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Ketones When To Go To Hospital

What To Do If You Have Ketones

What To Do If You Have Ketones

I woke up pretty late today, around 11am. I really didn’t feel like getting up at all because I was still really tired. I was woken up by a ringing house phone that I ignored, then a cell phone with my husband on the other end. Then my mom coming downstairs to get the laundry and reminding me that we were going out today. (I live in my parents basement apartment.) “Ok, Ok… I am getting up” I tell her. I took in a big yawn and stretch of the arms. Then I actually got up out of my bed. I felt weird but I just thought it was because I got out of the bed too quickly. I tried to lick my lips together, but I had no saliva in my mouth - it was like the Mojave desert in there. I went to the bathroom to wash up because now my mom was getting antsy and rushing me. Don’t you just love getting up like that? Anyway, I started to feel a bit nauseated after about 20 minutes. I know these symptoms all too well. Dry mouth, Nausea = High blood sugar or Ketones. So, I checked my blood sugar. 3 2 1 334. Oh boy. Ok, umm… how did this happen? I didn’t really eat anything high carb last night? I went to bed with a pretty decent number and I just changed my infusion set. I don’t feel sick. My pump site isn’t hurting. It really boggled my mind. I felt my heart race a bit and started feeling panicky, and my breathing was getting heavier. Can you say panic attack? I always get a little paranoid though, it’s just my thing. Anyway, I told myself “Ok, Gina just calm down, you know what to do.” So I did my thing. I went back into the bathroom and grabbed my Ketostix to check my urine for Ketones. This is something I do when I have an unexpected high blood sugar with nausea. My urine test came out with Large, the highest level. Ugh. Ketones on the back of the bottle start out w Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

Diabetes Care In The Hospital: It Ain't Pretty

Diabetes Care In The Hospital: It Ain't Pretty

Two ER visits within two days, thanks to a severe low blood sugar and then non-budging high blood sugars. Both are enough to make anyone with diabetes cringe. But then there's the fact that these experiences themselves highlighted how the urgent care establishment is ill-equipped to deal with diabetes. And it gets even more troublesome. I've long believed that we PWDs (people with diabetes) aren't going to get quality care in the emergency room if we end up there. From the Diabetes Community stories I've heard, opinions of medical professionals in the diabetes world, and my own experiences visiting ERs on a few occasions through my life, that is what I have come to believe. Sure, it may be more sarcastic than serious to say "the ER is trying to kill me," but there's certainly some real-world trauma weaved into that comment. The recent dual ER visits that my mom experienced reaffirm this, and I just want to share this story as a way to call out for whatever change can hopefully materialize ... I'm not happy with what happened in the ER relating to my mom last week. But more than that, it scares me that this type of thing could happen to any of us. What Happened? First, it's important to remember that my mom has been living with type 1 since the age of five -- which means it's now about 55 years. She hasn't had an A1C above 6% in at least a decade, and from what I have seen she doesn't often go above 160 for any extended period of time. She has had insulin reactions before, and they've been severe in some cases, but they typically don't last very long and we've all been able to manage them. Early on a recent Sunday morning, my didn't wake up from a hypoglycemic reaction. My dad awoke to her beeping Dexcom G4 continuous glucose monitor (CGM), and it showed that she was und Continue reading >>

Ketones And Children With Type 1 Diabetes – What’s Important?

Ketones And Children With Type 1 Diabetes – What’s Important?

What are ketones and when do you check for them in children with type one diabetes? This is a common question I get! I think when children are diagnosed, this a frequent part of the education that is easily forgotten or misunderstood due to the overwhelming amount of information being taught. So let’s look at why we would check ketones, how to check them, what the colors on the strips mean, and what to do if ketones are present. Why Check Ketones: When someone with type 1 diabetes does not not get enough insulin, their blood sugar levels rise, so the body is forced to use fat for energy. When fat is used for energy for an extended period of time, ketones develop. Ketones are a waste product of fat. If someone with type 1 diabetes does not get enough insulin, diabetic ketoacidosis (DKA) can develop. The length of time it takes and how high one’s blood sugar are varies, however DKA can occur in a few hours. Symptoms of DKA: high blood sugars ketones in blood and urine nausea, vomiting, and abdominal pain confusion lethargy (tired, sluggish, weak) difficulty breathing unconsciousness DKA is a very serious and life threatening situation. Speak with your health care providers to determine how you are to treat ketones and when you are to go to the emergency room. When to check ketones: Your doctor can tell you exactly, but usually when your blood sugars are over 250, especially if the blood sugar is not responding to insulin and remaining high after the second blood sugar check. Always check ketones when your child is sick, even if blood sugar numbers are not high. Anytime your child has nausea and vomiting, check ketones. How to check ketones: Ketones can be checked by using ketone urine strips. To check ketones, urinate on a strip, or collect urine and dip stick into ur Continue reading >>

