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 >>
Ketones — The 6 Must-knows
WRITTEN BY: Kyla Schmieg, BSN, RN Editor’s Note: Kyla Schmieg (BSN, RN) is a practicing pediatric endocrinology nurse in Cincinnati, OH, USA, and Type 1 Diabetic, working on the same unit she was diagnosed at 26 years ago. 1 – What are ketones? Ketones are chemicals that build up when your body starts to burn fat for energy. The most common cause of ketones in diabetics is insulin deficiency. Without enough insulin, glucose builds up in the blood stream and can’t enter cells. The cells then burn fat instead of glucose. This results in ketones forming in the blood and eventually spilling into urine. 2 – Why can ketones be dangerous? Having ketones can indicate that your body needs more insulin. (Always monitor your blood sugar levels to know how much insulin you need.) If you have a build up of ketones, this can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include moderate or large ketones, nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy. If left untreated, it can lead to a serious and life-threatening diabetic coma or death. High levels of ketones are toxic to the body and if you’re experiencing these, you should seek out medical attention. 3 – When should you check for ketones? You should be checked anytime your blood sugar is above 240 mg/dl (13.3 mmol/l) or any time you are sick. This includes any minor illness such as a cold. 4 – Can you get ketones with a high blood sugar? Ketones typically accompany high blood sugar. They indicate that your body needs more insulin. Most often if your body needs more insulin, it means you probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones Continue reading >>
Confused...having A Hypo With High Ketones!!!
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Confused...having a hypo with high ketones!!! This morning I checked my BS levels (fasting) as usual and they were 2.7...I also have a blood ketones monitor that I test every other morning just to make sure that my ketone levels are normal. Now, this morning during my hypo I thought I would test my ketone levels and they were reading at 3.1!!!! Of course, I was very shocked as I am in hypo mode and not feeling particularly unwell, just the usual hypo symptoms, which I have now treated. I am so confused as I associate high ketone levels with having high BS levels. Can anyone explain to me how this has happened. In my 10 years of having T1 I have never had high ketone levels like this before. Should I be worried? What do I need to do? Thanks for your help. M x Ketones are a by-product created when there is not enough glucose to fuel the body's needs, so the body burns it's fat reserves to create energy. Generally, this can happen when there is either: not enough insulin in the body to convert the glucose into energy (with high BG readings) when there is not enough glucose for the insulin to convert to energy (with low BG readings). Both of these conditions have the effect of preventing glucose being used as fuel for the body and, as a result, both can give rise to higher ketone levels. I'm at a loss to explain that I admit but I am not totally convinced by mrburden's explanation either unless you are low carbing? . If not your low BG state is (since you are T1) most likely a high insulin state and a high insulin state clears ketones and suppresses ketosis. If however you are low carbing then mrburden is completely correct, and also in that case your 0.3 Continue reading >>
All About Hypoglycemia (low Blood Sugar)
Hypoglycemia refers to an abnormally low level of sugar, or glucose, in the blood. Hypoglycemia is not a disease in itself, it is a sign of a health problem. The brain uses a lot of energy and needs glucose to function. Because the brain cannot store or manufacture glucose, it needs a continuous supply. Signs of low blood sugar include hunger, trembling, heart racing, nausea, and sweating. Hypoglycemia is commonly linked with diabetes, but many other conditions can also cause low blood sugar. This article will discuss the causes, diagnosis, and treatment of hypoglycemia, and the difference between hypoglycemia and hyperglycemia. We will also look at how to prevent it. Here are some key points about hypoglycemia. More detail is in the main article. Hypoglycemia is not a disease but a symptom of another condition. Early symptoms include hunger, sweating, and trembling. A common cause is diabetes. Alcohol abuse and kidney disorders can also lower blood sugar levels. What is hypoglycemia? Hypoglycemia is a condition where there is not enough glucose, or sugar, in the blood. Levels of blood sugar are below 4 mmol/L (72mg/dL). Adults and children with mild hypoglycemia may experience the following early symptoms: hunger tremor or trembling sweating irritability a pale face heart palpitations accelerated heart rate tingling lips dizziness weakness Severe hypoglycemia is sometimes called diabetic shock. It may involve: concentration problems confusion irrational and disorderly behavior, similar to intoxication inability to eat or drink Complications If a person does not take action when symptoms of hypoclycemia appear, it can lead to: A person who regularly experiences hypoglycemia may become unaware that it is happening. They will not notice the warning signs, and this can lea Continue reading >>
Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>
Symptoms And Detection Of Ketoacidosis
* these are more specific for ketoacidosis than hyperosmolar syndrome Everyone with diabetes needs to know how to recognize and treat ketoacidosis. Ketones travel from the blood into the urine and can be detected in the urine with ketone test strips available at any pharmacy. Ketone strips should always be kept on hand, but stored in a dry area and replaced as soon as they become outdated. Measurement of Ketones in the urine is very important for diabetics with infections or on insulin pump therapy due to the fact it gives more information than glucose tests alone. Check the urine for ketones whenever a blood sugar reading is 300 mg/dl or higher, if a fruity odor is detected in the breath, if abdominal pain is present, if nausea or vomiting is occurring, or if you are breathing rapidly and short of breath. If a moderate or large amount of ketones are detected on the test strip, ketoacidosis is present and immediate treatment is required. Symptoms for hyperglycemic hyperosmolar syndrome are linked to dehydration rather than acidosis, so a fruity odor to the breath and stomach upset are less likely. During any illness, especially when it is severe and any time the stomach becomes upset, ketone levels should be determined. Never assume an upset stomach is due to food poisoning or the flu without determining if ketones are the cause. During any prolonged illness, ketones should be tested every 4 hours. After ketones are formed from fat metabolism, they collect in the blood and are excreted into the urine. There are two ways to measure ketones at home: in the blood with a specialized meter, like the Precision Xtra™ , which measures both sugar and ketones in blood. This is the fastest way to tell if ketones are rising, and the best method for parents to use to quickly Continue reading >>
Ketotic hypoglycemia is a medical term used in two ways: (1) broadly, to refer to any circumstance in which low blood glucose is accompanied by ketosis, and (2) in a much more restrictive way to refer to recurrent episodes of hypoglycemic symptoms with ketosis and, often, vomiting, in young children. The first usage refers to a pair of metabolic states (hypoglycemia plus ketosis) that can have many causes, while the second usage refers to a specific "disease" called ketotic hypoglycemia. Hypoglycemia with ketosis: the broad sense There are hundreds of causes of hypoglycemia. Normally, the defensive, physiological response to a falling blood glucose is reduction of insulin secretion to undetectable levels, and release of glucagon, adrenaline, and other counterregulatory hormones. This shift of hormones initiates glycogenolysis and gluconeogenesis in the liver, and lipolysis in adipose tissue. Lipids are metabolized to triglycerides, in turn to fatty acids, which are transformed in the mitochondria of liver and kidney cells to the ketone bodies— acetoacetate, beta-hydroxybutyrate, and acetone. Ketones can be used by the brain as an alternate fuel when glucose is scarce. A high level of ketones in the blood, ketosis, is thus a normal response to hypoglycemia in healthy people of all ages. The presence or absence of ketosis is therefore an important clue to the cause of hypoglycemia in an individual patient. Absence of ketosis ("nonketotic hypoglycemia") most often indicates excessive insulin as the cause of the hypoglycemia. Less commonly, it may indicate a fatty acid oxidation disorder. Ketotic hypoglycemia in Glycogen storage disease Some of the subtypes of Glycogen storage disease show ketotic hypoglycemia after fasting periods. Especially Glycogen storage Continue reading >>
Ketones: Clearing Up The Confusion
Ketones, ketosis, ketoacidosis, DKA…these are words that you’ve probably heard at one point or another, and you might be wondering what they mean and if you need to worry about them at all, especially if you have diabetes. This week, we’ll explore the mysterious world of ketones, including if and how they may affect you. Ketones — what are they? Ketones are a type of acid that the body can form if there’s not enough carbohydrate to be burned for energy (yes, you do need carbs for fuel). Without enough carb, the body turns to another energy source: fat. Ketones are made in the liver from fat breakdown. This is called ketogenesis. People who don’t have diabetes can form ketones. This might occur if a person does extreme exercise, has an eating disorder, is fasting (not eating), or is following a low-carbohydrate diet. This is called ketosis and it’s a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy. Again, the body scrambles to find an alternate fuel source in the form of fat. You might be thinking that it’s a good thing to burn fat for fuel. However, for someone who has diabetes, ketosis can quickly become dangerous if it occurs due to a continued lack of insulin (the presence of ketones along with “normal” blood sugar levels is not necessarily a cause for concern). In the absence of insulin (which can occur if someone doesn’t take their insulin or perhaps uses an insulin pump and the pump has a malfunction, for example), fat cells continue to release fat into the circulation; the liver then continues to churn Continue reading >>
What Are Ketones And Their Tests?
