Hyperglycemic Crises
What They Are and How to Avoid Them One type results in about 100,000 hospitalizations a year with a mortality rate of under 5%. The other is thought to cause fewer hospitalizations, yet the mortality rate is about 15%. Severe hyperglycemic conditions, known as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), involve very serious imbalances in blood chemistry and usually require that a person be hospitalized until normal blood chemistry is restored. Because they can occur in anyone with diabetes, everyone should know what causes them, how to prevent them, how they are treated, and when to seek medical attention. The body in balance Glucose metabolism is a complex balancing act. In people who don’t have diabetes, a number of interconnected processes help the body to use glucose and keep blood glucose levels in the normal range. The body constantly balances glucose extracted from foods and produced by the liver with glucose utilization by the body’s tissues. When there is ample glucose in the bloodstream, the liver converts some of it into glycogen for storage. When the body needs more energy, such as during a prolonged period of fasting or activity, the liver converts stored glycogen back into glucose so that it can be used by the body’s tissues. The liver also can create glucose from amino acids and fats. Insulin lowers blood glucose levels both by slowing down the liver’s glucose production and by helping the body’s tissues to use glucose for energy. If the blood glucose level goes too low, other hormones, called counterregulatory hormones, work against the action of insulin to raise blood glucose levels. These hormones include glucagon, epinephrine, growth hormone, and cortisol. All work by prodding the liver to release glucose and by Continue reading >>
Diabetic Ketoacidosis
Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>
Short-term Complications Of Diabetes
The short-term or acute effects of high blood sugars (hyperglycemia) vary from mild to severe. Generally sugars that are mildly elevated (<200 ng/dl) may go unnoticed for years. At these levels, symptoms may be very subtle or may not be present at all. Some of the first symptoms that those with diabetes mellitus notice are increased thirst, increased urination and weight loss. This primarily comes from an inability of the kidneys to filter and hold on to the extra sugar that is in the blood. When this happens, the excess sugar is released into the urine where osmosis then draws water from the blood into the urine as well. This can cause mild and occasionally severe dehydration. Additionally, over time the excretion of large amounts of sugars in the urine, which leave the body as unused calories, can cause significant unhealthy weight loss. In addition, high blood sugars may acutely cause fatigue, nausea, blurry vision and headaches. Let the endocrinologists at Houston Thyroid and Endocrine Specialists help guide you through the complications of diabetes mellitus. High blood sugars appear to weaken the immune system and make diabetics predisposed to developing infections. Neutrophils as well as other several other immune responses, which are an important part of the immune system defense against bacterial and fungal infections, have been shown to function poorly when blood sugars are elevated. Several other factors which contribute to higher infection rates in diabetics include poor circulation, skin colonization of pathogens (organisms that causes infections) and a weakened nervous system. Common infections among diabetics are skin/foot infections, fungal infections and urinary tract infections. In addition to making the development of infections more likely, high blood Continue reading >>
Diabetic Ketoacidosis And Brain Function
Diabetic Ketoacidosis (DKA) is a life-threatening consequence of diabetes. DKA occurs when there is a lack of insulin in the body causing hyperglycemia. As a result of the inability of glucose to enter the cells, the body must find other means to obtain energy. As such, fat breakdown occurs resulting in the accumulation of fatty acids. The fatty acids are metabolized to ketones that cause the blood to become acidotic (pH less than7.3). Because glucose remains in the blood, there is an increase in thirst and drinking to eliminate the solute load of glucose, which also results in increased urination (polyuria and polydipsia). Thus, the combination of increased serum acidity, weight loss, polyuria, and polydipsia may lead to extreme dehydration, coma, or brain damage. Without a doubt, the most severe acute complication of DKA is cerebral edema. Many cases of new onset type 1 diabetes present DKA (15-70 percent depending on age and geographic region, according to multiple studies), hence the importance of an early diagnosis of diabetes in order to avoid potential consequences. Much research is being conducted to predict the development of severe complications of DKA, most notably on brain herniation, the swelling of the brain that causes it to push towards the spinal cord, as well as other neurological consequences. Fulminant cerebral edema, or swelling of the brain, is relatively rare and has an incidence rate of 0.5-0.9 percent. However, what about the subtler, less severe alterations in brain functions that occur after DKA? Indeed, a recent paper published in Diabetes Care 2014; 37: 1554-1562by Cameron, Scratch, Nadebaum, Northum, Koves, Jennings, Finney, Neil, Wellard, Mackay, and Inder on behalf of the DKA Brain Injury Study Group entitled "Neurological Consequences of Continue reading >>
The Outcome Of Brittle Type 1 Diabetes—a 20 Year Study
