What You Should Know About Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>
Diabetic Ketoacidosis Symptoms
What is diabetic ketoacidosis? Diabetic ketoacidosis, also referred to as simply ketoacidosis or DKA, is a serious and even life-threatening complication of type 1 diabetes. DKA is rare in people with type 2 diabetes. DKA is caused when insulin levels are low and not enough glucose can get into the body's cells. Without glucose for energy, the body starts to burn fat for energy. Ketones are products that are created when the body burns fat. The buildup of ketones causes the blood to become more acidic. The high levels of blood glucose in DKA cause the kidneys to excrete glucose and water, leading to dehydration and imbalances in body electrolyte levels. Diabetic ketoacidosis most commonly develops either due to an interruption in insulin treatment or a severe illness, including the flu. What are the symptoms and signs of diabetic ketoacidosis? The development of DKA is usually a slow process. However, if vomiting develops, the symptoms can progress more rapidly due to the more rapid loss of body fluid. Excessive urination, which occurs because the kidneys try to rid the body of excess glucose, and water is excreted along with the glucose High blood glucose (sugar) levels The presence of ketones in the urine Other signs and symptoms of ketoacidosis occur as the condition progresses: These include: Fatigue, which can be severe Flushing of the skin Fruity odor to the breath, caused by ketones Difficulty breathing Type 2 Diabetes Diagnosis, Treatment, Medication What should I do if I think I may have, or someone I know may diabetic ketoacidosis? You should test your urine for ketones if you suspect you have early symptoms or warning signs of ketoacidosis. Call your health-care professional if your urine shows high levels of ketones. High levels of ketones and high blood sug Continue reading >>
Type 1 Diabetes In Adults: Diagnosis And Management
High blood glucose (hyperglycaemia) that is not treated can lead to a serious condition called diabetic ketoacidosis (or DKA for short). It is caused by the build‑up of harmful ketones in the blood. People with type 1 diabetes are at risk of DKA. You may be advised to test for ketones in your blood or urine as part of sick-day rules. Your blood ketones may be measured by a healthcare professional if it is thought you might have DKA. If you have DKA you will need emergency treatment in hospital by a specialist care team. This will include having fluids through a drip. Questions to ask about DKA Continue reading >>
Substantial Reduction In Hospital Stay Of Children And Adolescents With Diabetic Ketoacidosis After Implementation Of Clinical Practice Guidelines In A University Hospital In Saudi Arabia
Abstract We aimed to determine the effect of Clinical Practice Guideline (CPG) implementation on length of hospital stay of children and adolescents with diabetic ketoacidosis (DKA). This was a 6-year (2008-2014) case-control retrospective study conducted at King Khalid University Hospital, Riyadh, that compared patients with DKA managed using CPG with those treated before CPG implementation. There were 63 episodes of DKA in 41 patients managed using CPG compared with 40 episodes in 33 patients treated before implementation of CPG. Baseline characteristics of the 2 groups were similar (age, sex, newly diagnosed patients, recurrent DKA, DKA severity, and mean glycosylated hemoglobin). The mean length of hospital stay (±SD) was 68.6 ± 53.1 hours after implementation of CPG compared with 107.4 ± 65.6 hours before implementation (P < .001). The reduction in length of hospital stay equals to 1700 bed days saved per year per 1000 patients. Implementation of CPG for DKA decreased the length of hospital stay. 1 INTRODUCTION Type 1 diabetes (T1D), the third leading chronic disease in children and adolescents, is a major health problem.[1, 2] There is an alarming increase in the world-wide incidence of T1D.[1, 2] In Saudi Arabia alone, it is estimated to be 27.5 per 100 000 individuals per year. Diabetic ketoacidosis (DKA) is the main acute complication of T1D.[4, 5] It is caused by reduced insulin levels, decreased glucose utilization, increased gluconeogenesis, and elevated counter-regulatory hormones including, glucagon, cortisol, and catecholamines. The incidence of DKA is 13.6 and 14.9 per 1000 patients with T1D per year in the UK and Swedenm respectively.[6, 7] The rate of hospital admission of diabetic patients with DKA has increased by about 30% in the last decade i Continue reading >>
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Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>
Diabetic Ketoacidosis (dka): How Do You Know When It Is Time To Go To The Hospital?