When You Need To Go To The Emergency Room With High Blood Sugars

When You Need To Go To The Emergency Room With High Blood Sugars

My uncle, like all his family, was a bit of a cheapskate. He hated to spend money unless it was absolutely necessary. He was thin and active, having only recently given up a career as a singer and dancer performing weekly on a nationally televised variety show. So when he felt unwell one weekend night, he turned down his wife's suggestion that she drive him to the emergency room and told her he'd wait til Monday when he could see his family doctor. Why waste all that money on an ER visit that was probably unnecessary? As it turned out, he didn't need to see his doctor on Monday. He died that night. He was a few years younger than I am now and the fatal heart attack he experienced was the first symptom he had of our family's odd form of inherited diabetes. But this is why, even though I've inherited the family "cheap" gene, if there's any possibility something dangerous is going on, I head for the ER. Usually it is a waste of money. I was in a small car accident a few weeks ago that left me with nerve pain running up and down my arms and legs. I sat for four hours at our local ER, saw the doctor for five minutes, and was sent home. The diagnosis, whiplash. The treatment, wait and see if it gets worse. The bill? Over $900. I went to the ER because I'd called my family doctor's office and they told me to. Whiplash usually resolves on its own, but occasionally it can cause swelling in your neck that can kill you. I'm not equipped to judge what kind I had, and unlike my uncle, I wasn't about to gamble. So with this in mind, you can understand my reaction when a stranger contacted me recently, after reading my web page, and told me that his blood sugar, which had been normal until very recently, was testing in the 500s on his meter except when his meter wasn't able to give hi Continue reading >>

Diabetic Ketoacidosis Symptoms

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

How To Keep Your Child With Diabetes Out Of The Hospital Or Er

How To Keep Your Child With Diabetes Out Of The Hospital Or Er

1. Keeping your child (or you) with diabetes out of the hospital Webinar August 19, 2014 Stephen W. Ponder MD, FAAP, CDE Baylor Scott & White Healthcare 7:30-9:00PM Central Standard Time 2. Housekeeping notes…  This Webinar IS being recorded for future playback.  I hope you reviewed the Prewebinar background materials I posted to Slideshare and You Tube.  This slide deck will be posted to Slideshare too  Links to all resources will be put on my Facebook page: “The Power Within by Stephen Ponder MD, FAAP CDE”  Submit your questions during the webinar and the moderator will collect them for our Q&A at the end.  This Webinar will end promptly at 9PM CST  The next Webinar is scheduled for Tuesday October 28th 2014 from 6:30-7:30PM CST: Topic “Travelling with Diabetes” by Dr. Matthew Stephen. 3. This area of the patient/parent brain needs some help DEALING WITH ANNOYING THINGS OTHERS SAY CENTRE INSULIN AND CARB CALCULATOR 4. 6 things you should remember… 1) How type 1 diabetes works 2) Importance of water 3) Dual role of insulin (on/off role) 4) Most carbs become sugar 5) Exercise is a form of stress 6) Our brains run on sugar 5. Your “toolkit”… A method to check BG A method to check ketones (urine or blood) Access to liquids (carb and non-carb) Carbs (fast and slow acting) Glucagon for injection Insulin and a way to deliver it reliably Anti-nausea medicine? Your wits (and maybe a phone) 6. “The process” 1) Get the necessary facts 2) Identify immediate needs 3) Prioritize your actions 4) Do your actions 5) Repeat the cycle as needed 6) Don’t stop until job is done 7. Common problems in type 1 diabetes  Missed insulin dose(s)  Insulin dose reversals  Surreptitious insulin doses  Outdated/damaged Continue reading >>

