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Short Term Prevention Of Ketoacidosis

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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 o Continue reading >>

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Popular Questions

  1. musio

    I've read a few posts on here about using a glucosemeter so I was just looking for some pointers.
    How many times should i take a reading?
    When (after meals/before?)
    From what i understand, it should read 5.6 or below for keto?
    Why haven't i read about this method on the net? As ketostix could be unreliable and this is a sure thing since you are taking your blood and can see how food effects you, I thought there would be much more on the net rather than the cobwebs i've tried to google!
    Thanks for any tips!

  2. ausbuilt

    there's plenty of information on BG levels and ketosis- do you know there are forums like this relating to diabetics- its where i learned loads; also I learned loads from books (and a few emails) from Dan Duchaine.
    OK its not that you use an BG meter to "detect" ketosis, because a BG meter by nature reads BLOOD GLUCOSE levels.
    However, you have to understand what ketosis is.
    first, for your body to burn energy, there is a process called the citric acid cycle (Krebs cycle):
    http://en.wikipedia.org/wiki/Citric_acid_cycle
    you will notice the following from that link:
    Major metabolic pathways converging on the TCA cycle
    Several catabolic pathways converge on the TCA cycle. Reactions that form intermediates of the TCA cycle in order to replenish them (especially during the scarcity of the intermediates) are called anaplerotic reactions.
    The citric acid cycle is the third step in carbohydrate catabolism (the breakdown of sugars). Glycolysis breaks glucose (a six-carbon-molecule) down into pyruvate (a three-carbon molecule). In eukaryotes, pyruvate moves into the mitochondria. It is converted into acetyl-CoA by decarboxylation and enters the citric acid cycle.
    2. In protein catabolism, proteins are broken down by proteases into their constituent amino acids. The carbon backbone of these amino acids can become a source of energy by being converted to acetyl-CoA and entering into the citric acid cycle.
    3.In fat catabolism, triglycerides are hydrolyzed to break them into fatty acids and glycerol.
    In the liver the glycerol can be converted into glucose via dihydroxyacetone phosphate and glyceraldehyde-3-phosphate by way of gluconeogenesis. In many tissues, especially heart tissue, fatty acids are broken down through a process known as beta oxidation, which results in acetyl-CoA, which can be used in the citric acid cycle. Beta oxidation of fatty acids with an odd number of methylene groups produces propionyl CoA, which is then converted into succinyl-CoA and fed into the citric acid cycle.[12]
    The total energy gained from the complete breakdown of one molecule of glucose by glycolysis, the citric acid cycle, and oxidative phosphorylation equals about 30 ATP molecules, in eukaryotes. The citric acid cycle is called an amphibolic pathway because it participates in both catabolism and anabolism.
    SO what this means is, your body moves from Glycolysis (burning glucose) to gluconeogenesis (burning amino acids from broken down protein- i.e muscle break down!) when blood sugar/glucose is below 5.6-5.8 mmol/L (this is called fasting glucose levels- ie. the level of blood sugar when you eat nothing! i.e when you wake up having gone 8+ hours without food..)
    however if there is not enough aminos available (usually because of AAS which retain nitrogen, -the "N' in the -NH3 amine molecule that makes an amino acid) the body moves from gluconeogenesis to ketosis (converting tri-glycerides to ketones, which in turn are used for energy in the krebs cycle.
    see also, in the order that they happen:
    http://en.wikipedia.org/wiki/Glycolysis
    http://en.wikipedia.org/wiki/Gluconeogenesis
    http://en.wikipedia.org/wiki/Ketosis
    so to get into ketosis, your BG reading MUST be at a fasted level; however this does not mean you are in ketosis immediately- usually it means you're in gluconeogenesis... and it can take 48 hours 60 hours to get into keto, unless you do cardio, or.. speed things up with met or 'slin..
    The use of BG monitor is so that when you take ZERO (or close to zero) carbs, you will move into gluconeogenesis, and then ketosis- however if you're above 5.6 on the BG, then its IMPOSSIBLE to be in ketosis..
    now how do you know you're in gluconeogenesis? easy.. you eat ZERO carbs, yet your BG readings are ABOVE 5.6 (usually around 6.0-6.2)...
    if you take AAS/T4 or T3 and met or 'slin you FORCE your body to move through/past gluconeogenesis VERY quickly... I can get a reading on keto stix in 10-12hours using AAS/T4/'slin.. as AAS retain aminos, and T4 and 'slin ALSO promote protein synthesis (anabolism) rather than burning aminos for energy.. so you have 3 actions to stop your body using aminos for energy..
    at any rate, the BG meter is useful to see that you are allowing yourself to get into keto (must be at fasted blood glucose levels),and also when eating keto meals, will tell you if protein intake is to high/fats to low- you will read above 5.6 even if taking in ZERO carbs....
    I haven't made any of this up, but don't forget diabetics are told ketosis is to BE AVOIDED and that its A BAD state for your body to be in... which is true- its the least preferred method of energy use, and its catabolic..
    as for measuring- a normal non diabetic should have close to fasted BG levels at 2-4 hours after eating. You need to measure at 15/30/60min post meal to make sure you haven't spiked above 5.6 with what you consumed.. Edited February 2, 2011 by ausbuilt