Aims: To determine the long-term (20 years from presentation) outcome of brittle type 1 diabetes characterized by recurrent episodes of ketoacidosis (DKA). Methods: The cohort studied was a group of brittle diabetic patients from various parts of UK originally identified between 1979 and 1985. Patients were traced, where possible, via their diabetic clinics and/or general practitioners. Data on survival or otherwise were obtained from hospital case notes and information from diabetes care team members. For survivors, clinical and demographic information obtained included complication status and whether they still had brittle characteristics. They were also compared with a matched case–control group of type 1 patients with no history of brittle behaviour. Results: The original cohort comprised 33 patients— all female and mean ± SD, aged 18 ± 5 years and diabetes duration 8 ± 4 years. Thirteen were not traceable and 10 of the remaining 20 (50%) had died during the mean 22 years of follow-up. Deaths occurred evenly throughout the period, and causes were chronic renal failure (3), DKA (3), hypoglycaemia (2), subarachnoid haemorrhage (1) and uncertain (1). Age at death ranged from 27 to 45 years. Of the 10 survivors, none remained brittle, but they had a substantial burden of complications. Compared with the non-brittle control group, there was a significant excess of nephropathy and autonomic neuropathy. Conclusions: We conclude that brittle diabetes characterized by recurrent DKA has high long-term outcome mortality. These deaths were premature and almost all diabetes related. Those who survived had resolution of brittleness, but suffered a significant complication burden. Background: The National Institute for Health and Clinical Excellence (NICE) recently released Continue reading >>
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How Does Ketoacidosis Affect The Human Brain?
Diabetic Ketoacidosis (DKA) is the body’s emergency reaction to glucose starvation in the absence of insulin. It is a disastrous reaction — in general, it makes things worse rather than better, and starts a vicious cycle of blood acidity, rising blood glucose, dehydration, and blood hyperosmolality (high concentration of dissolved stuff) that can be hard to break. One of the hardest-hit organs in DKA is the brain, due to the dehydration and acidic blood entering that sensitive organ. Severe DKA may lead to brain swelling (edema) which is life-threatening. But recent studies have shown that even a short, apparently fully-recovered stint of DKA leads to measurable brain injury. Diabetic Ketoacidosis (DKA) is a life–threatening consequence of diabetes. DKA occurs when there is a lack of insulin in the body causing hyperglycemia. As a result of the inability of glucose to enter the cells, the body must find other means to obtain energy. As such, fat breakdown occurs resulting in the accumulation of fatty acids. The fatty acids are metabolized to ketones that cause the blood to become acidotic (pH less than7.3). Because glucose remains in the blood, there is an increase in thirst and drinking to eliminate the solute load of glucose, which also results in increased urination (polyuria and polydipsia). Thus, the combination of increased serum acidity, weight loss, polyuria, and polydipsia may lead to extreme dehydration, coma, or brain damage. Without a doubt, the most severe acute complication of DKA is cerebral edema. Many cases of new onset type 1 diabetes present DKA (15-70 percent depending on age and geographic region, according to multiple studies), hence the importance of an early diagnosis of diabetes in order to avoid potential consequences. Much research is be Continue reading >>
Diabetes Complications
Complications caused by diabetes People with diabetes must routinely monitor and regulate their blood sugar. No matter how careful you may be, there’s still a possibility that a problem might arise. There are two types of complications you may experience: acute and chronic. Acute complications require emergency care. Examples include hypoglycemia and ketoacidosis. If left untreated, these conditions can cause: seizures loss of consciousness death Chronic complications occur when diabetes isn’t managed properly. Diabetes causes high blood sugar levels. If not controlled well over time, high blood sugar levels can damage various organs, including the: eyes kidneys heart skin Unmanaged diabetes can also cause nerve damage. People with diabetes can experience sudden drops in their blood sugar. Skipping a meal or taking too much insulin or other medications that increase insulin levels in the body are common causes. People who are on other diabetes medications that do not increase insulin levels are not at risk for hypoglycemia. Symptoms can include: blurry vision rapid heartbeat headache shaking dizziness If your blood sugar gets too low, you can experience fainting, seizures, or coma. This is a complication of diabetes that occurs when your body cannot use sugar, or glucose, as a fuel source because your body has no insulin or not enough insulin. If your cells are starved for energy, your body begins to break down fat. Potentially toxic acids called ketone bodies, which are byproducts of fat breakdown, build up in the body. This can lead to: dehydration abdominal pain breathing problems Diabetes can damage blood vessels in the eyes and cause various problems. Possible eye conditions may include: Cataracts Cataracts are two to five times more likely to develop in people Continue reading >>
Acute Mesenteric Ischaemia: A Thrombotic Complication Of Diabetic Ketoacidosis?