High Blood Glucose (hyper) & Type 1 Diabetes

High Blood Glucose (hyper) & Type 1 Diabetes

Key points Hyperglycaemia happens from time to time to all people who have diabetes. Hyperglycaemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it’s important to know what hyperglycaemia is, what its symptoms are, and how to treat it. Untreated hyperglycaemia diabetes can lead to a life threatening condition called diabetic ketoacidosis (DKA). If you have Type 1 diabetes, you will often develop high blood glucose levels. Managing your Type 1 diabetes is a lot to do with developing problem solving skills and learning to use them. Remember that if your body is producing its own insulin, it alters the amount all the time (minute by minute). When you have Type 1 diabetes you have to do this consciously by using your knowledge and making sensible choices. Your diabetes nurse educator can help you learn the skills you need to do this. Some people prefer to get guidance on any of the choices they make. Everyone is different. If you are making choices you haven’t previously put into practice, get advice and support from your diabetes team before and while you make the changes. The effects of high blood glucose levels are probably what first led you to visit the doctor when your diabetes was diagnosed. Normally the human body keeps its blood glucose level very stable (between 4mmol/L – 7.5mmol/L). The body has various systems (regulated by hormones such as insulin and glucagon) for keeping the blood glucose level in this range. This doesn’t happen if you have Type 1 diabetes. Symptoms of high blood glucose levels Feeling thirsty Passing a lot of urine (you may need to get up often during the night) Feeling very tired Treatment for high blood glucose levels Try to work out why your glucose level is high. If it is Continue reading >>

How To Lower Your Blood Sugar When It's Really High

How To Lower Your Blood Sugar When It's Really High

​This article is written for type 2 diabetics who need help coming down from a very high blood sugar during a single, isolated high blood sugar event. If you want to try an stabilize your baseline, consider signing up for my Baseline Blood Sugar Challenge course. ​THIS ARTICLE IS NOT A SUBSTITUTE FOR REAL MEDICAL ADVICE. If you're a type 2 diabetic and your blood sugar is high right now (greater than 300mg/dL for at least 6 hours), the first thing you should do is call your doctor. So, if you haven't called anyone for help yet, please stop reading this article and call your doctor. If your doctor is able to help, then you need not read on. Also, if you are having symptoms of Diabetic Ketoacidosis, stop reading this article and go to the hospital immediately. Diabetic Ketoacidosis can kill you if left untreated. But. If you're in a situation where your blood sugar has been high for an extended period of time, you could perhaps consider taking the following steps to solve your blood sugar problem. Disclaimer: This is friendly, non-medical advice from a random diabetic person you don't even know, which is a very (very) poor substitute for real, actual medical advice. Use at your own risk. First, you should try and lower your blood sugar without injectable insulin by completing the following steps: 1. Check your blood sugar. Write down the time and your blood sugar level. 2. Drink water (this doesn't actually lower blood sugar, but it helps flush sugar and ketones from your body, if you have them). Continue drinking water, but please don't make yourself sick. 3. Move. As in, walk. Walk around the block or walk in place or haul your ass up and down the stairs for 30-60 minutes. Walking helps your cells become less insulin resistant, which is what you need right now. Do N Continue reading >>

What Are Ketones, And Why Are They Important To Diabetes Self-management?

What Are Ketones, And Why Are They Important To Diabetes Self-management?

All blood tests are tools. Some are to diagnose diabetes, some are to help you manage your diabetes on a daily or long term basis and some are to keep you safe. People with diabetes are told about blood testing and how important testing is to manage their blood glucose. It is a critical part of diabetes management. Whether it is done in the physician’s office or the patient’s home it is an invaluable tool, Unfortunately a very important test, ketone testing is often not taught or taught only to people with type 1 diabetes. This test can be life saving and should be part of every person with diabetes knowledge and skills. It is simple and if you have diabetes you should know about it. What Are Ketones? When the body is unable to burn glucose it burns fat and this produces a chemical called ketones. This occurs when there is too little insulin for the amount of glucose in the body. Possible causes for this could be: Experiencing stress or illness such as fever, Having an infection. Omitting or taking too little insulin Eating more food than planned Improper storage of insulin If left untreated, ketones continue to rise and can result in a condition called Diabetic Ketoacidosis, or DKA. This condition is quite serious and requires immediate medical attention. DKA is the most common cause of hospitalization and death among children and young adults with diabetes, and the leading cause of adverse events for insulin pump users. Why Measure Blood Ketones? Studies suggest that most, if not all emergency department and hospital admissions beyond initial diabetes diagnosis could be prevented if people better managed their diabetes care and knew the warning signs when ketoacidosis was developing. Blood ketone testing provides a rapid, accurate, and early warning sign that keto Continue reading >>

The Scary Experience Of Diabetic Ketoacidosis

The Scary Experience Of Diabetic Ketoacidosis

Today, we’re excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company’s philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it. Throughout this past year, I’ve had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much. In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.) Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. – and I thought it was 11:00 a.m. The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walke Continue reading >>

