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Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

Ketosis

Ketosis

Not to be confused with Ketoacidosis. Ketosis is a metabolic state in which some of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose provides energy. Ketosis is a result of metabolizing fat to provide energy. Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted (or from metabolising medium-chain triglycerides[3]). The main ketone bodies used for energy are acetoacetate and β-hydroxybutyrate,[4] and the levels of ketone bodies are regulated mainly by insulin and glucagon.[5] Most cells in the body can use both glucose and ketone bodies for fuel, and during ketosis, free fatty acids and glucose synthesis (gluconeogenesis) fuel the remainder. Longer-term ketosis may result from fasting or staying on a low-carbohydrate diet (ketogenic diet), and deliberately induced ketosis serves as a medical intervention for various conditions, such as intractable epilepsy, and the various types of diabetes.[6] In glycolysis, higher levels of insulin promote storage of body fat and block release of fat from adipose tissues, while in ketosis, fat reserves are readily released and consumed.[5][7] For this reason, ketosis is sometimes referred to as the body's "fat burning" mode.[8] Ketosis and ketoacidosis are similar, but ketoacidosis is an acute life-threatening state requiring prompt medical intervention while ketosis can be physiological. However, there are situations (such as treatment-resistant Continue reading >>

Diabetes With Ketone Bodies In Dogs

Diabetes With Ketone Bodies In Dogs

Diabetes Mellitus with Ketoacidosis in Dogs Diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. The term “ketoacidosis,” meanwhile, refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies”. 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. This condition typically affects older dogs as well as females. In addition, miniature poodles and dachshunds are predisposed to diabetes with ketoacidosis. 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 dog'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 dog’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 (azo Continue reading >>

Genetic Welfare Problems Of Companion Animals

Genetic Welfare Problems Of Companion Animals

Poodle (all types) Diabetes Mellitus Related terms: Canine diabetes mellitus, DM, Diabetic Ketoacidosis VeNom term: Diabetes mellitus (VeNom code: 658). Related conditions: Cataract, Pancreatitis, Hyperadrenocorticism Outline: Diabetes mellitus is a hormonal disorder that occurs when there is a failure to adequately control blood sugar levels. Dogs that have the condition are unable to use blood sugar as an energy source for the cells in their body as they would normally, and therefore the level of sugar in the blood increases. The most common signs of diabetes mellitus are excessive thirst and urination with weight loss. The onset of diabetes mellitus occurs most commonly in middle aged or older dogs. Left untreated, diabetes mellitus can lead to complications including a severe illness called diabetic ketoacidosis where the body begins to break down body tissue, such as fats and muscle, to use as a source of energy in place of blood sugars. This process produces toxins that can cause dehydration, nausea and vomiting and can be life-threatening if left untreated. Diabetic dogs are generally reliant on dietary management and daily injections of the hormone insulin for the rest of their lives. There is evidence of a genetic basis for the development of diabetes mellitus, and Poodles have been shown to be at increased risk of the condition compared with the general dog population. Summary of Information (for more information click on the links below) 1. Brief description Diabetes mellitus is a hormonal disorder which results in high levels of sugar (glucose) in the blood. Glucose is an important source of energy in the body. In animals that are diabetic, the cells in the body are unable to absorb glucose properly, and this leads to an increase in the blood. In dogs, the m Continue reading >>

What Does Type 1 Diabetes Have To Do With Eating Disorders And Mental Health Conditions?

What Does Type 1 Diabetes Have To Do With Eating Disorders And Mental Health Conditions?