I Have These Symptoms All the Time If you are diabetic, and have been for a while, you develop a different sense of what feeling "normal" is and when it is time to be concerned. However, even those of us with the most keen sense of our blood sugar levels based on symptoms we experience can become desensitized to how close we are to falling into a far more dismal situation known as Diabetic Ketoacidosis otherwise known as DKA. As described by the American Diabetes Association DKA is “a serious condition that can lead to diabetic coma and even death”. The ADA goes on to explain that when your cells don’t get the level of glucose they need to produce energy, our bodies have to go elsewhere to find means, like burning fat. The problem is that when the body burns fat for energy it produces an acid called Ketones which spill into the blood stream and become very toxic to your body. A diabetic in the state of DKA is essentially being poisoned by their own body as it seeks energy it cannot get from glucose saturated blood cells as it normally would. What does Diabetic Ketoacidosis (DKA) feel like? Does it Hurt? Being in a state of DKA, from my experience, starts of rather mundane and usual and eventually becomes quite a surreal and alarming ordeal. For me, Diabetic Ketoacidosis began on a day no different than many others I had been having lately. I had gotten sloppy with my insulin doses and hadn’t been taking my blood glucose levels nearly often enough. I would take insulin based on what carbs I thought I was eating and when I was not eating, based on how I felt. I truly doing it all wrong, not because I don’t know what I need to do but because I had fallen into a bad habit of snacking constantly which makes it difficult to test correctly and almost impossible to gi Continue reading >>
What Are Reasons To Go The Hospital When Healthy?
There are lots of reasons. Off the top of my head: Health maintenance procedures——colonoscopy, annual lab work. To provide emotional support to a patient. To drive a family member or friend home, who was brought to the hospital by ambulance. To participate in educational events. (Nurses, for example, have many continuing education requirements, and most of the classes satisfying them meet in hospitals.) To take part in charitable fundraising activities. To take part in support groups. Clinicals for EMTs, nurses, phlebotomists, etc. To work. Hospitals are often major employers in a community. To participate in disaster drills. To apply for a job. To drop off charitable donations (toys, puzzles, games, CDs) for patients to use. Continue reading >>
Ketoacidosis - Put Me In The Hospital
First off, I should apologize to my mom, I don't think she previously knew about this and read about it in my last post and expressed her worry. Moms are made to worry, but I should have told her if I hadn't already :) sorry Mom... During our Canadian Thanksgiving in October, we decided to surprise Michelle's mom in Montana for our long weekend. During our visit, I became really ill with what I thought was food poisoning, but could have been a 24 hour bug. Doesn't sound too bad to the normal person, but when you add diabetes to the situation it can be complicated. Managing blood sugars without the ability to eat or drink anything becomes almost impossible. Adding to the mix, I was lacking my Dexcom continuous blood glucose monitor because to my dissatisfaction my insurance does not currently cover my supplies in Canada (I am working on it). Without Dexcom, my ability to know what was happening in my body was extremely tough. After hours of vomiting, my wife searched the internet and came across another blog that cautioned diabetics about ketoacidosis. I had heard of the condition, but honestly had never even checked for this before. I will hopefully add to the knowledge out there to help others understand the condition. How does Ketoacidosis happen? It is typical for diagnosed diabetics with elevated blood sugars for extended amounts of time. I have been diabetic for years and am pretty aware of it, so that wasn't the case. Since I started vomiting at around 9pm and didn't stop until 3am, there was a lot of stress on my body. Added complication, I started vomiting shortly after dinner, so the carbs I had already taken insulin to control were no longer in my body. So my blood sugar dropped because I did not have the expected sugars in my body and too much insulin. To cou Continue reading >>
Clinical Profile Of Diabetic Ketoacidosis In Tertiary Care Hospital Of Eastern Nepal