Introduction: Increasing evidence is emerging that demonstrates the increased prothrombotic risk associated with DKA.1 We present the case of a child who developed multiple complications which we believe can be explained by his hypercoaguable state. Case history: A 14-month-old male was admitted in DKA at first diabetic presentation, complicated by cardiovascular shock. Initial blood tests showed blood glucose 80 mmol/l, blood ketones 5.9 mmol/l and venous pH 7.2. He initially responded well to fluid replacement and insulin therapy according to BSPED guidelines, but subsequently developed abdominal distension and fulminant hyperkalaemia (K+10.3 mmol/l). Following stabilisation, laparotomy was performed with excision of 106 cm of necrotic jejunum and formation of a duodenal-ileal anastomosis. Post-operative course was complicated by multi-organ failure, development of arterial and venous femoral vasculature thrombosis, high stoma losses and difficult diabetes control. Despite this the patient survived and was eventually able to be discharged home following reversal of his ileostomy. Conclusions: Acute mesenteric ischaemia (AMI) is a rare complication of DKA. While there are a number of cases described in the adolescent and adult population with long term IDDM2,3, only two cases have previously been described in the literature of children developing AMI at first diabetic presentation4,5. These authors differ in their conclusion as to whether non-occlusive ischaemia or thrombotic causes are responsible for AMI in DKA. We believe our report puts a strong case for a thrombotic aetiology, given the level of hyperosmolarity present in our patient and, more significantly, the concurrent development of arterial and venous thromboses. This also provides a platform for discussion Continue reading >>
Diabetes Symptoms & Complications
Symptoms People with type 1 or type 2 diabetes may have a range of symptoms. These symptoms might include: Frequent urination (polyuria) -- often at night (nocturia) Excessive thirst (polydipsia) Extreme hunger (polyphagia) Dry skin Weakness/feeling tired much of the time Recurring or slow-healing infections Weight loss (usually with high blood sugars > 300 mg/dL) Blurred vision Tingling in the hands or feet Nausea/vomiting (often seen in diabetic ketoacidosis in type 1 diabetes) Yeast infections Skin Infections Urinary tract infections Acanthosis nigricans (in type 2 diabetes; a skin disorder with dark, thick, velvet-textured skin in body folds) Type 1 diabetes usually occurs in childhood or adolescence. Typical age at diagnosis can range from 5 to 15 years old, although there appears to be an increasing incidence in younger children. Type 1 diabetes is responsible for roughly 10 percent of all diabetes cases. Insulin treatment is required for all type 1 diabetes patients, as their pancreas has a defect in the beta cells that produce insulin. Type 2 diabetes accounts for the remaining 90 percent of diabetes cases. The incidence and prevalence of type 2 diabetes has been steadily increasing since the 1950’s. The rise in type 2 diabetes is a direct consequence of obesity, overweight and lack of exercise. The incidence of type 2 diabetes is now increasing in adolescents and young adults, while it used to be a disease that occurred primarily in middle-age and older adults. Insulin resistance and high levels of circulating insulin may occur many years before type 2 diabetes is diagnosed. About 40 percent of type 2 diabetics have no symptoms of their condition, and most patients with diabetes are diagnosed during a routine medical screening. Many patients with type 2 diabe Continue reading >>
Diabetics & Non-compliance