Diabulimia Diabulimia is the common term for when someone with Type 1 diabetes uses insulin omission as a process for weight control. Eating disorders present in different forms and with more severe consequences. Omitting insulin puts people at risk of Diabetic Ketoacidosis, which is fatal if left untreated. Some people develop symptoms of anorexia nervosa and this also has an impact on diabetic control. The nutritional consequences of starvation on the brain and body are more marked when insulin/glucose control is suboptimal. It is estimated that 40 percent of Type 1 females aged 15—30 regularly omit insulin for weight control. The combination of diabetes and an eating disorder produces a serious, pervasive and complex psychiatric condition and should be treated as such, with understanding & compassion but also with urgency as per NICE guidelines. Complications include blindness, limb loss, neuropathy blindness and fatality . ED-DMT1, Co-morbid Anorexia & Bulimia ED-DMT1 (Eating Disorders in Diabetes Mellitus Type 1) is an umbrella term to describe a multitude of eating disturbances in Type 1 diabetes . Current research suggests that those with Type1 Diabetes are twice as likely to develop anorexia or bulimia. Treatment for this condition is complex and requires good physical and psychological care. Psychological therapy which relies on a brain which can learn and reflect is less effective if brain function is compromised by poor diabetic control. Also, if diabetes professionals ignore emotions around food and body shape then diabetes education will be ineffective. Symptoms Recurrent episodes of hyperglycaemia Recurrent episodes of hypoglycaemia Frequent hospitalisations for poor blood sugar control Delay in puberty or sexual maturation or irregular menses / amenorrh Continue reading >>

Eating Disorders

Eating Disorders

Eating disorders are a significant health problem for many people with Type 1 diabetes, especially among adolescents. In Type 1 diabetes, the pancreas cannot produce insulin because the cells that manufacture insulin have been destroyed by the body’s own immune system. This insulin must be replaced in order for the body to absorb glucose from food, therefore people with Type 1 diabetes need to administer insulin daily. Managing Type 1 diabetes is a complex balancing act between different pharmacological insulin regimes and support from a diabetes health care team. A healthy eating plan is a central part of managing Type 1 diabetes, alongside insulin injections or a pump, and a program of physical activity. This means that a person with diabetes will have to focus on their food intake over a long period of time, which can sometimes lead to a problematic relationship with food and eating. Who is at risk? Anyone living with diabetes can be at risk of developing an eating disorder, however research suggests that adolescent and young adult women are most at risk. This may be due to the particular challenges that come with this period in their lives. For example, during adolescence, factors such as school, peer pressure and body image concerns can lead to significant stress. In addition, developmental and hormonal changes can have an impact on blood sugar control, leading to difficulties in diabetes management. Young adulthood is a similarly challenging time. Schedules often become busier, there are increasing work pressures, new friendships and serious relationships are formed. This is also a time that people begin to create their own identity. Factors that may increase the risk of developing an eating disorder As well as individual, family and social stresses that can con Continue reading >>

Ketosis

Ketosis

Ketosis is the process by which the body, suffering low intake of carbohydrates, instead converts stored fat into energy. During this conversion, ketones are produced as a by-product, causing an unpleasant fruity breath odor that may be mistaken for alcohol. Prolonged severe ketosis can change the acidity of the blood, and may eventually lead to serious damage to the liver and kidneys. Additional information. Keywords: define Ketosis, definition Ketosis, definition of Ketosis, meaning Ketosis, dictionary Ketosis, what is Ketosis If you came to the F.E.A.S.T. Eating Disorders Glossary from a page on the F.E.A.S.T site, click the "go back" button in your internet browser to return to that page; if not, we welcome you to visit the FEAST home page for a wealth of information on evidence-based treatment for eating disorders, support for parents and families, the latest eatings disorders research, a forum for parents and caregivers, useful books, etc. Continue reading >>

Anxiety, Blackouts (memory Time Loss), Blurred Vision And Compulsive Behavior

Anxiety, Blackouts (memory Time Loss), Blurred Vision And Compulsive Behavior

WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms anxiety, blackouts (memory time loss), blurred vision and compulsive behavior including Epilepsy (complex partial seizures), Generalized anxiety disorder, and Diabetes, type 2. There are 53 conditions associated with anxiety, blackouts (memory time loss), blurred vision and compulsive behavior. The links below will provide you with more detailed information on these medical conditions from the WebMD Symptom Checker and help provide a better understanding of causes and treatment of these related conditions. Epilepsy (complex partial seizures) During complex partial seizures, people lose consciousness briefly. Generalized anxiety disorder Generalized anxiety disorder is a condition in which a person has nearly constant anxiety. Diabetes, type 2 Diabetes can make you feel hungry, tired, or thirsty; you may urinate more than normal and have blurry vision. Transient ischemic attack (mini-stroke) Transient ischemic attacks cause headache, numbness, tingling, or weakness in the face, arm, or leg, and more. Epilepsy (simple partial seizures) During simple partial epileptic seizures, people remain fully conscious, able to respond to external stimuli. Short-acting sedative use The symptoms of short-acting sedatives include drowsiness, vertigo, muscle weakness, double vision, and more. Excessive caffeine use Excessive caffeine use can cause irritability, difficulty sleeping, anger, depression, and fatigue. Eye injury There are many types of eye injury, and symptoms include eye pain, burning, irritation, bleeding, and more. Nearsightedness Nearsightedness is a common eye problem that causes blurry, distant vision. Panic attack When someone has a panic attack, that person feels a sudden Continue reading >>