A ketone test can warn you of a serious diabetes complication called diabetic ketoacidosis, or DKA. An elevated level of this substance in your blood can mean you have very high blood sugar. Too many ketones can trigger DKA, which is a medical emergency. Regular tests you take at home can spot when your ketone levels run too high. Then you can take insulin to lower your blood sugar level or get other treatments to prevent complications. What Exactly Are Ketones? Everyone has them, whether you have diabetes or not. Ketones are chemicals made in your liver. You produce them when you don't have enough of the hormone insulin in your body to turn sugar (or “glucose”) into energy. You need another source, so your body uses fat instead. Your liver turns this fat into ketones, a type of acid, and sends them into your bloodstream. Your muscles and other tissues can then use them for fuel. For a person without diabetes, this process doesn’t become an issue. But when you have diabetes, things can run out of control and you build up too many ketones in your blood. If the level goes too high, it can become life-threatening. Who Needs a Ketone Test? You might need one if you have type 1 diabetes. In this type, your immune system attacks and destroys cells in your pancreas that make insulin. Without it, your blood sugar rises. People with type 2 diabetes can also get high ketones, but it isn't as common as it is with type 1. Tests can show you when your level gets high so you can treat it before you get sick. When Should You Test? Your doctor will probably tell you to test your ketones when: Your blood sugar is higher than 250 milligrams/deciliter (mg/dl) for two days in a row You're sick or you've been injured You want to exercise and your blood sugar level is over 250 mg/dl Continue reading >>
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Large Ketones - Low Blood Sugar!??
Ketones And Low Blood Sugar....
Ketones are totally normal in the human body. It's just when you get too many of them it gets dangerous. I have the same meter and usually test around .1 or .2 and it's fine. Read the instructions for your strips. I think it says you're in ketosis at .8 and above. Trust me, real ketosis will make you feel really sick and usually it comes with a blood sugar of 300 and above. You go into ketosis when you have little or no insulin. Happens when you forget your Lantus/Levemir or when your pump malfunctions. In case you are type 2, ketosis normally shouldn't be of concern anyway. Thank you for finding the brochure. I am printing it as we speak and I will keep it with my meter and my other important papers. For some strange reason I seem to have lost the instructions with my strips. In the beginning when I was first diagnosed I had a blood sugar of 450 (25) and I really did not feel well at all. Now quite a number of years later I was curious to see if a person registers ketones when your blood sugar is low. Then when I realized that maybe it also had something to do with low carbing - I was both concerned and curious. There are 2 ketone-related conditions, one (mostly) good and one bad. Ketoacidosis is the bad one, caused by insufficient insulin and ultra-high blood sugar spikes. Ketosis is the good one, caused by low-carb diet and exercise. Ketosis promotes weight loss. I'm glad to know I'm not doing something harmful. My GP has never explained these things to me. I need all the help I can get to lose a little weight btw - Shalynne - could you remove post #4 as I don't think there should be two of the same post - not sure what happened because for just a moment my computer screen froze, then I had to reboot. Continue reading >>
Urine Tests For Diabetes: Glucose Levels And Ketones
The human body primarily runs on glucose. When your body is low on glucose, or if you have diabetes and don’t have enough insulin to help your cells absorb the glucose, your body starts breaking down fats for energy. Ketones (chemically known as ketone bodies) are byproducts of the breakdown of fatty acids. The breakdown of fat for fuel and the creation of ketones is a normal process for everyone. In a person without diabetes, insulin, glucagon, and other hormones prevent ketone levels in the blood from getting too high. However, people with diabetes are at risk for ketone buildup in their blood. If left untreated, people with type 1 diabetes are at risk for developing a condition called diabetic ketoacidosis (DKA). While rare, it’s possible for people with type 2 diabetes to experience DKA in certain circumstances as well. If you have diabetes, you need to be especially aware of the symptoms that having too many ketones in your body can cause. These include: If you don’t get treatment, the symptoms can progress to: a fruity breath odor stomach pain trouble breathing You should always seek immediate medical attention if your ketone levels are high. Testing your blood or urine to measure your ketone levels can all be done at home. At-home testing kits are available for both types of tests, although urine testing continues to be more common. Urine tests are available without a prescription at most drugstores, or you can buy them online. You should test your urine or blood for ketones when any of the following occurs: Your blood sugar is higher than 240 mg/dL. You feel sick or nauseated, regardless of your blood sugar reading. To perform a urine test, you urinate into a clean container and dip the test strip into the urine. For a child who isn’t potty-trained, a pa Continue reading >>
