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Ketosis Symptoms In Babies

What You Should Know About Diabetic Ketoacidosis

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 >>

Know The Signs

Know The Signs

Do you know the signs of type 1 diabetes? The most dangerous time in the life of a diabetic child is prior to diagnosis when the symptoms are often confused with the flu. Tragically, children sometimes die or become brain damaged by the time anyone realizes that they have diabetes. Even doctors can miss that a child has diabetes until it’s too late. Learn the warning signs. Type 1 diabetes is one of the most common chronic illnesses of children. The majority–90%–of children diagnosed with type 1 diabetes have no family history, so all parents and healthcare providers need to recognize the symptoms. Every year, the number of children getting diabetes goes up. No one knows why. If you see any of these signs and symptoms in your child, see your healthcare provider and make sure that your child is tested for type 1 diabetes. If your child is showing signs of DKA (see symptoms below), go to the ER immediately. There is no time to waste. At this stage, children are often transported by ambulance or helicopter and sometimes are placed on life support. Let’s not lose one more child to this disease due to a missed diagnosis. Let the memory of Mary Kathryn and the tragic loss of this 8 year old girl help save another child’s life. See the International Diabetes Federation’s World Diabetes Day Web page and their campaign, A Life for a Child. No child should die of diabetes. Signs of Type 1 Diabetes •Excessive thirst—may be overlooked in warm weather. •Frequent urination—toilet-trained children often begin wetting the bed or getting up during the night to urinate. Babies can soak through diapers. •Loss of weight—often the most noticeable symptom. Any weight loss should be evaluated by a doctor. •Fruity-smelling breath or acetone-smelling breath—sign that 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 >>

Kids And Ketones: Checking And Treating High Blood Glucose

Kids And Ketones: Checking And Treating High Blood Glucose

Low blood glucose levels usually have warning signs such as shaking, sweating and rapid heartbeat, but high blood glucose levels can be silent until things start to get out of control. The staff in the Joslin Pediatic Clinic has this advice. One of the vital warning signs of an impending diabetic crisis is the appearance of ketones in the blood or urine. For children with type 1 diabetes and their parents, understanding the role of ketones in a diabetic emergency and knowing how to check for them and what to do if your child has them can mean the difference between a good night’s sleep and many tense hours in the emergency room. (Ketoacidosis almost always occurs in people with type 1 diabetes) Too little insulin for too long a time initiates a cascade of hormonal changes in the body that can lead to the dangerous condition of diabetic ketoacidosis (DKA). If left untreated, it can lead to coma and death. In the face of inadequate circulating insulin, glucose builds up in the blood instead of moving into the tissue cells where it would be used for fuel. Without glucose to burn for energy, the body turns to fat for fuel. The special type of fat it uses is called ketones. Because ketones are an acid, the body needs to supply a base (the opposite of an acid) to neutralize their effects and maintain the blood’s natural pH. However, the body’s supply of base,such as NH3 (anydrous ammonia) (is limited and at some point the system is overwhelmed and the blood pH starts to decline. This drop in blood pH is one of reasons ketoacidosis is so serious. The body can’t accommodate changes in blood pH well. Illness can often be a precipitating cause of DKA. Infection can spike glucose levels and additional insulin is often required. If the needs for additional insulin aren’t Continue reading >>

Babies In Ketosis

Babies In Ketosis

This post topic was inspired by the following article: Ketosis - key to human babies’ big brains? It is hosted on Tim Noakes' website and written by one of his associates in nutritional information misdirection, Tamzyn Murphy Campbell, RD. I'm going to address this misdirection and the disturbing parts of this article vis a vis Campbell in a future BabyGate Files, but for now I want to discuss the role of ketones in metabolism. In doing so, I'd also like to explain my somewhat cryptic recent post on heating my kitchen. (I've C&P'd that entire post to the end further down in this one, so if you don't wish to go to another page, you can just scroll down to The Kitchen Heating Analogy). I'm going to structure this post a little differently than most and get to my point, then provide the back up information. Let's see how this goes. The major source (6 of 12 numbered citations, 1 of 6 unique sources) for her article is: Survival of the fattest: fat babies were the key to evolution of the large human brain (2003) Stephen C. Cunnane, Michael A. Crawford (I'll call this C&C) In this paper, they make the following points: Human babies have higher body fat than other mammals and this may be as a source of ketones in early infancy. Infants have slightly elevated ketones (mild ketonemia) regardless of feeding status which differs from adults who only have elevated ketones when food is restricted (no details here). Glucose is the primary fuel for the human brain Ketones are an alternate source of fuel when glucose is less available Ketones "appear to be" an essential fuel for the midterm fetus, and may provide as much as 30% of the developing brain's needs Ketones are both an energy source and carbon source for fat and cholesterol synthesis in the brain. Campbell relates these so Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>

