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Short Term Prevention Of Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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

Diabetic Ketoacidosistreatment & Management

Diabetic Ketoacidosistreatment & Management

Diabetic KetoacidosisTreatment & Management Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: Correction of fluid loss with intravenous fluids Correction of electrolyte disturbances, particularly potassium loss Treatment of concurrent infection, if present It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis . It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. This always should be followed by gradual correction of hyperglycemia and acidosis. Correction of fluid loss makes the clinical picture clearer and may be sufficient to correct acidosis. The presence of even mild signs of dehydration indicates that at least 3 L of fluid has already been lost. Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. When the condition is stable, pH exceeds 7.3, and bicarbonate is greater than 18 mEq/L, the patient is allowed to eat a meal preceded by a subcutaneous (SC) dose of regular insulin. Insulin infusion can be discontinued 30 minutes later. If the patient is still nauseated and cannot eat, dextrose infusion should be continued and regular or ultrashort-acting insulin should be administered SC every 4 hours, according to blood glucose level, while trying to maintain blood glucose values at 100-180 mg/dL. The 2011 JBDS guideline recommends the Continue reading >>

Diabetic Ketoacidosis Forecasts Inferior Long-term Diabetes Management

Diabetic Ketoacidosis Forecasts Inferior Long-term Diabetes Management

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

Diabetes: Preventing Complications

Diabetes: Preventing Complications

Diabetes complications can be divided into two types: acute (sudden) and chronic (long-term). This article discusses these complications and strategies to prevent the complications from occurring in the first place. Acute complications Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) Acute complications of diabetes can occur at any time in the course of the disease. Chronic complications Cardiovascular: Heart disease, peripheral vascular disease, stroke Eye: Diabetic retinopathy, cataracts, glaucoma Nerve damage: Neuropathy Kidney damage: Nephropathy Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis. Basic principles of prevention of diabetes complications: Take your medications (pills and/or insulin) as prescribed by your doctor. Monitor your blood sugars closely. Follow a sensible diet. Do not skip meals. Exercise regularly. See your doctor regularly to monitor for complications. Results from untreated hyperglycemia. Blood sugars typically range from 300 to 600. Occurs mostly in patients with Type 1 diabetes (uncommon in Type 2). Occurs due to a lack of insulin. Body breaks down its own fat for energy, and ketones appear in the urine and blood. Develops over several hours. Can cause coma and even death. Typically requires hospitalization. Nausea, vomiting Abdominal pain Drowsiness, lethargy (fatigue) Deep, rapid breathing Increased thirst Fruity-smelling breath Dehydration Inadequate insulin administration (not getting Continue reading >>

Hyperglycemia And Diabetic Ketoacidosis

Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin ( type 1 diabetes ) or can't respond to insulin properly ( type 2 diabetes ). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: All of these need to be b Continue reading >>

Prevention Of Diabetic Ketoacidosis And Self-monitoring Of Ketone Bodies: An Overview.

Prevention Of Diabetic Ketoacidosis And Self-monitoring Of Ketone Bodies: An Overview.

Abstract OBJECTIVE: Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Self-monitoring of ketone bodies by diabetes patients can be done using blood or urine. We compared the two self-monitoring methods and summarized recent developments in the epidemiology and management of DKA. METHODS: MEDLINE and EMBASE were searched for relevant publications addressing the epidemiology, management and prevention of DKA up to 2009. The current, relevant publications, along with the authors' clinical and professional experience, were used to synthesize this narrative review. FINDINGS: Despite considerable advances in diabetes therapy, key epidemiological figures related to DKA remained nearly unchanged during the last decades at a global level. Prevention of DKA - especially in sick day management - relies on intensive self-monitoring of blood glucose and subsequent, appropriate therapy adjustments. Self-monitoring of ketone bodies during hyperglycemia can provide important, complementary information on the metabolic state. Both methods for self-monitoring of ketone bodies at home are clinically reliable and there is no published evidence favoring one method with respect to DKA prevention. CONCLUSIONS: DKA is still a severe complication potentially arising during prolonged hyperglycemic episodes with possibly fatal consequences. Education of patients and their social environment to promote frequent testing - especially during sick days - and to lower their glucose levels, as well as to recognize the early symptoms of hyperglycemia and DKA is of paramount importance in preventing the development of severe DKA. Both methods for self-monitoring of ketone bodies are safe and clinically reliable. Continue reading >>

Preventing Ketoacidosis Complications In Diabetes

Preventing Ketoacidosis Complications In Diabetes

Risk factors associated with diabetic ketoacidosis typically do not change. Preventing DKA should focus on identification of those most at risk and educating them good self-care to avoid incidents. Diabetic ketoacidosis (DKA) a hyperglycemic crisis most commonly associated with type 1 diabetes mellitus (T1DM) is often the first symptom of diabetes to appear in the undiagnosed population. Managing the condition effectively to prevent incidence is important because of the associated mor-bidity and resulting economic impact.1 Studies have shown that hospitalizations resulting from DKA amount to an annual cost of more than $2.4 billion in the United States.1 THE PATHOLOGY BEHIND KETOACIDOSIS? Reduced concentrations of effective insulin and increased amounts of coun-ter-regulatory hormones. Since the body cannot break down and use sugar as an energy source, it draws energy from fat tissue; increased lipolysis releases free fatty acids in the blood and causes oxi-dation of hepatic fatty acids to ketone bodies, resulting in ketonemia and metabolic acidosis.1,2 DKA is also observed in type 2 diabetes mellitus (T2DM) patients, most of-ten a result of uncontrolled blood sugar, missed doses of insulin, or a comorbidity. If left untreated, DKA can lead to cerebral edema, heart attack, pulmonary or gastrointestinal complications, or kidney failure.2,3 INCIDENCE OF DKA Multiple studies have determined that socioeconomic status can greatly influ-ence patients’ insulin compliance. One investigation, which focused on adult patients from an innercity area, found poor compliance to be dictated by be-havioral, socioeconomic, psychosocial, and educational factors. The authors concluded that culturally appropriate interventions and education programs could remedy DKA recurrence in this pop 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 >>