Go to: Abstract Diabetes ketoacidoisis (DKA) is characterized by hyperketonaemia, metabolic acidosis, and hyperglycemia. Aims: The aim of this study was to describe the demographic profile, clinical characterstics of patients admitted with diabetic ketoacidosis in BPKIHS, medical ward. We took all the patients admitted with a diagnosis of diabetic ketoacidosis (DKA) as defined ADA 2006 consensus statement in medical ward from January 2010 to December 2010. The statistical operations was done through Manufactured by IBM Corp. Only sixteen patients (7 type 1 and 9 type 2DM) were with DKA. When compared to the 16 subjects with type 1 DM, the type 2 were older (56.8 s 25.7 years) and had a significantly higher PH levels (7.11 s 7.28 P = 0.04). The mean body mass index was 20.5±2.44 in both Type 1 and type 2 DM. Four were on diet control and Insulin respectively. Five were on oral hypoglycemic agents (OHA) and three on both (insulin and OHA). Infection was most common precipitating factor (56.25%) followed by poor drug compliance (37.5%) and first presentation (6.25%). We found majority of patients were type 2 DM. Metabolic acidosis has significant association in both type of diabetic. We found infection was the most common precipitating factor for DKA. Keywords: B. P. Koirala Institute of Health Sciences, Dharan, diabetes, ketoacidosis PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers. Continue reading >>
What You Should Know About Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a buildup of acids in your blood. It can happen when your blood sugar is too high for too long. It could be life-threatening, but it usually takes many hours to become that serious. You can treat it and prevent it, too. It usually happens because your body doesn't have enough insulin. Your cells can't use the sugar in your blood for energy, so they use fat for fuel instead. Burning fat makes acids called ketones and, if the process goes on for a while, they could build up in your blood. That excess can change the chemical balance of your blood and throw off your entire system. People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when you miss a meal, you're sick or stressed, or you have an insulin reaction. DKA can happen to people with type 2 diabetes, but it's rare. If you have type 2, especially when you're older, you're more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). It can lead to severe dehydration. Test your ketones when your blood sugar is over 240 mg/dL or you have symptoms of high blood sugar, such as dry mouth, feeling really thirsty, or peeing a lot. You can check your levels with a urine test strip. Some glucose meters measure ketones, too. Try to bring your blood sugar down, and check your ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work, if you have any of the symptoms below and your ketones aren't normal, or if you have more than one symptom. You've been throwing up for more than 2 hours. You feel queasy or your belly hurts. Your breath smells fruity. You're tired, confused, or woozy. You're having a hard time breathing. Continue reading >>
Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia: Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA. Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA. However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>
Can Diabetes Kill You?
Here’s what you need to know about the life-threatening diabetes complication called diabetic ketoacidosis. Diabetic ketoacidosis is one of the most serious complications of diabetes. Symptoms can take you by surprise, coming on in just 24 hours or less. Without diabetic ketoacidosis treatment, you will fall into a coma and die. “Every minute that the person is not treated is [another] minute closer to death,” says Joel Zonszein, MD, professor of medicine at Albert Einstein College of Medicine in New York City. Diabetic ketoacidosis occurs when your body doesn’t produce enough insulin. (Diabetic ketoacidosis most often affects people with type 1 diabetes, but there is also type 2 diabetes ketoacidosis.) Without insulin, sugar can’t be stored in your cells to be used as energy and builds up in your blood instead. Your body has to go to a back-up energy system: fat. In the process of breaking down fat for energy, your body releases fatty acids and acids called ketones. Ketones are an alternative form of energy for the body, and just having them in your blood isn’t necessarily harmful. That’s called ketosis, and it can happen when you go on a low-carb diet or even after fasting overnight. “When I put people on a restricted diet, I can get an estimate of how vigorously they’re pursuing it by the presence of ketones in the urine,” says Gerald Bernstein, MD, an endocrinologist and coordinator of the Friedman Diabetes Program at Lenox Hill Hospital in New York City. RELATED: The Ketogenic Diet Might Be the Next Big Weight Loss Trend, But Should You Try It? But too many ketones are a problem. “In individuals with diabetes who have no or low insulin production, there is an overproduction of ketones, and the kidneys can’t get rid of them fast enough,” sa Continue reading >>
Must Read Articles Related To Diabetic Ketoacidosis
