diabetestalk.net

Long Term Complications Of Dka

Incidence And Long-term Outcomes Of Adult Patients With Diabetic Ketoacidosis Admitted To Intensive Care: A Retrospective Cohort Study

Incidence And Long-term Outcomes Of Adult Patients With Diabetic Ketoacidosis Admitted To Intensive Care: A Retrospective Cohort Study

Diabetic ketoacidosis is a life-threatening but avoidable complication of diabetes mellitus often managed in intensive care units. The risk of emergency hospital readmission in patients surviving an intensive care unit episode of diabetic ketoacidosis is unknown. We aimed to report the cumulative incidence of emergency hospital readmission and costs in all patients surviving an intensive care unit episode of diabetic ketoacidosis in Scotland. We used a national six-year cohort of survivors of first diabetic ketoacidosis admissions to Scottish intensive care units (1 January 2005–31 December 2010) identified in the Scottish Intensive Care Society Audit Group registry linked to acute hospital and death records (follow-up censored 31 December 2010). Diabetic ketoacidosis-related emergency readmissions were identified using International Classification of Disease-10 codes. During the study period, 386 patients were admitted to intensive care units in Scotland with diabetic ketoacidosis (admission rate 1.5/100,000 Scottish population). Median age was 44 (IQR 29–56); 51% male; 55% required no organ support on admission. Mortality after intensive care unit admission was 8% at 30 days, 18% at one year, and 35% at five years. A total of 349 patients survived their first intensive care unit diabetic ketoacidosis admission [mean (SD) age 42.5 (18.1) years; 50.4% women; 46.1% required ≥1 organ support]. Following hospital discharge, cumulative incidence of 90-day, one-year, and five-year diabetic ketoacidosis readmission (all-cause readmission) was 13.8% (31.8%), 29.7% (58.9%) and 46.4% (82.6%). Diabetic ketoacidosis in patients requiring intensive care unit admission is associated with high risk of long-term mortality and high hospital costs. An understanding of the precipit Continue reading >>

Long-term Complications Of Diabetes Mellitus In Cats

Long-term Complications Of Diabetes Mellitus In Cats

Diabetes mellitus and the resulting changes in the body's metabolism affect all systems of the body. Some systems are more capable of adapting than others. Long-term complications of diabetes vary between species. In cats, these complications are infrequent, but kidney disease and disease of the nervous system (neuropathy) are the most common. Cats are much less likely than dogs and humans to develop retinal disease. Diabetic nephropathy 'Diabetic nephropathy' is the term used to describe changes in the kidney resulting from diabetes mellitus. The changes occur in the glomeruli, which are the filtering structures in the kidney. The changes may be mild enough such that signs of disease do not occur, and the condition can only be diagnosed by biopsy of the kidney. Diabetic nephropathy is one of the most serious complications of diabetes in people. Diabetic neuropathy 'Diabetic neuropathy' is the term used to describe changes in the nervous system resulting from diabetes mellitus. One type of diabetic neuropathy is described as a condition in which cats walk or stand with their hocks touching the ground. This condition may occur as one of the early signs of diabetes in the cat, or it can occur later in the stage of the disease, especially if the cat is poorly regulated. Other cats with diabetic neuropathy may appear to limp or simply to have hind limb weakness. Cats with diabetes mellitus appear more prone to develop infections. Recurrent urinary tract infections are often a signal that the cat is not properly regulated. Hepatic lipidosis Feline hepatic lipidosis is a condition in cats in which the liver is injured, accumulates a large amount of fat and cannot function normally. It has been associated with diabetes mellitus. It is a very serious disease, and unless treated 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 Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab 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 >>

Hyperglycemic Crises

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

Diabetic Ketoacidosis

Introduction Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes caused by a lack of insulin in the body. Diabetic ketoacidosis occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a by-product called ketones. Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes. Symptoms of diabetic ketoacidosis include: passing large amounts of urine feeling very thirsty vomiting abdominal pain Seek immediate medical assistance if you have any of these symptoms and your blood sugar levels are high. Read more about the symptoms of diabetic ketoacidosis. Who is affected by diabetic ketoacidosis? Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes. Younger children under four years of age are thought to be most at risk. In about 1 in 4 cases, diabetic ketoacidosis develops in people who were previously unaware they had type 1 diabetes. Diabetic ketoacidosis accounts for around half of all diabetes-related hospital admissions in people with type 1 diabetes. Diabetic ketoacidosis triggers These include: infections and other illnesses not keeping up with recommended insulin injections Read more about potential causes of diabetic ketoacidosis. Diagnosing diabetic ketoacidosis This is a relatively straightforward process. Blood tests can be used to check your glucose levels and any chemical imbalances, such as low levels of potassium. Urine tests can be used to estimate the number of ketones in your body. Blood and urine tests can also be used to check for an underlying infec Continue reading >>