How To Identify Ketosis

How To Identify Ketosis

Expert Reviewed Ketosis is a normal metabolic process by which your body breaks down stored fat for energy, which can also result in a dangerous buildup of ketones in the body called ketoacidosis.[1] Ketosis is often the product of a low-carbohydrate diet that people use to lose weight and gain muscle or it can also be a product of malnutrition. Although the long-term risks of ketosis are not clear, there is some evidence that it can increase your risk of heart disease and certain cancers.[2] By recognizing the signs of ketosis, you can help minimize your risk for developing ketoacidosis.[3] Continue reading >>

Ketosis: What Is Ketosis?

Ketosis: What Is Ketosis?

Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

The Dept of Anaesthesia & Intensive Care, CUHK thanks for an unrestricted education grant BASIC instructor/provider course, Hong Kong, July 2nd-4th Other upcoming courses Diabetic hyperosmolar coma Diabetic ketoacidosis Causes -20% cases initial presentation of DM - failure to take insulin (Type I DM) - infection - sterile inflammation eg MI - excessive physical activity Clinical features Symptoms - when history available varies from a few weeks to a few days - osmotic symptoms - anorexia - vomiting +/- diarrhoea. Vomiting particularly useful as a warning in known diabetic - abdo pain (uncommon): dull persistent discomfort often affecting whole abdomen but usually centred on the umbilicus Signs 3 cardinal signs: dehydration overbreathing ketones on breath Others: confusion/coma +/- shock signs of DM and complications +/- signs of precipitating factor Differential diagnosis - hypoglycaemic coma - hyperosmolar coma - lactic acidosis - CVA Investigations - hyperglycaemia - metabolic acidosis. Initially high anion gap but as ketones excreted becomes normal anion gap acidosis - hyperkalaemia usual, but hypokalaemia possible - features of dehydration - glycosuria and ketonuria while urine flow adequate - ECG - CXR - cultures - FBC Treatment General - CVP line - NG tube - wide bore as contents may be viscous - urinary catheter - SC heparin unless clearly contra-indicated Fluids - NB patients with rapid onset of DKA are not necessarily severely dehydrated unlike patients who have gone out of control slowly. - urine output most useful indicator of hydration. If urine output is good patient is not severely dehydrated. - circulatory collapse should be treated with plasma expanders and blood not crystalloids - start replacement with 1L N/saline over 1 hour and then decrease to 100 Continue reading >>

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DHPC agreed by CHMP on 25 February 2016 *JARDIANCE and SYNJARDY are co-promoted by Boehringer Ingelheim Limited and Eli Lilly and Company Limited Direct Healthcare Professional Communication Updated advice on the risk of diabetic ketoacidosis during treatment with SGLT2 inhibitors (INVOKANA▼ (canagliflozin), VOKANAMET▼ (canagliflozin / metformin), FORXIGA▼ (dapagliflozin), XIGDUO▼ (dapagliflozin / metformin), JARDIANCE▼* (empagliflozin), SYNJARDY▼* (empagliflozin / metformin)) Dear Healthcare Professional, In agreement with the European Medicines Agency (EMA) and Health Products Regulatory Authority (HPRA), Janssen-Cilag Limited, AstraZeneca Limited and Boehringer Ingelheim Limited would like to inform you of the latest recommendations regarding the risk of diabetic ketoacidosis (DKA) during treatment with SGLT2 inhibitors (canagliflozin, dapagliflozin or empagliflozin). This follows on the outcome of an evaluation by the EMA of the risk of diabetic ketoacidosis during treatment with SGLT2 inhibitors. Rare but serious, sometimes life-threatening and fatal cases of diabetic ketoacidosis have been reported in patients on SGLT2 inhibitor treatment for type 2 diabetes. In a number of these reports, the presentation of the condition was atypical with only moderately increased blood glucose levels observed. Such atypical presentation of diabetic ketoacidosis in patients with diabetes could delay diagnosis and treatment. Summary of updated advice • The risk of diabetic ketoacidosis must be considered in the event of non-specific symptoms such as nausea, vomiting, anorexia, abdominal pain, excessive thirst, difficulty breathing, confusion, unusual fatigue or sleepiness. Prescribers should inform patients of signs and symptoms of metabol Continue reading >>