Diabetics can develop high levels of glucose in their bloodstreams. Without proper diet, exercise, regular checkups and monitoring of blood glucose levels, high glucose can lead to several complications, including some that are life-threatening. Despite this danger, health professionals find too many diabetic patients don't follow medical advice for controlling their disease. Video of the Day Medically, noncompliance, also referred to as nonadherence, means not following a physician's recommendations. Typically, diabetics may be directed to follow a specific kind of diet, take prescribed medication and exercise. Physicians and counselors may recommend additional lifestyle changes for the patient's optimal health. Examples of Noncompliance A noncompliant diabetic patient may not check his blood glucose levels regularly. He make take his medication incorrectly or not at all. He may fail to lose weight, stop smoking or exercise. His diet may contain too much fat and too many carbohydrates to control blood glucose levels, and he may not visit his doctor for regular check-ups. Diabetics who are noncompliant do not realize or accept that proper self-care will have a positive effect in the long-term. As a result, they are in danger of developing complications that affect the eyes, kidneys, heart, nerves, feet and more. Over time, uncontrolled diabetes can lead to permanent damage of these areas as well as stroke, heart disease and blindness. Dangers of High Glucose High blood glucose, or hyperglycemia, occurs when the body doesn't have enough insulin or can't use insulin effectively. Hyperglycemia has a major impact on the complications of diabetes. Diabetic ketoacidosis occurs when the body burns fat instead of glucose for energy. It's a serious condition, affecting primarily Continue reading >>
Cognitive Function In Diabetes
Cognitive deficits, that is clinically relevant problems in cognitive performance, are commonly observed in people with both type 1 (T1DM) as well as type 2 diabetes (T2DM). Both diseases are related specifically to slowing of mental processing speed, psycho-motor speed, executive functions and attention. In T2DM learning and memory problems are often noted but less so in T1DM. Evidence for changes in brain structure and functioning accompanying cognitive dysfunction is accumulating. Chronic hyperglycaemia and associated microvascular disease appear to be the most important determinants of cognitive decrements in diabetes. Hypoglycaemia and hyperglycaemia Hypoglycaemia can lead to unconsciousness, seizure, coma or even death. Mild to moderate levels of hypoglycaemia commonly affect higher-order cognitive functions. Patients may experience mood changes and difficulty with memory, planning, attention and concentration [1]. Mental speed rapidly decreases, while accuracy remains relatively unaffected. With severe hypoglycaemia, all cognitive functions may be affected, seriously decreasing a patient’s mental capabilities. Whereas blood glucose can be quickly restored, cognitive dysfunction may take up to 4 hours or more to recover fully. Acute effects of hypoglycaemia on brain structure in diabetes are rarely reported and pre-clinical data suggest that brain damage after hypoglycaemia may be the result of reactive hyperglycaemia through overcompensation of counter-regulatory actions. In neonates without diabetes, hypoglycaemia is a common cause of brain damage, delayed development and death. The acute effect of hyperglycaemia on cognition seems relatively mild, contrary to the long-term effects, and may be associated with diabetic ketoacidosis (DKA), usually observed in ch Continue reading >>
5 Common Type 1 Diabetes Complications
3 0 Type 1 diabetes carries with it a much higher risk of developing some associated serious health problems. While in the past, getting diabetes-related health complications was almost a certainty, with modern blood glucose monitoring, control, and treatment, the risks have decreased significantly. Even a few decades ago, life expectancy for people with diabetes was regularly considered to be 10 years shorter than for people without the disorder. In 2012, however, a large-scale study found that life-expectancy was now only about 6 years less than average. For comparison, a lifetime of smoking will reduce life expectancy by 10 years. So what are the diabetes complications that you need to be looking out for? Largely, they fall into either cardiovascular or neuropathic categories. To make diabetes complications even more complicated, they tend to affect people of different sexes and different ethnicities differently. One more wild card is that recent studies have found that some people with Type 1 diabetes actually never develop most of the complications associated with diabetes. The good news is that with proper blood glucose control and a healthy lifestyle, the risks for developing Type 1 diabetes complications are drastically reduced. Some studies have actually found that careful monitoring and management can reduce the chances of developing any of these by as much as 50%. Still, everyone with Type 1 diabetes should keep a careful eye out for the five most common diabetes complications. Diabetic Ketoacidosis Diabetic Ketoacidosis (or DKA), is a condition caused by severe hyperglycemia (high blood sugar) which causes rapid fat breakdown in the body. As the fat breaks down, they release fatty acids which are then converted into chemicals called ketones, which are highly Continue reading >>