The Outcome Of Brittle Type 1 Diabetes—a 20 Year Study

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 >>

Diabetic Ketoacidosis Forecasts Inferior Long-term Diabetes Management

Diabetic Ketoacidosis Forecasts Inferior Long-term Diabetes Management

Recognizing early signs of type 1 diabetes is crucial in the early prevention of diabetic ketoacidosis (DKA). Diabetic ketoacidosis (DKA) is a very serious condition that leads to diabetic coma or even leads to death. A recent research published online was carried out by Lindsey M Duca, PhD, at the Barbara Davis Center for Diabetes and the University of Colorado, Aurora. It revealed that children who had diabetic ketoacidosis during type-1 diabetes diagnosis were at a high risk for poor long term glycemic control. Glycemic control refers to the levels of glucose (blood sugar) in a person living with diabetes mellitus (DM). Glycemic control is still substandard for a number of patients diagnosed with type 1 diabetes. Long-term complications of diabetes results from many years of hyperglycemia. A study published online to determine the Factors Predicting Glycemic Control in Type 1 Diabetic Patient, DCCT and the follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC) suggested that proper glycemic management over a long period slows the onset as well as slowing the progression of microvascular and macro vascular complications in those who have type 1 diabetes. The method used involves the study of 188 patients who had diabetes type 1 and who showed several factors related to the disease. The results were a negative correlation between the age at diabetes onset and HbA1c value (p=0.02). Results show that youths had higher HbA1c value (10.8±2.9%) compared to adults (9.2±2.8%, p=0.02). There was no relationship found between the average HbA1c value and the number of daily insulin injections. Results reveal that average HbA1c was increased in patients with a lack of compliance (11.1±3.3%) to insulin therapy (8.9±2.4%, p<0.0001), in people with under Continue reading >>

Diabetes: Short Term Problems

Diabetes: Short Term Problems

Complications Diabetes can cause other health problems. Sometimes these problems are referred to as complications (COM-pli-KAY-shuns). Short-term problems can happen at any time when you have diabetes. Long-term problems may develop when you have diabetes for a long time. In case of emergency, you should always wear a form of medical identification (ID). Examples are ID bracelets and necklaces. To reduce your risk of getting other health problems from diabetes, you need good control of your blood glucose (sugar). Good control means keeping blood glucose at certain levels. To learn more about good control and healthy blood glucose numbers, see the UPMC patient education page Diabetes: Your Management Plan. This patient education sheet tells you about short-term problems, what to do for them, and how to prevent them: Low blood glucose High blood glucose with ketones High blood glucose without ketones Low Blood Glucose Low blood glucose is also called hypoglycemia (HI-po-glice-EE-me-uh). Blood glucose numbers under 70 mean you have low blood glucose. Several things can cause low blood glucose: Too much insulin Too much sulfonylurea (SULL-fon-ilyour-EE-uh) medicine Not enough food Too much exercise Symptoms of low blood glucose include: Hunger Feeling nervous Heavy sweating Weakness Shaking (tremors) Confusion Seizures Coma If you get low blood glucose If you get low blood glucose and you are awake and able to swallow, eat or drink something with sugar. Here is a list of some suggested foods: 4 ounces of fruit juice 4 to 6 ounces of sugary (non-diet) soft drink 3 to 4 glucose tablets (or 1 tube of glucose gel) 1 cup of skim milk 6 to 7 hard candies (not sugar-free), such as Lifesavers Wait for 10 to 15 minutes. Test your blood glucose again. If your blood glucose is above 7 Continue reading >>

Diabetics & Non-compliance

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 >>

Neurological Consequences Of Diabetic Ketoacidosis At Initial Presentation Of Type 1 Diabetes In A Prospective Cohort Study Of Children

Neurological Consequences Of Diabetic Ketoacidosis At Initial Presentation Of Type 1 Diabetes In A Prospective Cohort Study Of Children

