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Long Term Complications Of Dka

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 >>

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 >>

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 >>

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 >>

Effects Of Diabetic Ketoacidosis On Visual And Verbal Neurocognitive Function In Young Patients Presenting With New-onset Type 1 Diabetes

Effects Of Diabetic Ketoacidosis On Visual And Verbal Neurocognitive Function In Young Patients Presenting With New-onset Type 1 Diabetes

Go to: Abstract To evaluate the effects of diabetic ketoacidosis (DKA) on neurocognitive functions in children and adolescents presenting with new-onset type 1 diabetes. Newly diagnosed patients were divided into two groups: those with DKA and those without DKA (non-DKA). Following metabolic stabilization, the patients took a mini-mental status exam prior to undergoing a baseline battery of cognitive tests that evaluated visual and verbal cognitive tasks. Follow-up testing was performed 8-12 weeks after diagnosis. Patients completed an IQ test at follow-up. Results: There was no statistical difference between the DKA and non-DKA groups neither in alertness at baseline testing nor in an IQ test at follow-up. The DKA group had significantly lower baseline scores than the non-DKA group for the visual cognitive tasks of design recognition, design memory and the composite visual memory index (VMI). At follow-up, Design Recognition remained statistically lower in the DKA group, but the design memory and the VMI tasks returned to statistical parity between the two groups. No significant differences were found in verbal cognitive tasks at baseline or follow-up between the two groups. Direct correlations were present for the admission CO2 and the visual cognitive tasks of VMI, design memory and design recognition. Direct correlations were also present for admission pH and VMI, design memory and picture memory. Pediatric patients presenting with newly diagnosed type 1 diabetes and severe but uncomplicated DKA showed a definite trend for lower cognitive functioning when compared to the age-matched patients without DKA. Keywords: diabetic ketoacidosis, Cognition, dehydration, neuroinflammation Neurocognitive tasks. Mean (standard deviation) and median (range) of standard scores of Continue reading >>

The Risk And Outcome Of Cerebral Oedema Developing During Diabetic Ketoacidosis

The Risk And Outcome Of Cerebral Oedema Developing During Diabetic Ketoacidosis

Abstract BACKGROUND Cerebral oedema is a major cause of morbidity and mortality in children with insulin dependent diabetes. AIMS To determine the risk and outcome of cerebral oedema complicating diabetic ketoacidosis (DKA). METHODS All cases of cerebral oedema in England, Scotland, and Wales were reported through the British Paediatric Surveillance Unit between October 1995 and September 1998. All episodes of DKA were reported by 225 paediatricians identified as involved in the care of children with diabetes through a separate reporting system between March 1996 and February 1998. Further information about presentation, management, and outcome was requested about the cases of cerebral oedema. The risk of cerebral oedema was investigated in relation to age, sex, seasonality, and whether diabetes was newly or previously diagnosed. RESULTS A total of 34 cases of cerebral oedema and 2940 episodes of DKA were identified. The calculated risk of developing cerebral oedema was 6.8 per 1000 episodes of DKA. This was higher in new (11.9 per 1000 episodes) as opposed to established (3.8 per 1000) diabetes. There was no sex or age difference. Cerebral oedema was associated with a significant mortality (24%) and morbidity (35% of survivors). CONCLUSIONS This first large population based study of cerebral oedema complicating DKA has produced risk estimates which are more reliable and less susceptible to bias than those from previous studies. Our study indicates that cerebral oedema remains an important complication of DKA during childhood and is associated with significant morbidity and mortality. Little is known of the aetiology of cerebral oedema in this condition and we are currently undertaking a case control study to address this issue. 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 >>

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 >>

Type 1 Diabetes In Children And Adolescents

Type 1 Diabetes In Children And Adolescents

Chapter Headings Introduction Hypoglycemia Immunization Key Messages Suspicion of diabetes in a child should lead to immediate confirmation of the diagnosis and initiation of treatment to reduce the likelihood of diabetic ketoacidosis (DKA). Management of pediatric DKA differs from DKA in adults because of the increased risk for cerebral edema. Pediatric protocols should be used. Children should be referred for diabetes education, ongoing care and psychosocial support to a diabetes team with pediatric expertise. Note: Unless otherwise specified, the term “child” or “children” is used for individuals 0 to 18 years of age, and the term “adolescent” for those 13 to 18 years of age. Introduction Diabetes mellitus is the most common endocrine disease and one of the most common chronic conditions in children. Type 2 diabetes and other types of diabetes, including genetic defects of beta cell function, such as maturity-onset diabetes of the young, are being increasingly recognized in children and should be considered when clinical presentation is atypical for type 1 diabetes. This section addresses those areas of type 1 diabetes management that are specific to children. Education Children with new-onset type 1 diabetes and their families require intensive diabetes education by an interdisciplinary pediatric diabetes healthcare (DHC) team to provide them with the necessary skills and knowledge to manage this disease. The complex physical, developmental and emotional needs of children and their families necessitate specialized care to ensure the best long-term outcomes (1,2). Education topics must include insulin action and administration, dosage adjustment, blood glucose (BG) and ketone testing, sick-day management and prevention of diabetic ketoacidosis (DKA), nutr 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 >>

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 >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the 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 >>

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 >>

Acute Mesenteric Ischaemia: A Thrombotic Complication Of Diabetic Ketoacidosis?

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 >>

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