  3. Fatstuff

    ausbuilt said:

    there's plenty of information on BG levels and ketosis- do you know there are forums like this relating to diabetics- its where i learned loads; also I learned loads from books (and a few emails) from Dan Duchaine.
    OK its not that you use an BG meter to "detect" ketosis, because a BG meter by nature reads BLOOD GLUCOSE levels.
    However, you have to understand what ketosis is.
    first, for your body to burn energy, there is a process called the citric acid cycle (Krebs cycle):
    http://en.wikipedia.org/wiki/Citric_acid_cycle
    you will notice the following from that link:
    Major metabolic pathways converging on the TCA cycle
    Several catabolic pathways converge on the TCA cycle. Reactions that form intermediates of the TCA cycle in order to replenish them (especially during the scarcity of the intermediates) are called anaplerotic reactions.
    The citric acid cycle is the third step in carbohydrate catabolism (the breakdown of sugars). Glycolysis breaks glucose (a six-carbon-molecule) down into pyruvate (a three-carbon molecule). In eukaryotes, pyruvate moves into the mitochondria. It is converted into acetyl-CoA by decarboxylation and enters the citric acid cycle.
    2. In protein catabolism, proteins are broken down by proteases into their constituent amino acids. The carbon backbone of these amino acids can become a source of energy by being converted to acetyl-CoA and entering into the citric acid cycle.
    3.In fat catabolism, triglycerides are hydrolyzed to break them into fatty acids and glycerol.
    In the liver the glycerol can be converted into glucose via dihydroxyacetone phosphate and glyceraldehyde-3-phosphate by way of gluconeogenesis. In many tissues, especially heart tissue, fatty acids are broken down through a process known as beta oxidation, which results in acetyl-CoA, which can be used in the citric acid cycle. Beta oxidation of fatty acids with an odd number of methylene groups produces propionyl CoA, which is then converted into succinyl-CoA and fed into the citric acid cycle.[12]
    The total energy gained from the complete breakdown of one molecule of glucose by glycolysis, the citric acid cycle, and oxidative phosphorylation equals about 30 ATP molecules, in eukaryotes. The citric acid cycle is called an amphibolic pathway because it participates in both catabolism and anabolism.
    SO what this means is, your body moves from Glycolysis (burning glucose) to gluconeogenesis (burning amino acids from broken down protein- i.e muscle break down!) when blood sugar/glucose is below 5.6-5.8 mmol/L (this is called fasting glucose levels- ie. the level of blood sugar when you eat nothing! i.e when you wake up having gone 8+ hours without food..)
    however if there is not enough aminos available (usually because of AAS which retain nitrogen, -the "N' in the -NH3 amine molecule that makes an amino acid) the body moves from gluconeogenesis to ketosis (converting tri-glycerides to ketones, which in turn are used for energy in the krebs cycle.
    see also, in the order that they happen:
    http://en.wikipedia.org/wiki/Glycolysis
    http://en.wikipedia.org/wiki/Gluconeogenesis
    http://en.wikipedia.org/wiki/Ketosis
    so to get into ketosis, your BG reading MUST be at a fasted level; however this does not mean you are in ketosis immediately- usually it means you're in gluconeogenesis... and it can take 48 hours 60 hours to get into keto, unless you do cardio, or.. speed things up with met or 'slin..
    The use of BG monitor is so that when you take ZERO (or close to zero) carbs, you will move into gluconeogenesis, and then ketosis- however if you're above 5.6 on the BG, then its IMPOSSIBLE to be in ketosis..
    now how do you know you're in gluconeogenesis? easy.. you eat ZERO carbs, yet your BG readings are ABOVE 5.6 (usually around 6.0-6.2)...
    if you take AAS/T4 or T3 and met or 'slin you FORCE your body to move through/past gluconeogenesis VERY quickly... I can get a reading on keto stix in 10-12hours using AAS/T4/'slin.. as AAS retain aminos, and T4 and 'slin ALSO promote protein synthesis (anabolism) rather than burning aminos for energy.. so you have 3 actions to stop your body using aminos for energy..
    at any rate, the BG meter is useful to see that you are allowing yourself to get into keto (must be at fasted blood glucose levels),and also when eating keto meals, will tell you if protein intake is to high/fats to low- you will read above 5.6 even if taking in ZERO carbs....
    I haven't made any of this up, but don't forget diabetics are told ketosis is to BE AVOIDED and that its A BAD state for your body to be in... which is true- its the least preferred method of energy use, and its catabolic..
    as for measuring- a normal non diabetic should have close to fasted BG levels at 2-4 hours after eating. You need to measure at 15/30/60min post meal to make sure you haven't spiked above 5.6 with what you consumed..
    in a nutshell?

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