OBJECTIVE To investigate the impact of new-onset diabetic ketoacidosis (DKA) during childhood on brain morphology and function. RESEARCH DESIGN AND METHODS Patients aged 6–18 years with and without DKA at diagnosis were studied at four time points: <48 h, 5 days, 28 days, and 6 months postdiagnosis. Patients underwent magnetic resonance imaging (MRI) and spectroscopy with cognitive assessment at each time point. Relationships between clinical characteristics at presentation and MRI and neurologic outcomes were examined using multiple linear regression, repeated-measures, and ANCOVA analyses. RESULTS Thirty-six DKA and 59 non-DKA patients were recruited between 2004 and 2009. With DKA, cerebral white matter showed the greatest alterations with increased total white matter volume and higher mean diffusivity in the frontal, temporal, and parietal white matter. Total white matter volume decreased over the first 6 months. For gray matter in DKA patients, total volume was lower at baseline and increased over 6 months. Lower levels of N-acetylaspartate were noted at baseline in the frontal gray matter and basal ganglia. Mental state scores were lower at baseline and at 5 days. Of note, although changes in total and regional brain volumes over the first 5 days resolved, they were associated with poorer delayed memory recall and poorer sustained and divided attention at 6 months. Age at time of presentation and pH level were predictors of neuroimaging and functional outcomes. CONCLUSIONS DKA at type 1 diabetes diagnosis results in morphologic and functional brain changes. These changes are associated with adverse neurocognitive outcomes in the medium term. The incidence of childhood-onset type 1 diabetes varies from 0.1 to 57.6 per 100,000 and is increasing worldwide (1). Long Continue reading >>

Short Term Complications

Short Term Complications

Tweet Short term complications occur if blood glucose levels go too low or too high for the body to function properly in the present state. Short term complications can present immediate danger and therefore need to be treated quickly to avoid emergencies. What are the short term complications of diabetes? The most common short term complications of diabetes are the following: Hypoglycemia Hypoglycemia is a state of having blood glucose levels that are too low. Hypoglycemia is defined as having a blood glucose level of below 4.0 mmol/l. Symptoms include tiredness, weakness, confusion and a raised pulse rate. If you take blood glucose lowering medication such as insulin, sulfonylureas and post prandial glucose regulators, it is important to treat hypoglycemia immediately to prevent blood glucose levels from going dangerously low. Hypoglycemia can also occur in people that do not take diabetes medication but in this case, the body should low blood sugar levels naturally and treatment is not normally needed unless you have a condition known as reactive hypoglycemia or will be carrying out a dangerous task such as operating machinery or driving. Read about hypoglycemia Ketoacidosis Ketoacidosis can occur if the body spends a significant amount of time with too little insulin to refuel the cells of the body. Without insulin the body will break down fat to release ketones into the blood that can be used for energy without the need for insulin to be present. However, if the level of ketones in the blood becomes too high, ketoacidosis is said to occur, and this condition can be very dangerous. Ketoacidosis will only usually occur if the body has too little insulin and there can affect people with type 1 diabetes, people that have had a pancreatectomy (surgical removal of the pa Continue reading >>

How Does Ketoacidosis Affect The Human Brain?

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 >>

Psychology In Diabetes Care, 2nd. Ed, Part 9

Psychology In Diabetes Care, 2nd. Ed, Part 9

Edited by Frank J. Snoek and T. Chas Skinner Diabetes in Adolescents 2.1 Introduction- Recurrent ketoacidosis Diabetic ketoacidosis (DKA) is the single most common cause of mortality in individuals with type 1 diabetes under the age of 40.21 In addition to the risk of fatality, recurrent DKA has a major impact on the quality of life of both the individuals with diabetes and their families, and microvascular complications may be accelerated. Research shows a number of consistent themes that enable us to identify individuals at potential risk for recurrent DKA, with about 20 per cent of individuals accounting for 80 per cent of hospital admissions for DKA.22,23 The incidence is higher in females, peaks in the early teenage years and rarely occurs in anyone diagnosed for less than 2 years. Individuals with earlier age of onset and lower socioeconomic backgrounds seem to be at increased risk, along with individuals who had existing psychopathology before diabetes onset.22,23 However, there is a distinct lack of evidence for individuals with recurrent DKA to have a subtype of brittle diabetes,24 and the main cause of DKA is insulin omission. Further long term follow-up data indicates that recurrent DKA is usually not sustained into adulthood.25,26 This leads to consideration of why some young adolescents persistently omit insulin. There are multiple reasons for this, but the literature seems to point to a relative few main candidates. There is consistent support for psychosocial risk factors as predictive of recurrent DKA. Individuals from families low in warmth and support, where there are high levels of unresolved family conflict and a distinct lack of parental involvement in the adolescent’s diabetes care seem to be typical of this population. 26–29 Linked to this is Continue reading >>

More in ketosis