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Diabetic Ketoacidosis (dka)
Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>
Invokana Side Effects
Invokana belongs to a class of drugs known as sodium-glucose cotransporter-2 (SGLT2) inhibitors. These drugs lower blood sugar levels in type 2 diabetes patients, but they may also cause serious side effects like diabetic ketoacidosis (DKA), limb amputations, and kidney problems. Some patients have filed lawsuits against Johnson & Johnson and other drug companies, claiming that drug makers did not sufficiently warn about these side effects. If you or a loved one suffered DKA or kidney problems after taking Invokana or another SGLT2 inhibitor, you may be eligible for a lawsuit. Contact us for a free legal consultation. Diabetic Ketoacidosis (DKA) Diabetic ketoacidosis (DKA) is a severe diabetes complication that occurs when the body produces high levels of blood acids called ketones. Ketones are produced when cells don’t receive the energy they need from glucose and begin to break down fat for energy. Ketone accumulation acidifies the blood and can poison the body. DKA may send the patient into a diabetic coma and can even be fatal. In May 2015, the FDA warned that Invokana and other SGLT2 inhibitors may lead to DKA. In May 2015, the U.S. Food and Drug Administration (FDA) warned that Invokana and other SGLT2 inhibitors may lead to DKA. The FDA based the warning on 20 cases of DKA reported to the agency over a one-year period. This is an unusually high number of cases considering that DKA most commonly occurs in patients with type 1 diabetes. All of the patients required hospitalization and/or a visit to an emergency room. In December 2015, the FDA declared that SGLT2 inhibitors would now be required to carry warnings about the risk of excessive blood acids. The FDA added that the drugs must also warn against serious urinary tract infections. Symptoms of DKA include: N Continue reading >>
Diabetes: Long Term Complications
Diabetes, unfortunately, is a disease capable of affecting almost every part of your body and especially if it’s poorly managed. Certain conditions related to diabetes can create the potential for a myriad of complications that have long term and serious effects. It’s important to understand what the most common long term complications are and how to prevent them from happening. Diabetic Retinopathy Diabetic retinopathy is a disease involving the retina in the eye. The blood vessels in the retina are damaged or become blocked. The disease affects both type 1 (T1D) and type 2 (T2D) diabetics. It is a progressive disease that goes through various stages and over a period of time affects your ability to see well and can even lead to partial or full blindness. In fact, 99% of those who have had T1D for more than 20 years are at high risk of developing diabetic retinopathy. The figure is 60% for those who have T2D.[1] Half of all diabetics will develop some stage of retinopathy in their lifetimes according to the National Eye Institute. Retinopathy stages are defined as follows:[2] Mild nonproliferative Moderate nonproliferative Severe nonproliferative Proliferative At the proliferative stage, there is abnormal blood vessel growth. Diabetics also have a higher risk of developing glaucoma and cataracts. Neuropathy The root words for neuropathy – neuro and path – mean “distressed nerves.” There are three types of neuropathy common to diabetics: Peripheral Neuropathy – nerve damage in the nerve system transmitting information from peripheral nervous system found in the arms and legs to the central nervous system made up of the brain and spinal cord Autonomic Neuropathy – nerve damage in the nerves that control the involuntary nervous system managing biological a Continue reading >>
