucose increased linearly with their filtered loads, and no maximal renal tubular transport rates were demonstrated for any ketone body or glucose. Because renal absorption of ketone bodies was less than 100%, ketonuria increased as filtered loads increase. Unlike ketone bodies, glucose reabsorptive rate was directly related to GFR. Total renal excretion of nitrogen in the forms of urea, ammonium, creatinine, and uric acid amounted to 16 ± 2 mg/min. This huge loss of body nitrogen reflected ongoing protein catabolism and not he Continue reading >>
Diabetic Ketoacidosis - Symptoms
A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), 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. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>
Diabetic Ketoacidosis Or Dka
Diabetic ketoacidosis, often referred to as ketoacidosis or simply DKA, is a short term complication of high blood glucose levels in people with diabetes. It most commonly occurs in people with type 1 diabetes but it can also affect some people with type 2 diabetes who are also reliant on insulin (insulin-dependent). Ketoacidosis is a serious medical condition and can advance very quickly within a matter of hours, or sometimes as quickly as within one hour. It is therefore important to know whether you are at risk of ketoacidosis and, if so, to be able to spot the signs and react accordingly. What causes diabetic ketoacidosis? Ketoacidosis occurs when the body starts running out of insulin – the hormone responsible for regulating levels of blood sugar. Without enough insulin, the cells cannot access glucose from the blood and so the body responds by breaking down protein and fat to produce an alternative form of energy called ketones. Whilst the body can cope with lower levels of ketones, higher levels can turn the blood acidic and pose an immediate danger to health, often causing severe illness. Am I at risk of ketoacidosis? People with type 1 diabetes or LADA (Latent Autoimmune Diabetes of Adulthood) who require insulin injections are most at risk of developing ketoacidosis. Type 2 diabetics who need to take meal time insulin (short or rapid-acting insulin) in addition to long term (basal) insulin may also be at risk. What the signs of diabetic ketoacidosis? The symptoms of ketoacidosis include: Lethargy Nausea and/or stomach pains Vomiting Dehydration Laboured breathing Confusion If you have any of the symptoms of ketoacidosis contact your health care provider immediately. Early detection and treatment is vital in cases of DKA, as failure to treat the condition qui Continue reading >>
Which Foods Increase Blood Acidity?
Before Having Your Tonsils Removed Tonsillectomies are performed under general anesthesia. You will be completely asleep and will not be able to feel pain during the procedure. You will not be able to eat before surgery. This is because there is a risk of vomiting with anesthesia. Your physician or nurse will give you exact instructions about when to stop eating and drinking. In addition to not eating or drinking, you should not smoke, chew gum, or suck on mints or candy. Tonsillectomies are mostly performed in same day surgery settings. This means that you will go home the same day that you have your tonsils removed. You should wear loose comfortable clothing to the surgical center. Arrive on time. In some cases a medication called Versed can be given prior to the procedure to reduce anxiety, especially in small children. If you have other health problems, your doctor may order blood work or other tests before the surgery. If you are a woman of childbearing age (usually age 12 to 55 unless you have had a hysterectomy), it is mandatory that you have a pregnancy test before the surgery. This requires a small amount of urine. If the patient is a child and has a comfort item, such as a blanket or a favorite toy, bring it with you. Also, if your child drinks from a bottle or special cup, bring it along so your child can drink after the surgery. Make sure you bring comfortable clothing and extra diapers or underwear. Prior to having your tonsils removed, you will need to remove any metal from your body, including jewelry, retainers or body piercings. You will also need to remove contact lenses, dentures, and hearing aids. You will also need to refrain from medications that have the ability to thin your blood for one to two weeks before surgery. These medications include aspi Continue reading >>
Editorial Review Diabetic Ketoacidosis: Role Of The Kidney In The Acid-base Homeostasis Re-evaluated
