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What Causes The Fluid And Electrolyte Disturbances In Dka?

Hyperglycemic Crises: Managing Acute Complications Of Diabetes

Hyperglycemic Crises: Managing Acute Complications Of Diabetes

Authors: Kim Cathcart, MS, RN, RRT | Cheryl Duksta, RN, ADN, M.Ed | Kate Biggs, RN, MSN Hyperglycemia occurs from time to time in all people with diabetes. However, at times, hyperglycemia can lead to acute, life-threatening complications known as Hyperglycemic Crises. This course is designed to educate healthcare professionals about the emergencies associated with hyperglycemic crises, including causes, diagnosis, treatment, and prevention of Hyperosmolar Hyperglycemic State (HHS) and Diabetic Ketoacidosis (DKA). Course objectives include: Paraphrase the pathophysiology of diabetic ketoacidosis (DKA) Interpret diagnostic findings related to DKA Relate the nurse’s role in caring for patients with diabetic complications About the Authors Kim Cathcart, MS, RN, RRT, started working in the field of inhalation therapy in 1976 and by 1979 had completed her first test to become a registered respiratory therapist. She earned a bachelor's degree in general studies and a master's degree in educational administration from the University of Dayton, and later she received her bachelor's degree in nursing from Wright State University. She has taught clinicals and labs in respiratory therapy and has served as a respiratory nurse liaison. Her nursing career includes work in skilled nursing, orthopedics, and med-surg/chemical detox. She has also worked as a diabetic resource nurse and in an infectious disease/HIV clinic. Her publishing credentials include articles on respiratory care, contributions to hospital publications, and a tribute in a nursing magazine. Cheryl Duksta, RN, ADN, M.Ed, is currently a critical care nurse in an intermediate care unit in Austin, Texas. She is an active member of the American Association of Critical-Care Nurses (AACN) Greater Austin chapter. A master' Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>

Fluid And Electrolyte/acid-base Flashcards

Fluid And Electrolyte/acid-base Flashcards

1. 50 year old with pneumonia, diaphoresis and a high fever Rationale: Diaphoresis and high fever can lead to free water loss through the skin, resulting in hypernatremia. Loop diuretics are more likely to result in a hypovolemic hyponatremia. Diarrhea and vomitting cause both sodium and water losses. Clients with SIADH have hyponatremia due to increased water reabsorption in the renal tubules. A client is admitted with diabetic ketoacidosis and, with treatment, has a normal blood glucose, pH, and serum osmolality. During assessment, the client complains of weakness in the legs. Which of the following is a priority nursing intervention? 1. Request a physical therapy consult from the physician. 2. Ensure the client is safe from falls and check the most recent potassium level. 3. Allow uninterrupted rest periods throughout the day. 4. Encourage the client to increase intake of dairy products and green leafy vegetables. 2. Ensure the client is safe from falls and check the most recent potassium level. Rationale: In the treatment of diabetic ketoacidosis the blood sugar is lowered, the pH is corrected, and potassium moves back into the cells, resulting in low serum potassium. Client safety and the correction of low potassium levels are a priority. The weakness in the legs is a clinical manifestation of the hypokalemia. Dairy products and green, leafy vegetables are a source of calcium. A client with a potassium level of 5.5 mEq/L is to receive sodium polystyrene sulfonate (Kayexalate) orally. After administering the drug the priority nursing action is to monitor Normal serum potassium levels are 3.5 to 5.5 mEq/L. The nurse is caring for a bedridden client admitted with multiple myeloma and a serum calcium level of 13 mg/dL. Which of the following is the most appropriate nu Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

