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Long Term Complications Of Dka

Dka Final

Dka Final

1. Diabetic Ketoacidosis EPU Team (Dr. Uko P., Dr. Eke E.P., Dr. Jemide O., Dr. Osang S.) FMC Keffi 28th of May, 2014 2. Outline  Overview of Diabetic Mellitus  Diabetic Ketoacidosis: Introduction  Epidemiology  Physiology  Pathophysiology  Clinical Presentation  Diagnosis  Complications  Treatment/Monitoring  Prevention  Conclusion  References 2 3. Overview of Diabetes Mellitus Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both. 4. Criteria for diagnosis Symptoms of DM and casual plasma glucose conc. > 11.1mmol/L(200mg/dl) (10 for venous) Fasting Plasma Glucose > 7.0mmol/L (126mg/dl) (6.3 for venous and capillary) 2hr post load of glucose >11.1mmol/L during an OGTT 5. Types of DM 1. Type 1 Diabetes Mellitus (T1DM):- β cell destruction leading to absolute insulin deficiency. Immune mediated, idiopathic 2. Type 2 Diabetes Mellitus (T2DM):- insulin resistance with relative insulin deficiency 3. Other types  Gestational DM 6. Genetic defects of ◦ β cell function ◦ Insulin action Diseases of the pancreas Endocrinopathies Infections Drug or chemical induced Genetic syndromes Uncommon forms of immune related 7. TYPE 1 DM Type 1 DM is the most common endocrine metabolic disorder of childhood and adolescence. Autoimmune mechanisms are factors in the genesis of T1DM. • Most cases are primarily due to T-cell mediated pancreatic islet β-cell destruction. 8. Serological markers of an autoimmune pathologic process, including islet cell, glutamic acid decarboxylase (GAD), islet antigen (IA)-2, IA-2b, or insulin autoantibodies (IAAs), are present in 85– 90% of individuals when fasting hyp Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management

Type 1 Diabetes In Adults: Diagnosis And Management

High blood glucose (hyperglycaemia) that is not treated can lead to a serious condition called diabetic ketoacidosis (or DKA for short). It is caused by the build‑up of harmful ketones in the blood. People with type 1 diabetes are at risk of DKA. You may be advised to test for ketones in your blood or urine as part of sick-day rules. Your blood ketones may be measured by a healthcare professional if it is thought you might have DKA. If you have DKA you will need emergency treatment in hospital by a specialist care team. This will include having fluids through a drip. Questions to ask about DKA Continue reading >>

Diabetic Ketoacidosis And Brain Function

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 >>

Long-term Prognosis Of Type 1 Diabetes In Relation To The Clinical Characteristics At The Onset Of Diabetes

Long-term Prognosis Of Type 1 Diabetes In Relation To The Clinical Characteristics At The Onset Of Diabetes

Abstract It is known that age, the degree of glycemic deterioration and the immune status at the time of the onset of type 1 diabetes (T1DM) are objective factors that can predict the residual B-cell function and the glycemic control 1 year after diagnosis. Objective: Evaluation of the long-term prognosis of T1DM in relation to the clinical characteristics at the time of diabetes onset. Methods: An observational retrospective study conducted on 200 patients including all the patients with newly diagnosed T1DM in the period from 2003 to 2013. Results: Fifty-three percent of the studied cohort presented initially by diabetic ketoacidosis (DKA). The current studied cohort showed that younger patients required more insulin during follow-up. Female patients needed higher insulin doses at 8 and 10 years after diagnosis, yet no difference among both genders during early years of follow up. Patients presenting with DKA required higher insulin requirements over the first 2 years and poor glycemic control. C-peptide levels at diagnosis correlated with insulin requirements during the first 2 years. Insulin dose at onset correlated positively with the insulin dose over the entire follow up period. A positive correlation was found between HbA1c at onset and 1, 2 and 4 year. Conclusion: Female gender, younger age, presence of DKA, lower C-peptide and higher HbA1c at onset could predict a poor long-term outcome. Identification of factors related to a worse outcome of T1DM at the onset of diabetes might help in selecting those patients who should be given more intensive treatment. 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 >>

Diabetic Coma Recovery: What You Need To Know

Diabetic Coma Recovery: What You Need To Know

In people with diabetes, a diabetic coma occurs when severe levels of either high or low uncontrolled blood sugar are not corrected. If treated quickly, a person will make a rapid recovery from a diabetic coma. However, diabetic coma can be fatal or result in brain damage. It is important for people with diabetes to control their blood sugars and know what to do when their blood sugar levels are not within their target range. The severe symptoms of uncontrolled blood sugar that can come before a diabetic coma include vomiting, difficulty breathing, confusion, weakness, and dizziness. Recovery from diabetic coma If a diabetic coma is not treated within a couple of hours of it developing, it can cause irreversible brain damage. If no treatment is received, a diabetic coma will be fatal. In addition, having blood sugar levels that continue to be too low or too high can be bad for long-term health. This remains true even if they do not develop into diabetic coma. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range. Doing so will also reduce the risk of associated complications and diabetic coma. What is diabetes? Diabetes is a long-term condition in which the body is unable to control the level of a sugar called glucose in the blood. Diabetes is caused by either a lack of insulin, the body's inability to use insulin correctly, or both. In people who don't have diabetes, insulin usually ensures that excess glucose is removed from the bloodstream. It does this by stimulating cells to absorb the glucose they need for energy from the blood. Insulin also causes any remaining glucose to be stored in the liver as a substance called glycogen. The production of insul Continue reading >>

