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Nutritional Ketoacidosis

Ispad Clinical Practice Consensus Guidelines 2014

Ispad Clinical Practice Consensus Guidelines 2014

Editor in Chief: Mark A. Sperling, Pittsburgh, USA. Guest Editors: Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Introduction Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 1–3. Uploaded: 2. Sept 2014 Download Introduction Chapter 1: Definition, epidemiology, diagnosis and classification Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 4–17. Uploaded: 2. Sept 2014 Download Chapter 1 Chapter 2: Phases of Type 1 Diabetes Couper JJ, Haller MJ, Ziegler A-G, KnipM, Ludvigsson J, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 18–25. Download Chapter 2 Chapter 3: Type 2 diabetes Zeitler P, Fu J, Tandon N, Nadeau K, Urakami T, Bartlett T, Maahs D. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 26-46. Uploaded: 2. Sept 2014 Download Chapter 3 Chapter 4: The Diagnosis and Management of Monogenic diabetes Rubio-Cabezas O, Hattersley AT, Njølstad PR, Mlynarski W, Ellard S,White N, Chi DV, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 47-64. Uploaded: 2. Sept 2014 Download Chapter 4 Chapter 5: Management of cystic fibrosis-related diabetes Moran A, Pillay K, Becker DJ, Acerini CL. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 65-76. Uploaded: 2. Sept 2014 Download Chapter 5 Chapter 6: Diabetes education Lange K, Swift P, Pankowska E, Danne T. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 77-85. Uploaded: 2. Sept 2014 Download Chapter 6 Chapter 7: The delivery of ambulatory diabetes care Pihoker C, Forsander G, Fantahun B, Virmani A, Luo X, Hallman M, Wolfsdorf J, Maahs DM. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 86-101. Up Continue reading >>

Ketosis & Measuring Ketones

Ketosis & Measuring Ketones

Generally, ketone concentrations are lower in the morning and higher in the evening. Whatever time you pick to measure ketone levels, make sure to keep it consistent. Also, do not measure your ketone levels right after exercise. Ketone levels tend to be lower while your glucose levels higher so you won't get representative numbers. Keep in mind there are daily fluctuations caused by changes in hormone levels. Don't get discouraged! Another aspect that affects the level of ketones is the amount of fat in your diet. Some of you may show higher concentration of ketones after a high-fat meal. Coconut oil contains MCTs that will help you boost ketones. To easily increase your fat intake on a ketogenic diet, try fat bombs - snacks with at least 80% fat content. Ketone levels tend to be higher after extensive aerobic exercise as your body depletes glycogen stores. Exercise may help you get into ketosis faster. ketogenic "fruity" breath is not pleasant for most people. To avoid this, drink a lot of water, mint tea and make sure you eat foods rich in electrolytes. Avoid too many chewing gums and mints, as it may put you out of ketosis; there may be hidden carbs affecting your blood sugar. Increase your electrolyte intake, especially potassium. You are likely going to lose some sodium and potassium when switching to the keto diet. Finally, if you find it hard to lose weight on a ketogenic diet, there may be plenty other reasons than the level of ketone bodies: Not Losing Weight on Low-Carb Ketogenic Diet? Don’t Give Up and Read Further. Continue reading >>