A A A Diabetic Ketoacidosis (cont.) Fluid replacement and insulin administration intravenously (IV) are the primary and most critical initial treatments for diabetic ketoacidosis. These therapies together reverse dehydration, lower blood acid levels, and restore normal sugar and electrolyte balance. Fluids must be administered wisely - not at an excessive rate or total volume due to the risk of brain swelling (cerebral edema). Potassium is typically added to IV fluids to correct total body depletion of this important electrolyte. Insulin must not be delayed and must be given promptly as a continuous infusion (not as a bolus - a large dose given rapidly) to stop further ketone formation and to stabilize tissue function by driving available potassium back inside the body's cells. Once blood glucose levels have fallen below 300mg/dL, glucose may be co-administered with ongoing insulin administration to avoid the development of hypoglycemia (low blood sugar). People diagnosed with diabetic ketoacidosis are usually admitted into the hospital for treatment and may be admitted to the intensive care unit. Some people with mild acidosis with modest fluid and electrolyte losses, and who can reliably drink fluid and follow medical instructions can be safely treated and sent home. Follow-up must be available with a health care practitioner. Individuals with diabetes who are vomiting should be admitted to the hospital or urgent care center for further observation and treatment. In cases of mild dehydration with borderline diabetic ketoacidosis, you may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner. Whether you are released to go home or monitored in the hospital, it is important th Continue reading >>
Diabetic Ketoacidosis: Treatment In The Intensive Care Unit Or General Medical/surgical Ward?
Go to: INTRODUCTION Patients with diabetes mellitus (DM) have health care costs 2.3 times higher than others without this diagnosis. In a prevalence-based study, by the American Diabetes Association, in the United States in 2012, the total cost for diagnosed DM was $245 billion United States dollars, and of it, $176 billion was used for direct medical care costs. In addition, and even more concerning, is the fact that hospitalizations for patients with DM have being increasing. The National Surveillance of Diabetes Public Health Resources, reported that diabetic ketoacidosis (DKA) admissions increased from 80000/year in 1988 to 140000/year in 2009. DKA causes an acute metabolic disorder, which is primarily characterized by an increased presence of circulating ketone bodies, and the development of severe ketoacidosis in the presence of prolonged uncontrolled hyperglycemia, usually due to insulin deficiency. It is more commonly seen in patients with insulin-dependent diabetes mellitus (IDDM), especially among children and young adults. Occasionally, patients with insulin resistant DM can present this complication; especially those that are noncompliant with insulin therapy or who present severe infection. DKA has arbitrarily been classified by some as mild, moderate and severe, according to the initial diagnostic criteria (which includes plasma glucose, arterial pH, serum bicarbonate, urine and serum ketones, serum osmolality and anion gap; and the alteration in the mental status). Continue reading >>
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My Encounter With Diabetic Ketoacidosis
A day like any other, can turn into a day you’ll never forget. With diabetes comes the good and the bad. When it’s good, it can be really good. But when it’s bad…it can be life-threatening. I’ve certainly had my share of bad days. Trying to battle the high and the lows, and trying to stay as close to normal without losing my sanity. With having diabetes I’ve experienced many symptoms. But one day came symptoms like no other… chills – nausea – vomiting – back pain – weakness – blurred vision …and lots of ketones Yes, you’ve guessed it! I had DKA (Diabetic Ketoacidosis). This was years ago, after a night of drinking with friends. Wanting to live a free, independent young adult life. Knowing, yet not knowing, how destructive being the slightest bit careless could affect my diabetes. I just felt terrible; to the point where I questioned where to take insulin or not. I thought to myself…Well I don’t really plan on eating today, and I don’t want to worry about dropping “low.” I thought I was saving myself from having to fix my blood sugar. So I missed my morning dose. (Boy, was that a mistake – never– would I do this again.) I didn’t know at the time that insulin is needed (with or without food). Even on sick days! Without enough insulin in my body, my body can’t receive the glucose necessary for energy. I kept close eyes on my blood sugar for a few hours that day, which was only in the mid 200’s. I thought that due to the fact I wasn’t eating, that my blood sugar would come down eventually anyways. But the symptoms progressed. I couldn’t keep anything down…not even water. To be honest, DKA never came to mind. I had never had it since being diagnosed, and was most recently been keeping my blood sugars in better control. I Continue reading >>