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Long Term Complications Of Dka

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 >>

Cardiovascular Complications Of Ketoacidosis

Cardiovascular Complications Of Ketoacidosis

US Pharm. 2016;41(2):39-42. ABSTRACT: Ketoacidosis is a serious medical emergency requiring hospitalization. It is most commonly associated with diabetes and alcoholism, but each type is treated differently. Some treatments for ketoacidosis, such as insulin and potassium, are considered high-alert medications, and others could result in electrolyte imbalances. Several cardiovascular complications are associated with ketoacidosis as a result of electrolyte imbalances, including arrhythmias, ECG changes, ventricular tachycardia, and cardiac arrest, which can be prevented with appropriate initial treatment. Acute myocardial infarction can predispose patients with diabetes to ketoacidosis and worsen their cardiovascular outcomes. Cardiopulmonary complications such as pulmonary edema and respiratory failure have also been seen with ketoacidosis. Overall, the mortality rate of ketoacidosis is low with proper and urgent medical treatment. Hospital pharmacists can help ensure standardization and improve the safety of pharmacotherapy for ketoacidosis. In the outpatient setting, pharmacists can educate patients on prevention of ketoacidosis and when to seek medical attention. Metabolic acidosis occurs as a result of increased endogenous acid production, a decrease in bicarbonate, or a buildup of endogenous acids.1 Ketoacidosis is a metabolic disorder in which regulation of ketones is disrupted, leading to excess secretion, accumulation, and ultimately a decrease in the blood pH.2 Acidosis is defined by a serum pH <7.35, while a pH <6.8 is considered incompatible with life.1,3 Ketone formation occurs by breakdown of fatty acids. Insulin inhibits beta-oxidation of fatty acids; thus, low levels of insulin accelerate ketone formation, which can be seen in patients with diabetes. Extr Continue reading >>

Short-term Complications Of Diabetes

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 >>

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 >>

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 >>

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 >>

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 >>

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 >>

Diabetic Ketoacidosis

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 >>

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 >>

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 >>

Invokana And Dka Lawsuit

Invokana And Dka Lawsuit

First available to the U.S. market in 2013, Janssen Pharmaceutical’s diabetes drug Invokana was considered a revolutionary improvement for Type 2 diabetes management. The Johnson & Johnson subsidiary announced its new product as an “important [and] much-needed” development in the fight against type 2 diabetes. Forbes acclaimed the drug’s “market potential,” while highlighting Invokana’s ability to “attack blood sugar right from the get go.” The US Food & Drug Administration praised Invokana as an “advance [in] innovation.” Invokana’s market potential soared, with approximately 2 million prescriptions written in 2014 alone Unfortunately, the FDA soon had to admit the truth – that Invokana was found to be the cause of serious complications including ketoacidosis. Call us today at 713-893-8808 or contact us online to discuss an invokana and DKA lawsuit. Is Ketoacidosis Caused by Invokana? According to an FDA Safety Announcement released on May 15, 2015, Invokana and other similar drugs “may lead to ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalization.” Less than a year later, the FDA added a new warning to Invokana’s label. Physicians were advised to immediately discontinue Invokana in patients with signs and symptoms of ketoacidosis. Invokana was the first of a new class of drugs known as SGLT2, or sodium-glucose cotransporter-2, inhibitors. Invokana has been proven to cause ketoacidosis, according to the FDA. In response to recent developments, patients who experienced ketoacidosis after taking Invokana, many of whom face costly medical bills, lost work and considerable suffering, have begun to file lawsuits. What Is Ketoacidosis or DKA? Ketoacidosis develops d 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 >>

Ketoacidosis: A Diabetes Complication

Ketoacidosis: A Diabetes Complication

Ketoacidosis can affect both type 1 diabetes and type 2 diabetes patients. It's a possible short-term complication of diabetes, one caused by hyperglycemia—and one that can be avoided. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious complications of diabetes. These hyperglycemic emergencies continue to be important causes of mortality among persons with diabetes in spite of all of the advances in understanding diabetes. The annual incidence rate of DKA estimated from population-based studies ranges from 4.8 to 8 episodes per 1,000 patients with diabetes. Unfortunately, in the US, incidents of hospitalization due to DKA have increased. Currently, 4% to 9% of all hospital discharge summaries among patients with diabetes include DKA. The incidence of HHS is more difficult to determine because of lack of population studies but it is still high at around 15%. The prognosis of both conditions is substantially worsened at the extremes of age, and in the presence of coma and hypertension. Why and How Does Ketoacidosis Occur? The pathogenesis of DKA is more understood than HHS but both relate to the basic underlying reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counter regulatory hormones such as glucagons, catecholamines, cortisol, and growth hormone. These hormonal alterations in both DKA and HHS lead to increased hepatic and renal glucose production and impaired use of glucose in peripheral tissues, which results in hyperglycemia and parallel changes in osmolality in extracellular space. This same combination also leads to release of free fatty acids into the circulation from adipose tissue and to unrestrained hepatic fatty acid oxidation to ketone bodies. Some drugs ca Continue reading >>

Diabetic Ketoacidosis Or Dka

Diabetic Ketoacidosis Or Dka

Diabetic ketoacidosis, often referred to as ketoacidosis or simply DKA, is a short term complication of high blood glucose levels in people with diabetes. It most commonly occurs in people with type 1 diabetes but it can also affect some people with type 2 diabetes who are also reliant on insulin (insulin-dependent). Ketoacidosis is a serious medical condition and can advance very quickly within a matter of hours, or sometimes as quickly as within one hour. It is therefore important to know whether you are at risk of ketoacidosis and, if so, to be able to spot the signs and react accordingly. What causes diabetic ketoacidosis? Ketoacidosis occurs when the body starts running out of insulin – the hormone responsible for regulating levels of blood sugar. Without enough insulin, the cells cannot access glucose from the blood and so the body responds by breaking down protein and fat to produce an alternative form of energy called ketones. Whilst the body can cope with lower levels of ketones, higher levels can turn the blood acidic and pose an immediate danger to health, often causing severe illness. Am I at risk of ketoacidosis? People with type 1 diabetes or LADA (Latent Autoimmune Diabetes of Adulthood) who require insulin injections are most at risk of developing ketoacidosis. Type 2 diabetics who need to take meal time insulin (short or rapid-acting insulin) in addition to long term (basal) insulin may also be at risk. What the signs of diabetic ketoacidosis? The symptoms of ketoacidosis include: Lethargy Nausea and/or stomach pains Vomiting Dehydration Laboured breathing Confusion If you have any of the symptoms of ketoacidosis contact your health care provider immediately. Early detection and treatment is vital in cases of DKA, as failure to treat the condition qui Continue reading >>

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