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Abstract Ketoacidosis is a potential complication of type 1 diabetes. Severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. Three weeks after delivery, a young woman was admitted because of tachypnoe and tachycardia. Blood gas analysis showed a severe metabolic acidosis with a high anion gap. Further workup revealed the presence of ketone bodies in the urine with normal blood glucose and no history of diabetes. The patient reported that she had not eaten for days because of abdominal pain. After initial treatment in the ICU and immediate re-feeding, the patient’s condition rapidly improved. While under normal circumstances fasting causes at most only mild acidosis, it can be dangerous during lactation. Prolonged fasting in combination with different forms of stress puts breast feeding women at risk for starvation ketoacidosis and should therefore be avoided. Background Severe acidosis is a potentially life-threatening condition. In case of metabolic acidosis, determination of the serum anion gap helps to narrow down the differential diagnosis. An increased anion gap indicates the presence of an unusual amount of an acid that is most commonly found in ketoacidosis, lactic acidosis, renal insufficiency, and intoxications while other causes are rare. Ketoacidosis is a potential complication of type 1 diabetes while severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. In diabetic ketoacidosis, glucose is not properly taken up into tissue due to an absolute insulin deficiency that is mainly found in type 1 diabetes. In parallel, glucagon release is not suppressed leading to hyperglucagonemia. Subsequently the body activates stress hormones, which worsen hyperglycemia by promoting gluconeogenesis (and also ketog Continue reading >>

What Everybody Ought To Know About Ketosis

What Everybody Ought To Know About Ketosis

Recently I wanted to explore the world of Ketosis. I thought I knew a little bit about ketosis, but after doing some research I soon realised how wrong I was. 3 months later, after reading numerous books, listening to countless podcasts and experimenting with various diets I know have a sound understanding of ketosis. This resource is built as a reference guide for those looking to explore the fascinating world of ketosis. It is a resource that I wish I had 3 months ago. As you will soon see, a lot of the content below is not mine, instead I have linked to referenced to experts who have a greater understanding of this topic than I ever will. I hope this helps and if there is something that I have missed please leave a comment below so that I can update this. Also, as this is a rather long document, I have split it into various sections. You can click the headline below to be sent straight to the section that interests you. For those that are really time poor I have created a useful ketosis cheat sheet guide. This guide covers all the essential information you should know about ketosis. It can be downloaded HERE. Alternatively, if you're looking for a natural and sustainable way to improve health and lose weight head to this page - What is Ketosis? What Are The Benefits from being in Ketosis? Isn’t Ketosis Dangerous? Ketoacidosis vs Ketosis What Is The Difference Between a Low Carb Diet and a Ketogenic Diet? Types of Ketosis: The Difference Between Nutritional, Therapeutic & MCT Ketogenic Diets Is The Ketogenic Diet Safe? Long Term Effects Thyroid and Ketosis - What You May Want To Know What is a Typical Diet/Macro Breakdown for a Ketogenic Diet? Do I Need to Eat Carbs? What do I Eat On a Ketogenic Diet? What Do I Avoid Eating on a Ketogenic Diet? Protein Consumption a Continue reading >>

Beyond Weight Loss: A Review Of The Therapeutic Uses Of Very-low-carbohydrate (ketogenic) Diets

Beyond Weight Loss: A Review Of The Therapeutic Uses Of Very-low-carbohydrate (ketogenic) Diets

Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960s onwards they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possible mechanisms for the therapeutic actions of the ketogenic diet on different diseases. The present review also questions whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician’s hand. During recent years, an increasing amount of evidence has accumulated in the literature, suggesting that very-low-carbohydrate ketogenic diets (VLCKD) could have a therapeutic role in numerous diseases. The use of VLCKD in treating epilepsy has been well established for many decades and these diets have become even more widely known, as they became popular in the 1970s for weight loss—especially as the ‘Atkins Diet’.1 More recently, the therapeutic use of ketogenic diets in other diseases has been studied with positive results—it is an important direction for research because, clearly, Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA is usually signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. Diabetic Ketoacidosis (DKA) – a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with type 1 diabetes. Although less common, it also can happen when you have type 2 diabetes. DKA is usually, but not always, signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. As a consequence the excess fat goes to the liver and glucose builds up in the bloodstream. The liver makes ketoacids (also known as ketones) out of the fat. Before long, the body is literally poisoning itself with excess glucose and ketoacids. What causes DKA? A lack of insulin usually due to: Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin, or spoiled insulin Infection Steroid medications An extremely stressful medical condition DKA is rare in type 2 diabetes – but can develop if someone with type 2 diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in type 2 diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids. Symptoms of DKA include: Nausea, vomiting Stomach pain Fruity breath – the smell of ketoacids Frequent urination Excessive thirst Weakness, fatigue Speech problems, confusion or unconsciousness Heavy, deep breathing How do you know if you have DKA? Check your blood or urine for ketones. And if the test is positive, you will need immediate medical care. Treatment includes agg Continue reading >>

