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Ketones When To Go To Hospital

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 >>

Five Things To Know About Ketones

Five Things To Know About Ketones

If you live with diabetes, you have probably heard that ketones are something to watch out for. That they have something to do with the dreaded diabetic ketoacidosis (DKA). But do you really understand what ketones are and why they happen? It’s scary to think about, sure. But it’s also very important to be in the know about ketones and to be prepared. 1) What are ketones? If there isn’t enough insulin in your system, you can’t turn glucose into energy. So your body starts breaking down body fat. Ketones are a chemical by-product of this process. This can occur when people with type 1 diabetes don’t take insulin for long periods of time, when insulin pumps fail to deliver insulin and the wearer does not monitor blood glucose, or during serious illness (in type 1 or type 2) when insulin doses are missed or not increased appropriately for the stress of illness. Ketones can happen to anyone with diabetes, but the condition is more common in people with type 1. 2) Why are ketones dangerous? Ketones upset the chemical balance of your blood and, if left untreated, can poison the body. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Eventually they build up in the blood. The presence of ketones could be a sign that you are experiencing, or will soon develop, diabetic ketoacidosis (DKA)—a life-threatening medical emergency. 3) When should I test for ketones, and how? There are several situations in which it is a good idea to check for ketones, usually every four to six hours. Talk to your doctor to know what makes the most sense for you and your diabetes management plan. Your blood glucose is more than 300 mg/dl (or a level recommended by your doctor) You feel nauseated, are vomiting or have abdominal pain You are 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 >>

Diabetes: Safety Alerts And Emergencies

Diabetes: Safety Alerts And Emergencies

Diabetes is a slow, steady illness that can turn serious very quickly. If you have diabetes, you should prepare yourself for a diabetic emergency. In a way, you're like a person living on a fault line who plans ahead for an earthquake. But you have an advantage: Instead of just preparing for a possible disaster, you can take steps to prevent it. Your doctor can tell you if you are at risk for a diabetic emergency. If you're in danger, you'll have to learn how to minimize the risks and how to respond to the worst-case scenario. For starters, you should wear an alert bracelet or other form of I.D. that will inform medical personnel of your condition. You should also set aside a stash of extra diabetes supplies in your home in case you can't make your regular shopping trips because of a blackout, flood, blizzard, or some other unforeseen problem. Items you may want to consider for your emergency pack include a cooler or other cold storage container with pre-made ice for keeping insulin and other supplies in case of an electrical outage; emergency glucose to treat hypoglycemia; a spare battery for your glucose test meter; canned food and several gallons of bottled water; flashlights and extra batteries; candles and matches; and, if you take insulin, extra insulin, syringes, lancets, blood test strips, and (if necessary) insulin pump supplies, according to the association Children with Diabetes. Common emergencies Extreme high blood sugar (hyperglycemia) Read about how to prepare for the most common diabetes emergencies: Like everyone else with diabetes, you have days when your blood sugar is a little higher than you'd like it to be. Usually, you can bring the levels back down with a little more exercise, a little less food, or a small change in medications (as directed by a 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 >>

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 >>

Sick Days

Sick Days

When you’re unwell, you need to take extra care. As a person with diabetes, when you are sick your body’s increased production of stress hormones will cause your blood glucose levels to rise. Make sure you keep a list of contact numbers for your doctor, Credentialled Diabetes Educator, hospital and ambulance by the phone. If possible, have a friend or relative come and regularly check on you. You can also see our information sheets on sick days with type 1 type 2 diabetes in our Publications and Resources section. When you’re sick, you should continue to take your usual dose of insulin. Never stop taking or reduce your insulin dose. Sometimes when you are sick you may need more insulin or extra doses of insulin. Contact your doctor or Credentialled Diabetes Educator if your illness lasts for more than one day, or if you vomit more than three times in a day, to discuss whether your insulin needs to be changed. Eat according to how you feel and what food you can tolerate. If you can’t eat your usual meals, make sure you have small low-fat snacks at regular intervals throughout the day (for example, toast, crackers, boiled rice, soup, low-fat custard or ice-cream). If you can’t eat food, have sips of fluid every few minutes. Include carbohydrate drinks (such as fruit juice or lemonade) if your blood glucose level is below 15 mmol/L or unsweetened fluids (such as soda water or diet lemonade) if your blood glucose level is above 15 mmol/L. High blood glucose levels, vomiting and diarrhoea can all lead to dehydration. You will need to drink more, but it is important what you should drink, based on your blood glucose levels. If your blood sugar level is more than 15 mmol/L then you should drink unsweetened fluids like water, clear soups, weak tea, or diet lemonade. I 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 >>

Must Read Articles Related To Diabetic Ketoacidosis

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 >>

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 (hyperglycemia) And Ketones

High Blood (hyperglycemia) And Ketones

Hyperglycemia (said like: hi per glie SEE mee ah) is also called high blood glucose. It happens when blood glucose numbers are higher than 120 mg/dl. What causes high blood glucose? Eating more carbohydrates than you calculated for your insulin dose Not enough insulin is taken Stress Illness How do I prevent high blood glucose? Count your carbohydrate closely. Give the right insulin dose based on your meal and blood glucose number. Change the insulin doses when you see a pattern of high blood glucose levels. Give insulin for all the carbohydrate you eat. How will I feel when my blood glucose is high? Thirsty Need to go to the bathroom a lot Need to get up at night to go to the bathroom Tired Dry lips and mouth What should I do if my blood glucose is high? • Drink fluids that do not have carbohydrates. Try to drink 1 full glass (8 ounces) every 30 to 60 minutes. • Check your urine or blood for ketones if blood glucose is higher than 300 mg/dl. Why would I have ketones? You need glucose in every cell in your body to use for energy. Your body needs glucose and insulin in your blood. When there is not enough glucose or not enough insulin, your cells will not have glucose to use for energy. When cells do not have glucose to use for energy: The body starts to use fat for energy. --> Ketones are made when fat is used for energy. --> Ketones are in the blood and in the urine. --> Ketones are acids. --> What 2 things does your body need to prevent ketones? _________________________________________________________ _________________________________________________________ How do I check for ketones? Collect urine in a cup. Dip the test strip into the cup (Picture 1). Remove the test strip from the urine. Wait 15 seconds. Match the color on the strip to the colors on the bottle Continue reading >>

What Is Diabetic Ketoacidosis?

What Is Diabetic Ketoacidosis?

Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 1 diabetes are at risk for a problem called diabetic ketoacidosis (DKA). It is very rare in people with type 2 diabetes. DKA happens when your body does not have enough insulin to move glucose into your cells, and your body begins to burn fat for energy. The burning of fats causes a build-up of dangerous levels of ketones in the blood. At the same time, sugar also builds up in the blood. DKA is an emergency that must be treated right away. If it is not treated right away, it can cause coma or death. What can I expect in the hospital? You will need to stay in the hospital in order to bring your blood sugar level under control and treat the cause of the DKA. Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include: Monitoring You will be checked often by the hospital staff. You may have fingersticks to check your blood sugar regularly. This may be done as often as every hour. You will learn how to check your blood sugar level in order to manage your diabetes when you go home. A heart (cardiac) monitor may 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 >>

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 >>

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 >>

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