Signs And Symptoms Of Diabetes In Infants

Signs And Symptoms Of Diabetes In Infants

Diabetes can affect individuals of any age, including infants and children. Knowing that your baby has diabetes can be really frightening. But by learning how to perform glucose testing and give insulin, you can help your child to grow up healthy. The first thing you need to do, though, is to keep your own stress level down. Your baby can sense if you feel anxious, so it is up to you to be as brave as your little one. Types Medical experts say that Type 1 diabetes is the form of the disease most often diagnosed in infants. More commonly known as juvenile onset diabetes, this autoimmune disorder prevents the body from producing enough insulin, a hormone needed so that cells can break down glucose for energy. Type 2, or non-insulin dependent diabetes, can also affect infants. Insulin resistance is the primary cause of Type 2 diabetes. As a result, both insulin and blood sugar levels in the body continue to rise. Certain medical conditions or genetic disorders, such as Down syndrome and Turner syndrome, can cause this type of diabetes as well. Symptoms The American Academy of Pediatrics tells parents to contact their child’s pediatrician immediately if she shows any of the following symptoms. Crankiness, sweating, trembling, paleness and bluish tinge to the lips or fingers are symptoms that an infant might be hypoglycemic. A glucose test should be performed, as treatment may be needed if the infant’s blood sugar is too low. A baby’s brain development requires a continuous supply of glucose. Therefore, parents must carefully manage their child’s diabetes. Likewise, when an infant’s glucose levels climb too high, hyperglycemia means that your infant may not be getting enough insulin in combination with how much you are feeding her. While infants often display no sy Continue reading >>

Ketone Testing: About Your Child's Test

Ketone Testing: About Your Child's Test

What is it? A ketone test checks for ketones in your child's blood or urine. Ketones are made when the body breaks down fat for energy instead of using sugar. This can happen when children with diabetes are ill or don't get enough insulin. Newer home blood sugar meters can measure ketone levels in the blood. You can also use home urine tests to measure ketones. Why is this test done? Measuring your child's ketones is recommended whenever your child has symptoms of illness, such as nausea, vomiting, or belly pain. These symptoms are similar to symptoms of high blood sugar and may mean that your child has diabetic ketoacidosis. This condition is very serious and needs immediate treatment. How can you prepare for the test? In general, your child doesn't need to prepare before having this test. Your doctor may give you some specific instructions. What happens during the test? Blood test in a doctor's office or hospital: A health professional takes a sample of your child's blood. Blood test at home: Some home blood sugar meters can also measure blood ketones. You use the same finger-prick method that you use to measure your child's blood sugar. Home urine test: Collect a sample of urine in a clean container. Follow the manufacturer's directions on the bottle of test strips or tablets. What else should you know about the test? With the home urine test, if either the test strip changes colour or the urine changes colour when the tablet is dropped into the sample, ketones are present in your child's urine sample. The test results are read as negative to 1+ to 4+, or small to large. Blood ketone tests using a meter display the result on the monitor. Your doctor can tell you what ketone range is high for your child (for example 0.6 mmol/L or higher). Your doctor may recommend tha Continue reading >>

Episode 63 – Pediatric Dka

Episode 63 – Pediatric Dka

Pediatric DKA was identified as one of key diagnoses that we need to get better at managing in a massive national needs assessment conducted by the fine folks at TREKK – Translating Emergency Knowledge for Kids – one of EM Cases’ partners who’s mission is to improve the care of children in non-pediatric emergency departments across the country. You might be wondering – why was DKA singled out in this needs assessment? It turns out that kids who present to the ED in DKA without a known history of diabetes, can sometimes be tricky to diagnose, as they often present with vague symptoms. When a child does have a known history of diabetes, and the diagnosis of DKA is obvious, the challenge turns to managing severe, life-threatening DKA, so that we avoid the many potential complications of the DKA itself as well as the complications of treatment – cerebral edema being the big bad one. The approach to these patients has evolved over the years, even since I started practicing, from bolusing insulin and super aggressive fluid resuscitation to more gentle fluid management and delayed insulin drips, as examples. There are subtleties and controversies in the management of DKA when it comes to fluid management, correcting serum potassium and acidosis, preventing cerebral edema, as well as airway management for the really sick kids. In this episode we‘ll be asking our guest pediatric emergency medicine experts Dr. Sarah Reid, who you may remember from her powerhouse performance on our recent episodes on pediatric fever and sepsis, and Dr. Sarah Curtis, not only a pediatric emergency physician, but a prominent pediatric emergency researcher in Canada, about the key historical and examination pearls to help pick up this sometimes elusive diagnosis, what the value of serum Continue reading >>