When To Worry About Ketones

When To Worry About Ketones

“Your blood sugar is over 250. We’ll have to test for ketones, just to make sure you’re not spilling any.” The nurse stuck a label featuring my name and date of birth onto a plastic cup. “The bathroom is down the hall and to the right,” she said. By now, I was familiar with the drill, having experienced it a handful of times in the past: Provide urine sample to endocrinologist and keep my fingers crossed that it’s negative. Fortunately, it was—no ketones spilled. Though we often toss the word ketones around when we talk about diabetes, there tends to be confusion about what ketones are and when they’re dangerous. What are ketones? Ketone bodies are produced by the liver and are byproducts of fat metabolism. They occur when muscles in the body (which normally uses glucose as fuel) begin to use fat instead. This can happen when a person restricts carbohydrates (i.e., following a ketogenic diet—see below), eats too little, or feels ill. Simply put, ketones are markers of fat burning in the body. People with diabetes need to be concerned about ketones, though, because they can be a sign of a life-threatening condition. The presence of ketones makes the blood acidic and can result in an illness known as diabetic ketoacidosis (DKA), which occurs when blood sugar levels are very high. DKA can be caused by not getting enough insulin, and it may occur prior to a diagnosis of type one diabetes. DKA symptoms of concern include a dry mouth, blood sugar levels greater than 240 mg/dL, strong thirst, and frequent urination. Without treatment, these symptoms can worsen into confusion, extreme fatigue, flushed skin, fruity-smelling breath, nausea, vomiting, stomach pain, and difficulty breathing. The most serious effects include swelling in the brain, loss of conscio Continue reading >>

Ketone Monitoring And Management Of Diabetic Ketoacidosis (dka)

Ketone Monitoring And Management Of Diabetic Ketoacidosis (dka)

The 2015 GDG updated self-monitoring and in hospital monitoring of ketones. The 2004 content that has been superseded by the 2015 update can be found in Appendix S. Management of DKA was not in the scope for the 2015 update and therefore the original recommendations and content from CG15are reproduced in this chapter. Go to: 12.1.1. Introduction Ketosis and ketonuria reflect a greater degree of insulin deficiency than hyperglycaemia alone. The presence of ketones indicates that insulin concentrations are too low not only to control blood glucose concentrations but also to prevent the breakdown of fat (lipolysis). Because ketones are acid substances, high ketone concentrations in the blood may create acidosis. Diabetic ketoacidosis (DKA) is a medical emergency and in its established state carries a 0.7–5% mortality in adults.459,476,784 High ketones in the blood are associated with high levels of fatty acids and together create insulin resistance. The patient with significant ketonaemia will require more insulin than usual to control the blood glucose. Traditionally, ketonaemia has been assessed by urine testing. This has been applied in three main settings: it is recommended as part of guidance for patient self-management of acute illness at home, when patients are advised to increase their usual corrective insulin doses in the presence of significant ketonuria; in the assessment of patients presenting to emergency services with hyperglycaemia, where presence of ketonuria may influence management decisions, including need for admission and in the management of established DKA, where resolution of ketonuria is an important indication of recovery. However, not all ketone bodies are detected by urine testing. For example, beta-hydroxybutyrate (β-OHB) is not detected wit Continue reading >>

High Blood Glucose

High Blood Glucose

A diabetic emergency can occur if you have very high blood glucose (hyperglycemia). You can prevent a high blood glucose emergency by being aware of your blood glucose levels and by having a treatment plan. A high blood glucose emergency requires immediate treatment. Plan ahead with your healthcare provider so that you have clear instructions about what blood glucose levels pose a threat to your health and how to receive prompt treatment. Have a Treatment Plan Ready! Some healthcare providers will supply you with a written insulin dosing plan, or an emergency phone number to call for instructions. Other healthcare providers will instruct you to go to an emergency center. If you know these instructions ahead of time, you will be better prepared to get the treatment you need in a timely manner. Timely treatment can lead to a prompt resolution and less confusion at a time when you are not feeling well. It is also a good idea to share your high blood glucose treatment plan with your family, friends, and coworkers so that they understand how they can help you get the special help that you may need. In addition, careful daily attention to your diabetes can help you avoid dangerously high glucose levels. Emergencies can be the result of a temporary mistake or a slip in taking care of your diabetes. If you find out early that your blood glucose levels are getting dangerously high, you can get earlier treatment and prevent possible hospitalization or even death. Another way to prepare for a high blood glucose crisis is by wearing a MedicAlert bracelet or necklace at all times (available from www.medicalert.ca, or call 1-800-668-1507 or 416-696-0267 from outside Canada. Wearing medical ID jewelry increases your likelihood of getting prompt, appropriate care if you have a blood gl Continue reading >>

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