Ketosis Vs. Ketoacidosis: Understanding The Differences

Ketosis Vs. Ketoacidosis: Understanding The Differences

Introduction to Ketosis vs Ketoacidosis Historically, ketosis has been one of the most vaguely defined and poorly understood concepts of the last century. There are different scenarios in which are body can be in a state of ketosis (including ketoacidosis). The most basic definition of ketosis is a general increase in blood levels of ketone bodies to 0.5 mmol or above. However, the reasons for the development of ketosis, the resultant levels of blood ketones, and the associated outcomes (health versus possible death) differ drastically between different situations of ketosis. Failure to understand the differences between various incidents of ketosis has led to the common misconceptions we have today that ultimately has made educating the masses on the ketogenic diet difficult. The single most important take home from this article should be that diabetic ketoacidosis is not the same as the ketosis experienced from a ketogenic diet. Diabetic Ketoacidosis Whenever I speak about ketogenic dieting, almost inevitably I am asked the question: “But shouldn’t you be worried about going into a state of ketoacidosis?” Ketoacidosis occurs when the formation ketone bodies are uncontrolled (15-25 mmol) and acidity in the blood increases (1). It is important to understand that our body regulates blood acid concentrations tightly. We typically measure blood acidity vs. alkalinity using the pH scale. If your blood’s pH is less than 7 it is acidic, and if greater it is basic, or alkaline. Our blood is usually slightly alkaline with a pH ranging from 7.35 to 7.45. Any deviation up or down from the norm by even the smallest amount can prove fatal! The most common form of ketoacidosis to occur is known as diabetic ketoacidosis. This usually occurs in type I diabetics but can also oc Continue reading >>

Diabetic Ketoacidosis Pes Statement

Diabetic Ketoacidosis Pes Statement

How to bill for morgellons disease icd     Broward county schools academic calendar 2017-2018      Lolliwood studios mrwhitespade DKA: diabetic ketoacidosis. NCP-Nutrition Diagnosis • PES format – Problem: describes alterations in client's nutritional status – Etiology: cause or contributing risk factors – Signs and symptoms: identifiable. NCP- Nutrition Intervention Establish patient goals and expected outcomes – Goals are related to statements are provided by PES for reference and use by members. They represent statements sponsored by PES that the Society either initiated or was actively involved in developing. Revised D&T statement. (pdf, 159 KB). Consensus Statement on Diabetic Ketoacidosis in TEENren and Adolescents (pdf , 130 KB).      I Universidade de São Paulo, Escola de Enfermagem, Programa de Residência em Enfermagem na Saúde do Adulto e do Idoso. São Paulo-SP, Brasil. BackgroundPreventive care for adults with diabetes has improved substantially in recent decades. We examined trends in the incidence of diabetes-related complications. My mother’s cancer diagnosis gave me the opportunity to approach my patients with a new resolve in the coming year. By MIKKAEL A. SEKERES, M.D. Check the link to solve the quiz . Please help "Biochemistry for Medics" by CLICKING ON THE ADVERTISEMENTS above! LITFL’s Critical Care Compendium (CCC) comprehensive collection concisely covering the core topics and controversies of emergency medicine and critical care. A Beginner's Guide to Low Carbing - Everything You Wanted To Know About Ketosis And Ketone Testing Strips. Diabetes mellitus type 1 (also known as type 1 diabetes) is a form of diabetes mellitus in which not enough insulin is produ Continue reading >>