Potassium Balance In Acid-base Disorders

Potassium Balance In Acid-base Disorders

INTRODUCTION There are important interactions between potassium and acid-base balance that involve both transcellular cation exchanges and alterations in renal function [1]. These changes are most pronounced with metabolic acidosis but can also occur with metabolic alkalosis and, to a lesser degree, respiratory acid-base disorders. INTERNAL POTASSIUM BALANCE Acid-base disturbances cause potassium to shift into and out of cells, a phenomenon called "internal potassium balance" [2]. An often-quoted study found that the plasma potassium concentration will rise by 0.6 mEq/L for every 0.1 unit reduction of the extracellular pH [3]. However, this estimate was based upon only five patients with a variety of disturbances, and the range was very broad (0.2 to 1.7 mEq/L). This variability in the rise or fall of the plasma potassium in response to changes in extracellular pH was confirmed in subsequent studies [2,4]. Metabolic acidosis — In metabolic acidosis, more than one-half of the excess hydrogen ions are buffered in the cells. In this setting, electroneutrality is maintained in part by the movement of intracellular potassium into the extracellular fluid (figure 1). Thus, metabolic acidosis results in a plasma potassium concentration that is elevated in relation to total body stores. The net effect in some cases is overt hyperkalemia; in other patients who are potassium depleted due to urinary or gastrointestinal losses, the plasma potassium concentration is normal or even reduced [5,6]. There is still a relative increase in the plasma potassium concentration, however, as evidenced by a further fall in the plasma potassium concentration if the acidemia is corrected. A fall in pH is much less likely to raise the plasma potassium concentration in patients with lactic acidosis Continue reading >>

Electrolyte Disturbances | Definition Of Electrolyte Disturbances By Medical Dictionary

Electrolyte Disturbances | Definition Of Electrolyte Disturbances By Medical Dictionary

Electrolyte disturbances | definition of electrolyte disturbances by Medical dictionary Related to electrolyte disturbances: Electrolyte disorders a chemical substance that, when dissolved in water or melted, dissociates into electrically charged particles ( ions ) and thus is capable of conducting an electric current. The principal positively charged ions in the body fluids ( cations ) are sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+). The most important negatively charged ions ( anions ) are chloride (Cl), bicarbonate (HCO3), and phosphate (PO43). These electrolytes are involved in metabolic activities and are essential to the normal function of all cells. Concentration gradients of sodium and potassium across the cell membrane produce the membrane potential and provide the means by which electrochemical impulses are transmitted in nerve and muscle fibers. The concentration of the various electrolytes in body fluids is maintained within a narrow range. However, the optimal concentrations differ in the extracellular fluid and intracellular fluid. For example, the concentration of sodium in extracellular fluid (serum) is about 15 times higher than in the intracellular fluid. Conversely, the concentration of potassium is about 30 times higher within the cell than in the serum or extracellular fluid. electrolyte imbalance. This exists when the serum concentration of an electrolyte is either too high or too low. (See accompanying table.) The terms for excessive and deficient blood levels of electrolytes are derived from the Greek prefixes hyper- (over) and hypo- (under), the English or Latin name of the electrolyte, and the Latin suffix -emia. For example, an excess of sodium (Latin, natrium) cations in the serum is called hypernatremia, and a deficit Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

In diabetes, blood glucose is not able to reach the body cells where it can be utilized to produce energy. In such cases, the cells start to break down fat to produce energy. This process produces a chemical called ketone.[1] The buildup of ketones makes the blood more acidic. When the blood ketone level gets too high, a condition develops called diabetic ketoacidosis (DKA). It is a serious condition that can lead to coma or even death. DKA can happen to anyone with diabetes though it is more common in people with type 1 diabetes.[2] In this article, well explore the causes, symptoms treatment options, and complications of this life-threatening condition. DKA results from inadequate insulin levels that cause the cells to burn fat for energy. Ketones are released into the blood when fats are broken down. In people with diabetes, an underlying problem often triggers the onset of DKA. The following problems or conditions may contribute to DKA: An illness where the body produces higher levels of stress hormones like cortisol or adrenalin; these illnesses have a countereffect on the action of insulin (conditions like pneumonia or a urinary tract infection are common culprits) Inadequate insulin due to missed doses or more requirements Less food intake (this could be caused by sickness, fasting, or an eating disorder; bulimia, for example, produces excess ketones) Medications like corticosteroids and diuretics Symptoms of DKA typically evolve over a period of 24 hours. Some symptoms to be aware of include the following: Long, deep labored breathing (affected person may be gasping for breath) Check your blood glucose levels if you develop these symptoms. If your blood glucose levels are above 240mg/dl (13.3mmol/L), check for ketone levels using a blood or urine ketone testing Continue reading >>