The development of diabetic ketoacidosis (DKA) involves a series of closely interrelated derangements of intermediary metabolism and of body fluid volume and composition whose fundamental nature has not been completely unraveled [1–8]. The composite clinical picture in full-blown DKA on admission includes hyperglycemia with hyperosmolality, metabolic acidosis due to the accumulation of ketoacids, extracellular and intracellular fluid (ECF and ICF, respectively) volume depletion, and varying degrees of electrolyte deficiency, particularly of potassium and phosphate [9–11]. Since proper correction of the alterations in volume status, acid-base, and electrolyte composition is critical for survival, a clear understanding of the pathogenesis of these derangements is essential for the adequate management of DKA. The present review will focus on the role of the kidney in the pathogenesis of the different patterns of electrolyte and acid-base composition observed on admission for and during recovery from DKA. Special emphasis will be placed on the role of the kidney in the defense of acid-base homeostasis during the recovery phase. Other aspects of the alterations that develop in DKA have been reviewed in detail elsewhere [12–14]. Continue reading >>
Effects Of Diabetes
In some cases the effects may be short term and can be eliminated through appropriate treatment. In the case of long term complications, any damage sustained tends to be permanent. Whilst there are a lot of ways in which diabetes can affect the body, it’s important to note that the risks of developing health problems can be significantly reduced through good management of diabetes and living a healthy life. Heart Higher than normal blood sugar levels over a period of time can lead to an increase in risk of damage occurring to larger blood vessels in the body. This raises the risk of blood clots forming in blood vessels which can lead to heart attacks – a form of coronary heart disease. Approximately, 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Learn more about Heart disease. Brain The brain is another major organ that can pose a threat to life if it is affected by damage or blockages in its blood supply. Elevated blood sugar levels over a long period of time can cause blockages in the blood vessels supplying the brain, resulting in stroke, and can also damage the very small blood vessels in the outer part of the brain, increasing the risk of brain damage and conditions such as Alzheimer’s disease. In the short term, too low blood glucose levels can lead to a reduced ability to make decisions and cause confusion and disorientation. Nerves The nerves play a very important part throughout the body. Not only do they allow us to sense touch, nerves also allow our organs to function properly. For instance, nerves are crucial in helping the digestive system to sense how it should respond. If the nerves become damaged we can lose our ability to sense pain in parts of the body that are affected and if nerve damage (ne Continue reading >>
Is Ketosis Dangerous?
Duck Dodgers October 14, 2014 Peter, An article by Per Wikholm was published in this month’s LCHF Magasinet, where Per demonstrates that the Inuit could not have been in ketosis given that the scientific literature is abundantly clear, over and over again, that the Inuit consumed too much protein, and more importantly, Per debunks Stefansson’s claims for high fat with writing from his own books—Stef admitted in the pemmican recipes that Arctic caribou was too lean to make pemmican that supported ketosis. The most popular LCHF bloggers in Sweden, Andreas Eenfeldt/Diet Doctor and Annika Dahlquist have reluctantly agreed with Per’s findings—admitting that the Inuit were likely not ketogenic from their diet. I’ve put together a comprehensive review of the scientific literature regarding the Inuit, encompassing over two dozen studies, spanning 150 years, with references from explorers, including Stefansson. In the comments section of that post, Per gives a brief overview of how he was able to prove Stefansson’s observations on high fat intake were flawed. The post is a review of all the available literature that I could find (over two dozen studies). But, the literature certainly does not in any way support ketosis from the Inuit diet due to such high protein consumption. As Per (and Stefansson) points out, the caribou is too lean and as the many quotes show, the Inuit were saving their blubber and fat for the long dark Winter to power their oil lamps and heat their igloos. Again and again, we see that in the literature, as even Stefansson admits this. As far as glycogen is concerned, their glycogen intake is probably not worth scrutinizing given the well-documented high protein consumption in every published study. It really is besides the point. But, interest Continue reading >>
Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)
Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>