Ketosis

Ketosis

There is a lot of confusion about the term ketosis among medical professionals as well as laypeople. It is important to understand when and why nutritional ketosis occurs, and why it should not be confused with the metabolic disorder we call ketoacidosis. Ketosis is a metabolic state where the liver produces small organic molecules called ketone bodies. Most cells in the body can use ketone bodies as a source of energy. When there is a limited supply of external energy sources, such as during prolonged fasting or carbohydrate restriction, ketone bodies can provide energy for most organs. In this situation, ketosis can be regarded as a reasonable, adaptive physiologic response that is essential for life, enabling us to survive periods of famine. Nutritional ketosis should not be confused with ketoacidosis, a metabolic condition where the blood becomes acidic as a result of the accumulation of ketone bodies. Ketoacidosis can have serious consequences and may need urgent medical treatment. The most common forms are diabetic ketoacidosis and alcoholic ketoacidosis. What Is Ketosis? The human body can be regarded as a biologic machine. Machines need energy to operate. Some use gasoline, others use electricity, and some use other power resources. Glucose is the primary fuel for most cells and organs in the body. To obtain energy, cells must take up glucose from the blood. Once glucose enters the cells, a series of metabolic reactions break it down into carbon dioxide and water, releasing energy in the process. The body has an ability to store excess glucose in the form of glycogen. In this way, energy can be stored for later use. Glycogen consists of long chains of glucose molecules and is primarily found in the liver and skeletal muscle. Liver glycogen stores are used to mai Continue reading >>

The Ketogenic Diet And Type 1 Diabetes

The Ketogenic Diet And Type 1 Diabetes

What is type 1 diabetes? How is it different than type 2? Type 2 diabetes is a condition where the body becomes resistant to insulin, forcing the pancreas to produce ever more insulin, and leading to a downward spiral of metabolic illness. It’s also called “Adult Onset Diabetes”, because the vast majority of people who develop it do so in adulthood, after years of eating a high-carb diet. Type 1 diabetes, also known as “Juvenile Diabetes”, is a disorder where the body’s immune system attacks the cells of the pancreas responsible for producing insulin. Only the pancreas can produce insulin, and insulin is the hormone primarily responsible for shuttling molecules out of the blood and into cells for energy or storage. That means, if the pancreas isn’t producing insulin, a person will starve to death from the inside. Their cells, literally, cannot get any food. They can eat and eat and eat, but there’s no mechanism to transport that food energy into the cells. That’s why they need regular insulin shots. On a regular-carb diet, those insulin shots might be several times per day. On a high-carb diet, those shots will be even more frequent. Type 1 diabetics must keep injecting themselves with insulin in order to deal with all the glucose in their blood stream. They have to keep insulin levels high, if they eat high carbs, because they have a high level of glucose to deal with. Being ketogenic means insulin levels don’t have to be high, because there isn’t a high level of glucose that needs to be shuttled around. And, because there isn’t a big requirement for insulin, the type 1 diabetic can reduce the amount of insulin needed on a daily basis (many reduce this requirement by 80%). The important thing to remember is that someone suffering from type 1 dia Continue reading >>