Management Of Diabetic Ketoacidosis And Other Hyperglycemic Emergencies

Management Of Diabetic Ketoacidosis And Other Hyperglycemic Emergencies

Understand the management of patients with diabetic ketoacidosis and other hyperglycemic emergencies. ​ The acute onset of hyperglycemia with attendant metabolic derangements is a common presentation in all forms of diabetes mellitus. The most current data from the National Diabetes Surveillance Program of the Centers for Disease Control and Prevention estimate that during 2005-2006, at least 120,000 hospital discharges for diabetic ketoacidosis (DKA) occurred in the United States,(1) with an unknown number of discharges related to hyperosmolar hyperglycemic state (HHS). The clinical presentations of DKA and HHS can overlap, but they are usually separately characterized by the presence of ketoacidosis and the degree of hyperglycemia and hyperosmolarity, though HHS will occasionally have some mild degree of ketosis. DKA is defined by a plasma glucose level >250 mg/dL, arterial pH <7.3, the presence of serum ketones, a serum bicarbonate measure <18 mEq/L, and a high anion gap metabolic acidosis. The level of normal anion gap may vary slightly by individual institutional standards. The anion gap also needs to be corrected in the presence of hypoalbuminemia, a common condition in the critically ill. Adjusted anion gap = observed anion gap + 0.25 * ([normal albumin]-[observed albumin]), where the given albumin concentrations are in g/L; if given in g/dL, the correction factor is 2.5.(3) HHS is defined by a plasma glucose level >600 mg/dL, with an effective serum osmolality >320 mOsm/kg. HHS was originally named hyperosmolar hyperglycemic nonketotic coma; however, this name was changed because relatively few patients exhibit coma-like symptoms. Effective serum osmolality = 2*([Na] + [K]) + glucose (mg/dL)/18.(2) Urea is freely diffusible across cell membranes, thus it will Continue reading >>

Hyponatremia In Diabetes Mellitus: Clues To Diagnosis And Treatment

Hyponatremia In Diabetes Mellitus: Clues To Diagnosis And Treatment

Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece Citation: Liamis G, Tsimihodimos V, Elisaf M (2015) Hyponatremia in Diabetes Mellitus: Clues to Diagnosis and Treatment. J Diabetes Metab 6: 560. doi: 10.4172/2155-6156.1000560 Copyright: © 2015 Liamis G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Hyponatremia is the most common electrolyte abnormality in clinical practice and is associated with increased morbidity and mortality [1,2]. Even small decreases of serum sodium are associated with increased probability for adverse outcomes (cognitive impairment, falls, osteoporosis and fractures) [3]. Decreased serum sodium levels are occasionally observed in patients with diabetes mellitus and can be attributed to numerous underlying pathogenetic mechanisms (Table 1) [4,5]. A) Non hypotonic hyponatremia With increased Posm: Hyperglycemia - induced (dilutional) With normal Posm: Pseudohyponatremia (marked hypertriglyceridemia and hyperproteinemia) B) Hypotonic hyponatremia • Hypovolemia-induced • Drug –induced hyponatremia (mainly with thiazides and first generation sulphonylureas) • Diabetes mellitus - associated hyponatremia • Syndrome of inappropriate antidiuresis associated with coexisting disorders or administered drugs • Chronic renal failure (diabetic nephropathy) or associated with the syndrome of hyporeninemichypoaldosteronism Table 1: Causes of hyponatremia in diabetic patients. The direct measurement of serum osmolality (Posm) can differentiate be Continue reading >>