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Diabetic Ketoacidosis (dka)
Diabetic Ketoacidosis (DKA) Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin. Insulin is what breaks down sugar into energy. When insulin is not present to break down sugars, our body begins to break down fat. Fat break down produces ketones which spill into the urine and cause glucose build up in the blood, thus acidifying the body. Because sugar is not entering into our body’s cells for energy breakdown, the sugar is being processed by the kidneys and excreted through the urine; as a result, we become dehydrated and our blood becomes even more acidic. This leads to sickness and hospitalization if not treated. If a person’s blood sugar is over 240, they should start checking their blood for ketones. If you have diabetes, or love someone who does, being aware of warning signs of diabetic ketoacidosis (DKA) can help save a life. Early Symptoms of DKA: High blood glucose level, usually > 300 High volume to ketones present in blood or urine Frequent urination or thirst that lasts for a day or more Dry skin and mouth Rapid shallow breathing Abdominal pain (especially in children) Muscle stiffness or aches Flushed face As DKA Worsens: Decreases alertness, confusion – brain is dehydrating Deep, labored, and gasping breathing Headache Breath that smells fruity or like fingernail polish remover Nausea and/or vomiting Abdomen may be tender and hurt if touched Decreased consciousness, coma, death If you think you might have DKA, test for ketones. If ketones are present, call your health care provider right away. To treat high blood sugar, hydrate with water or sugar free, caffeine free drinks. Sugar free popsicles and snacks are also good alternatives. Always call the doctor if vomiting goes on for more than two hours. Symptoms can go from mild Continue reading >>
Diabetes: Sending Your Child To School
www.CardioSmart.org Managing diabetes can be hard, especially for children and teenagers. Having diabetes may cause your child to feel different or embarrassed at school, especially when checking blood sugar or taking shots. As your child faces these challenges, be as helpful and supportive as you can. Remind your child that diabetes care is very important. It may help for your child to explain to classmates what diabetes is and what shots and meters are for. Having a good treatment plan can make things easier. Keep your child's teachers, coaches, and other school staff informed about how to give diabetes care and manage blood sugar emergencies. Youmaywant to schedule a yearly meeting with the school staff. Managing diabetes at school Your doctor can help you make a written treatment plan for managing diabetes. Give this plan to your child's teachers and coaches and other school staff who work with your child. The plan should include: â€¢ When to check blood sugar and give insulin. Include your child's target blood sugar range and dose amounts for insulin. â€¢ Your child's usual symptoms of low and high blood sugar. â€¢ What to do for high and low blood sugar emergencies, and when to contact you. â€¢ When to give meals and snacks, and what foods are best. Include instructions for parties and field trips. â€¢ Instructions for testing for ketones, including what to do if ketones are present. â€¢ Emergency contact numbers, including your child's main caregivers and doctor. For older children who take insulin to school, check whether the school has rules about students carrying their own medicines, needles, and blood sugar meters. Many schools require that students get special permission or that supplies be kept at the school. Your child should have Continue reading >>
High Blood Glucose (hyperglycemia) And Ketones
Chapter 9: High Blood Glucose (Hyperglycemia) and Ketones High Blood Glucose (Hyperglycemia) and Ketones Hyperglycemia (said like: hi per glie SEE mee ah) is also called high blood glucose. It happens when blood glucose numbers are higher than 120 mg/dl. Eating more carbohydrates than you calculated for your insulin dose Give the right insulin dose based on your meal and blood glucose number. Change the insulin doses when you see a pattern of high blood glucose levels. Give insulin for all the carbohydrate you eat. How will I Feel when My Blood Glucose is High? Need to get up at night to go to the bathroom What Should I do if My Blood Glucose is High? Drink fluids that do not have carbohydrates. Try to drink 1 full glass (8 ounces) every 30 to 60 minutes. Use the high blood glucose correction dose. Check your urine or blood for ketones if blood glucose is higher than 300 mg/dl. High blood glucose, by itself, is not an emergency. High blood glucoseandsmall, moderate, or large ketones IS something you should take care of right away. You need glucose in every cell in your body to use for energy. Your body needs glucose and insulin in your blood. When there is not enough glucose or not enough insulin, your cells will not have glucose to use for energy. When Cells do not Have Glucose to Use for Energy: Ketones are made when fat is used for energy. Ketones are in the blood and in the urine. What 2 things does Your Body Need to Prevent Ketones? _________________________________________________________ Dip the test strip into the cup (Picture 1). Match the color on the strip to the colors on the bottle (Picture 2 and 3). NOTE: There are some blood glucose meters that are able to measure ketones in a drop of blood if using a special test strip specific to check ketones. Picture Continue reading >>
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