Management Of Feline Diabetic Ketoacidosis

Management Of Feline Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus with concurrent and often severe metabolic derangements associated with hyperglycaemia, glucosuria, metabolic acidosis, ketonaemia +/- ketonuria. Patients with ketonaemia/ketosis are usually still bright, eating and maintaining their hydration. Those with ketoacidosis are dehydrated, clinically unwell (e.g., anorexia, vomiting, lethargy) and typically require hospitalisation and intensive management. DKA is distinguished from uncomplicated diabetes mellitus (DM) by a relative insulin lack and increased counter-regulatory hormones. The latter are thought to occur secondary to intercurrent disease. Concurrent disease has been documented in approximately 90% of cats with DKA, with the most common being hepatic lipidosis, chronic kidney disease, acute pancreatitis, bacterial or viral infections and neoplasia (Bruskiewicz et al. 1997). Heinz bodies, neutrophilia with a left shift, increased ALT and azotaemia is common. Most cats presenting with DKA are newly diagnosed diabetics or recently diagnosed but poorly controlled diabetics. Diagnosis Hyperglycaemia, Glucosuria, Metabolic Acidosis Plus Ketones in Plasma and/or Urine Traditionally DKA has been diagnosed using urinary ketone dipsticks, which detect acetoacetate but not beta-hydroxybutyrate. However as the latter is the principle ketone body in DKA, measuring serum beta-hydroxybutyrate is a more sensitive indicator of DKA. In humans portable meters that measure beta-hydroxybutyrate in whole blood have largely superseded urine dipsticks. These ketone meters have recently proven useful in diagnosing DKA in cats, although they tend to underestimate beta-hydroxybutyrate at higher values (Zeugswetter, Rebuzzi 2012; Weingart et al. 2012). In the absence of a ke Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>

Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?

Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?

In this article we will cover what a Ketogenic diet is and if you can manage your diabetes while on this diet. Ketogenic diet for diabetics is a highly controversial topic, but we will break down everything here for you! As a Certified Diabetes Educator (CDE), I have to tell you from the start I will have a biased view here. Sorry, but I feel that I need to be completely honest right up front! I will however, present all the evidence that is available currently on the subject. As a CDE, I have been taught to follow the American Diabetes Association Dietary Guidelines for Americans which is low in carbohydrates, high in fiber, with fresh vegetables, fruits and whole grains. The Ketogenic Diet this article will be discussing is much lower in carbohydrates, in order to promote the state of nutritional ketosis, or the fat burning state for weight loss. What is a Ketogenic Diet? The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up? Your body uses the carbohydrates you eat for energy, so if we restrict how many carbohydrates we eat, the body has to get its fuel source from fat. A byproduct of this fat burning state are ketones which are produced; this is called nutritional ketosis. You can determine if you are in this fat burning state by purchasing urine ketone testing strips from your local pharmacy. The Ketogenic Diet with Diabetes Some precautions must be made clear; this diet is not appropriate for people with any Continue reading >>

Ketosis: What Is Ketosis?

Ketosis: What Is Ketosis?

Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>

Defining Keto, And Ketosis Vs. Ketoacidosis

Defining Keto, And Ketosis Vs. Ketoacidosis

Ketosis Is Often Misunderstood And Confused With Ketoacidosis …A good number of less-informed doctors and medical professionals confuse ketoacidosis, a diabetic complication, with the dietary ketosis that is associated with ketogenic diets and fasting states in the body…which leads them to advise you that ketosis is dangerous. The truth is, ketosis and ketoacidosis are completely different, and nutritional ketosis is totally safe. Now, clearly, if you’ve had previous health problems involving your liver, kidneys, gallbladder, or pancreas, then you should seek advice from your doctor before making any changes to your diet, to insure your safety. Differentiating Nutritional Ketosis & Ketoacidosis First, let’s cover some semantics. Your body can produce, from fat and some amino acids, three ketone bodies (“ketone” refers to the chemical structure where oxygen is double-bonded to carbon sandwiched between at least two other carbons), which are: acetone, acetoacetone, and beta-hydroxybutyrate (B-OHB). And why does your body produce ketones? …Basically, it’s a key evolutionary advantage. Your brain can only function with glucose and ketones. And, since you can only store about 24 hours worth of glucose, you would die of hypoglycemia if you were ever forced to fast for longer than 24 hours. Quite fortunately, however, your liver can turn fat and certain amino acids (the building blocks of proteins) into ketones to feed our brains (among other uses). So the ability of our bodies to produce ketones is required for even basic survival. Next, what is diabetic ketoacidosis? …A diabetic person will effectively go into a state of starvation when they don’t receive enough insulin (typically a Type I diabetic, but sometimes in insulin-dependent Type II diabetics). T Continue reading >>

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