Long-term Risk Of Stroke In Type 2 Diabetes Patients With Diabetic Ketoacidosis: A Population-based, Propensity Score-matched, Longitudinal Follow-up Study

Long-term Risk Of Stroke In Type 2 Diabetes Patients With Diabetic Ketoacidosis: A Population-based, Propensity Score-matched, Longitudinal Follow-up Study

Abstract Aim To investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA). Methods This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities. Patients with type 1 diabetes (T1D), identified by glucagon C-peptide stimulation or glutamic acid decarboxylase (GAD) antibody blood tests and possession of a catastrophic illness certificate were excluded. All patients were tracked until a new stroke diagnosis, death or the end of 2011. Results Of the 3572 selected patients, 270 with DKA and 404 of the 7144 controls were diagnosed with a new stroke, giving an incidence rate ratio (IRR) of 1.56 (95% CI: 1.34–1.82; P < 0.0001). DKA patients had a higher risk of ischaemic stroke than those without DKA (IRR: 1.62, 95% CI: 1.34–1.96; P < 0.0001), and DKA patients with hypertension and hyperlipidaemia were at even greater risk of stroke. Also, DKA patients were at particular risk for stroke during the first half-year following DKA diagnosis. After adjusting for patient characteristics and comorbidities, these patients were 1.55 times more likely to have a stroke than those without DKA (95% CI: 1.332–1.813, P < 0.0001). Continue reading >>

Cognitive Function In Diabetes

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 >>

Diabetes: Preventing Complications

Diabetes: Preventing Complications

Diabetes complications can be divided into two types: acute (sudden) and chronic (long-term). This article discusses these complications and strategies to prevent the complications from occurring in the first place. Acute complications Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) Acute complications of diabetes can occur at any time in the course of the disease. Chronic complications Cardiovascular: Heart disease, peripheral vascular disease, stroke Eye: Diabetic retinopathy, cataracts, glaucoma Nerve damage: Neuropathy Kidney damage: Nephropathy Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis. Basic principles of prevention of diabetes complications: Take your medications (pills and/or insulin) as prescribed by your doctor. Monitor your blood sugars closely. Follow a sensible diet. Do not skip meals. Exercise regularly. See your doctor regularly to monitor for complications. Results from untreated hyperglycemia. Blood sugars typically range from 300 to 600. Occurs mostly in patients with Type 1 diabetes (uncommon in Type 2). Occurs due to a lack of insulin. Body breaks down its own fat for energy, and ketones appear in the urine and blood. Develops over several hours. Can cause coma and even death. Typically requires hospitalization. Nausea, vomiting Abdominal pain Drowsiness, lethargy (fatigue) Deep, rapid breathing Increased thirst Fruity-smelling breath Dehydration Inadequate insulin administration (not getting Continue reading >>

Diabetes Symptoms & Complications

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 >>

5 Common Type 1 Diabetes Complications

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 >>

2. Learning Objectives

2. Learning Objectives

4.1. Diabetic Ketoacidosis (DKA) Diabetic ketoacidosis results from lack of insulin and it is considered a medical emergency as it has a mortality rate of approximately 5 percent, mostly because of late recognition and frequently suboptimal management. Diabetic ketoacidosis can be the first manifestation of type 1 diabetes in a previously undiagnosed patient or can occur in a patient with type 1 diabetes when insulin requirements rise during medical stress. Noncompliance with insulin administration is another common cause of DKA. Although DKA is much more common in type 1 diabetes, it can also occur in patients with type 2 diabetes who have a predominant insulin secretory defect under severe medical stress. 4.1.1. Pathophysiology Diabetes is often referred to as "starvation in the midst of plenty" and the progression of events that results from acute insulin deficiency holds this concept to be valid. Insulin deficiency leads to impaired peripheral glucose uptake. In the presence of inadequate insulin, energy stores in fat and muscle are rapidly broken down into fatty acids and amino acids, which are then transported to the liver for conversion to glucose and ketones (beta-hydroxybutyrate and acetoacetate). Counter-regulatory hormones such as glucagon, catecholamines, cortisol and growth hormone rise in an attempt to correct the perceived low glucose levels, further contributing to hyperglycemia and ketonemia. The combination of increased production of glucose and ketones with decreased utilization (due to insulin deficiency) results in high levels of these substances. Hyperglycemia causes osmotic diuresis with an ensuing reduction of intravascular volume, which in turn causes an impairment of renal blood flow and an inability to excrete glucose which worsens the hypergl Continue reading >>

Diabetes Complications

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 >>

Type 1 Diabetes Complications

Type 1 Diabetes Complications

Type 1 diabetes is complicated—and if you don’t manage it properly, there are complications, both short-term and long-term. “If you don’t manage it properly” is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if you’ve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage. Diabetes complications are all related to poor blood glucose control, so you must work carefully with your doctor and diabetes team to correctly manage your blood sugar (or your child’s blood sugar). Short-term Diabetes Complications Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar). It develops when there’s too much insulin—meaning that you’ve taken (or given your child) too much insulin or that you haven’t properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose). There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when it’s in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely). The signs and symptoms of low blood glucose are usually easy to recognize: Rapid heartbeat Sweating Paleness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech For more information about hypoglycemia and how to treat it, please read our article on hy Continue reading >>

Diabetes: Long Term Complications

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 >>

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