Hypoglycemia

Hypoglycemia

Hypoglycemia refers to low blood sugar, or technically a lower than normal blood glucose level. It is rarely encountered in pediatric practice outside of the newborn nursery, where it is a commonplace event. Profound hypoglycemia in the newborn can cause brain damage. Aggressive blood glucose monitoring of asymptomatic (nothing appears to be wrong) infants has been the standard. I think attitudes are softening in the era of cost-benefit analysis, since many babies seem to be subjected to large numbers of (in retrospect) needless blood glucose determinations compared to the actual number of significant problems identified. Symptoms of hypoglycemia are generally related to the body's efforts to raise the blood glucose level back to where it should be. These symptoms are really just the manifestations of adrenaline (epinephrine) release, which is the chief signal the body uses to mobilise stored glucose into the bloodstream. The most noticable adrenaline effects are nervousness, light-headedness, increased heart rate, and a particularly urgent sense of hunger. Headache is sometimes a symptom of hypoglycemia; I believe the explanation is brain neuronal cell dysfunction. In the newborn, symptoms of hypoglycemia include sweating, jitteriness, rapid breathing, rapid heart rate, pallor, or even apnea. Profound or very difficult to treat hypoglycemia in a newborn can signal the presence of rare but dangerous conditions such as galactosemia, growth hormone deficiency, insulin secreting tumors, or may reflect severe intrauterine growth restriction (IUGR). Hypoglycemia is the opposite of hyperglycemia - high blood glucose - which is the hallmark of diabetes. True hypoglycemia in children older than newborns is reasonably rare and is not the cause of the myriad complaints and condit 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 >>

Clinical Features And Diagnosis Of Diabetic Ketoacidosis In Children And Adolescents

Clinical Features And Diagnosis Of Diabetic Ketoacidosis In Children And Adolescents

INTRODUCTION Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus. Less commonly, it can occur in children with type 2 diabetes mellitus. DKA is caused by absolute or relative insulin deficiency. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) The incidence and prevalence of type 2 diabetes mellitus have increased across all ethnic groups. This has been coupled with an increasing awareness that children with type 2 diabetes mellitus can present with ketosis or DKA, particularly in obese African American adolescents [1-7]. (See "Classification of diabetes mellitus and genetic diabetic syndromes", section on 'DKA in type 2 diabetes'.) The clinical features and diagnosis of DKA in children will be reviewed here. This discussion is primarily based upon the large collective experience of children with type 1 diabetes mellitus. There is limited experience in the assessment and diagnosis of DKA in children with type 2 diabetes mellitus, although the same principles should apply. The management of diabetes in children, treatment of DKA in children and the epidemiology and pathogenesis of DKA are discussed separately. (See "Management of type 1 diabetes mellitus in children and adolescents" and "Treatment and complications of diabetic ketoacidosis in children and adolescents" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".) DEFINITION Diabetic ketoacidosis – A consensus statement from the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2014 defined the following biochemical criteria for the diagnosis of DKA [8]: Hyperglycemia – Blood glucose of >200 mg/dL (11 mmol/L) AND Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

Definition Diabetes mellitus is a chronic disease in which the body is not able to correctly process glucose for cell energy due to either an insufficient amount of the hormone insulin or a physical resistance to the insulin the body does produce. Without proper treatment through medication and/or lifestyle changes, the high blood glucose (or blood sugar) levels caused by diabetes can cause long-term damage to organ systems throughout the body. Description There are three types of diabetes mellitus: type 1 (also called juvenile diabetes or insulin-dependent diabetes), type 2 (also called adult-onset diabetes), and gestational diabetes. While type 2 is the most prevalent, consisting of 90 to 95 percent of diabetes patients in the United States, type 1 diabetes is more common in children. Gestational diabetes occurs in pregnancy and resolves at birth. Every cell in the human body needs energy in order to function. The body's primary energy source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (primarily sugars and starches). Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. However, glucose requires insulin in order to be processed for cellular energy. Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of a cell. It acts like a key to open a doorway into the cell through which glucose can enter. When there is not enough insulin produced (as is the case with type 1 diabetes) or when the doorway no longer recognizes the insulin key (which happens in type 2 and gestational diabetes), glucose stays in the bloodstream rather entering the cells. The high blood glucose, or blood Continue reading >>

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys filter some of the glucose (suga Continue reading >>

Childhood Ketoacidosis

Childhood Ketoacidosis

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 one of our health articles more useful. Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes.[1]The primary cause of DKA is absolute or relative insulin deficiency: Absolute - eg, previously undiagnosed type 1 diabetes mellitus or a patient with known type 1 diabetes who does not take their insulin. Relative - stress causes a rise in counter-regulatory hormones with relative insulin deficiency. DKA can be fatal The usual causes of death are: Cerebral oedema - associated with 25% mortality (see 'Cerebral odedema', below). Hypokalaemia - which is preventable with good monitoring. Aspiration pneumonia - thus, use of a nasogastric tube in the semi-conscious or unconscious is advised. Deficiency of insulin. Rise in counter-regulatory hormones, including glucagon, cortisol, growth hormone, and catecholamines. Thus, inappropriate gluconeogenesis and liver glycogenolysis occur compounding the hyperglycaemia, which causes hyperosmolarity and ensuing polyuria, dehydration and loss of electrolytes. Accelerated catabolism from lipolysis of adipose tissue leads to increased free fatty acid circulation, which on hepatic oxidation produces the ketone bodies (acetoacetic acid and beta-hydroxybutyric acid) that cause the metabolic acidosis. A vicious circle is usually set up as vomiting usually occurs compounding the stress and dehydration; the cycle can only be broken by providing insulin and fluids; otherwise, severe acidosis occurs and can be fatal. Biochemical criteria The biochemical criteria required for a diagnosis of DKA to be made are Continue reading >>

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