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>

What Is Ketoacidosis? A Comprehensive Guide

What Is Ketoacidosis? A Comprehensive Guide

Ketoacidosis is lethal. It is responsible for over 100,000 hospital admissions per year in the US with a mortality rate of around 5%. In other words, ketoacidosis is to blame for about 5,000 deaths per year. The cause? A deadly combination of uncontrolled hyperglycemia, metabolic acidosis, and increased ketone body levels in the blood (more on this deadly combination later). Luckily, this lethal triad rarely affects individuals who don’t have diabetes. However, the majority (80%) of cases of diabetic ketoacidosis occur in people with a known history of diabetes mellitus (any form of diabetes). Ketoacidosis vs. Diabetic Ketoacidosis — What’s The Difference? At this point, you may have noticed that I used ketoacidosis and diabetic ketoacidosis interchangeably. This is because it is difficult for the body to get into a state of ketoacidosis without the blood sugar control issues that are common in people with diabetes. Hence, the term diabetic ketoacidosis. (However, there is another form of ketoacidosis called alcoholic ketoacidosis. This occurs in alcoholics who had a recent alcohol binge during a period of time when they didn’t eat enough.) Ketoacidosis tends to occur the most in people who have type 1 diabetes. Somewhere between 5 and 8 of every 1,000 people with type 1 diabetes develops diabetic ketoacidosis each year. Type 2 diabetics also run the risk of ketoacidosis under stressful situations, but it is much rarer because type 2 diabetics have some remaining insulin production (type 1 diabetics do not). If you are not part of the 422 million people worldwide that have diabetes, your risk of getting ketoacidosis is negligible. You would have to put yourself through years of stress, inactivity, and unhealthy eating habits before you experience ketoacidosis. ( Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

Diabetic Ketoacidosis: What It Is And How To Prevent It

Diabetic Ketoacidosis: What It Is And How To Prevent It

What is diabetic ketoacidosis? Diabetic ketoacidosis (say: key-toe-acid-OH-sis), or DKA for short, happens when your body has high blood sugar (also called glucose) and a build-up of acid. If it isn’t treated, it can lead to coma and even death. It mainly affects persons with type 1 diabetes. But, it can happen with other types of diabetes, including type 2 diabetes and diabetes during pregnancy. What causes DKA? The main cause of DKA is not having enough insulin. This raises the blood glucose levels, but stops the body from using the glucose for energy. To get calories, the body starts to burn fat. This causes a build-up of acid in the body. A high level of blood glucose can cause excessive urination, which leads to a lack of fluids in the body (dehydration). What are triggering factors? The most common triggering factors are “skipping” insulin doses and illnesses, especially infections that raise your body’s need for insulin. How can I prevent DKA? You should work with your doctor to have a plan if your blood glucose level gets too high. Make sure that you know how to reach your doctor in an emergency. Careful monitoring is needed, especially if you are sick. What should I do? Check your blood glucose level at least every three to four hours if you are sick. Check your glucose level every one to two hours if you have critical blood glucose values. Ask your doctor what your critical level should be. Most patients should watch their glucose levels closely when they are higher than 250 mg per dL. Keep testing at least every four hours during the night. Test your urine for ketones or your blood for beta-hydroxybutyrate every four hours or if your blood glucose is over 250 mg per dL. If you are not eating, do NOT stop your insulin completely. Your body needs insuli 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 >>

How To Avoid Diabetic Ketoacidosis

How To Avoid Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a possible complication of diabetes caused by extreme hyperglycemia, or high blood glucose. It is a serious and potentially life-threatening complication, one that you should work hard to avoid when you have diabetes. Diabetic ketoacidosis mainly affects people with type 1 diabetes, but it is a very rare possible complication for people with type 2 diabetes. Your doctor and certified diabetes educator will teach you how to recognize and manage diabetic ketoacidosis. It's critical to know and recognize the signs and symptoms of DKA, as well as how to treat it. What Is Diabetic Ketoacidosis? Diabetic ketoacidosis happens when your blood glucose level gets too high—usually higher than 300 mg/dL. Because people with type 1 diabetes do not have the insulin to process this extra glucose, their body cannot break down this glucose to create energy. To create energy for itself, the body starts to aggressively break down fat. Ketones or ketoacids are a byproduct of this process. Your body can handle a small amount of ketones circulating in your blood. However, the sizeable amounts from DKA are toxic. Diabetic Ketoacidosis Causes Illness, infections, stress, injuries, neglecting diabetes care (not properly taking your insulin, for example), and alcohol consumption can cause DKA. Diabetic Ketoacidosis Symptoms Initial symptoms of DKA include a stomach ache, nausea, and vomiting. One problem with DKA is that people could mistake it for an illness that typically gets better over time like the flu or food poisoning. Other symptoms of diabetic ketoacidosis include: fruity breath (when fat is broken down by the body, it creates a chemical called acetone that smells fruity) fatigue frequent urination intense thirst headache If you feel any of these sympto 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 >>

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