Ketoacidosis : The Organic Diabetic

Ketoacidosis : The Organic Diabetic

Posted by Chris - The Organic Diabetic 5 Comments Ever wonder why when we are severely dehydrated as diabetics or when we are dealing with an extreme high blood sugar our medical team tells us to make sure we replenish our electrolytes ? I mean, what is an electrolyte anyway, what are the symptoms of low electrolytes and how can they help us as diabetics or if your just out mowing the lawn? Diabetic or not, they are extremely important when it comes to our overall health so lets take a closer look! When dissolved in fluid, salts tend to break apart into their component ions, creating an electrically-conductive solution. For example, table salt (NaCl) dissolved in water dissociates into its component positive ion of sodium (Na+) and negative ion of chloride (Cl-). Any fluid that conducts electricity, such as this new saltwater solution, is known as an electrolyte solution: the salt ions of which its composed are then commonly referred to as electrolytes. So that leads us to the next question There are several common electrolytes found in the body, each serving a specific and important role, but most are in some part responsible for maintaining the balance of fluids between the intracellular (inside the cell) and extracellular (outside the cell) environments. This balance is critically important for things like hydration, nerve impulses, muscle function, and pH levels. With the correct body water balance, the electrolytes separate into positive and negative ions. When the body loses water or becomes dehydrated an electrolyte imbalance starts to occur. During heavy exercise, sodium and potassium electrolytes in particular are lost through sweating. To ensure constant electrolyte concentrations in the body, fluids must be regularly consumed. To avoid an electrolyte imbalan Continue reading >>

How I Treat Electrolyte Disturbances In Diabetic Ketoacidosis

How I Treat Electrolyte Disturbances In Diabetic Ketoacidosis

Proceeding of the NAVC North American Veterinary Conference Reprinted in the IVIS website with the permission of the NAVC Close window to return to IVIS Small Animal – Critical Care Nishi Dhupa, BVM, DACVIM, DACVECC College of Veterinary Medicine Cornell University, Ithaca, NY INTRODUCTION Diabetic ketoacidosis (DKA) results from an absolute or relative insulin deficiency in conjunction with glucagon and stress hormone excess. It is crucial to identify underlying disease factors contributing to stress in these patients. Stress factors include changes in environment, dehydration and concomitant disease. Commonly associated diseases include renal disease, urinary tract and other infection, and pancreatitis; in cats, hepatic lipidosis is also commonly seen. DKA is characterized by hyperglycemia, dehydration, ketonemia, metabolic acidosis and multiple electrolyte abnormalities. Treatment must be intensive and directed towards the correction of fluid, electrolyte and acid-base abnormalities as well as the correction of abnormal carbohydrate metabolism. The treatment itself (particularly the correction of acid-base imbalance with sodium bicarbonate therapy and the use of insulin therapy) may exacerbate the electrolyte abnormalities, and careful monitoring and aggressive treatment of these abnormalities is critical. Without treatment, DKA is fatal and it should be considered a medical emergency. The mortality rate for DKA is 25-30 %, even with aggressive treatment. CLINICAL SIGNS Clinical signs seen in dogs and cats with ketoacidosis include polyuria, polydipsia, weight loss, anorexia, vomiting, diarrhea, lethargy, weakness, dehydration, obtundation and hyper- or hypoventilation. These clinical signs may develop in various combinations and are usually severe in the keto Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

Fluid And Electrolyte Imbalances: Nclex-rn

Fluid And Electrolyte Imbalances: Nclex-rn

In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills for fluis and electrolyte imbalances in order to: Identify signs and symptoms of client fluid and/or electrolyte imbalance Apply knowledge of pathophysiology when caring for the client with fluid and electrolyte imbalances Manage the care of the client with a fluid and electrolyte imbalance Evaluate the client's response to interventions to correct fluid or electrolyte imbalance Electrolytes are ions that can have either a negative or positive charge. Electrolytes and the levels of electrolytes play roles that are essential to life. For example, these electrically charged ions contract muscles, move fluids about within the body, they produce energy and they perform many other roles in the body and its physiology. Electrolytes, similar to endocrine hormones, are produced and controlled with feedback mechanisms when the kidneys or adrenal gland sense a deficit of the particular electrolyte and an imbalance in terms of the client's electrolyte balance. The body's electrolytes are positively or negatively charged as shown below: Hydrogen phosphate which is abbreviated as HPO4- Bicarbonate which is abbreviated as HCO3- Identifying the Signs and Symptoms of the Client's Fluid and/or Electrolyte Imbalances The functions of the major bodily electrolytes, imbalances of these electrolytes in terms of deficits and excesses and their signs and symptoms as well as the treatments for these imbalances are discussed below. The normal range for sodium is 135 to 145 milliequivalents per liter (mEq/L). Sodium plays a primary role in terms of the body's fluid balance and it also impacts on the functioning of the bodily muscles and the central nervous system. This electrolyte is most Continue reading >>

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys f Continue reading >>

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