Severe Diabetic Ketoacidosis In Combination With Starvation And Anorexia Nervosa At Onset Of Type 1 Diabetes: A Case Report

Severe Diabetic Ketoacidosis In Combination With Starvation And Anorexia Nervosa At Onset Of Type 1 Diabetes: A Case Report

Go to: A 53-year-old woman with a history of AN since adolescence was admitted to the psychiatric clinic at the Uppsala University Hospital due to psychotic behaviour and inability to take care of herself. There were reports of paranoid schizophrenia and personality disorders, but her contacts with the psychiatric clinic were sparse, and she used no medications. According to her relatives she had isolated herself the last two weeks, and over the last two months she had barely been eating at all. Twenty-four hours after admission to the psychiatric clinic she was admitted to the clinic of internal medicine and presented at the emergency room (ER) in a cachectic state with hypothermia (32.6°C). Her mental status was altered (reaction level scale 2), and she barely responded to questions, being close to stupor. There were clinical signs of severe dehydration and muscle atrophy. Her breathing was shallow with 30 bpm, whereas blood pressure and pulse rate were normal, 110/60 mmHg and 77 bpm (see Table I for a summary of the initial physical examination). She denied alcohol and any substance abuse. An initial arterial blood gas analysis displayed pH 6.895, pCO2 0.93 kPa, pO2 22 kPa, and P-glucose 40.6 mmol/L. There were no signs of infection, and electrolytes were normal (see Table II for a summary of laboratory screening). She was immediately admitted to the intensive care unit (ICU), where rehydration was initiated with warm fluid combined with re-warming with heated blankets. Bicarbonate (100 mL) was administered i.v. in order to reverse acidosis; pH increased to 7.1, and blood glucose decreased to 35 mmol/L. Six hours after ICU admission insulin infusion was started with initially 0.5 IU/h (0.0128 IU/kg) combined with 5 mmol potassium/h. The patient's pH was normalized 1 Continue reading >>

Eating Disorders In Type 1 Diabetes: Risks And Recommendations

Eating Disorders In Type 1 Diabetes: Risks And Recommendations

Girls and women with type 1 diabetes (T1DM) are almost 2.5 times as likely to develop an eating disorder as those without diabetes(1). In order to understand why this might be, one must first understand the complexity of T1DM and the unique symptom of insulin restriction. Recently, this phenomenon has been referred to as “diabulimia” in both the popular press and by those who are struggling themselves. I have a love-hate relationship with the term. My love comes from the knowledge that having a name has given women who struggle an actual voice. They have something to call it and something to describe. Also, if something has a name, then they can’t be the only ones with the problem. This awareness is a huge step forward as it brings with it the possibility of decreasing shame and possible secrecy. My hate, which is too strong a word, comes from several angles. First, the “bulimia” part of the word runs the risk of implying that only people who binge have this problem. What I’ve seen in my practice is that eating disorders of all kinds occur in the context of T1DM. I think of them as falling on a continuum—people can exclusively restrict food and calories, they can restrict both food and insulin, they can eat normally and restrict insulin, they can binge and restrict insulin, they can use other means of purging, or they can binge without purging. This leads to my second problem with the term, which is that it seems to oversimplify the problem taking all these nuances and fitting them into one entity. The reality is that all eating disorders in the context of T1DM are complex, tormenting, and dangerous and all deserve access to appropriate treatment. With that said, the remainder of this article will focus on the problem of insulin restriction, since up to 30 Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

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