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What Is Dka Type 1?

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What Is Brittle Diabetes?

Brittle diabetes mellitus is a term used to describe particularly hard to control type 1 diabetes. Those people who have brittle diabetes will experience frequent, extreme swings (up and down) of blood sugar levels. These swings in glucose levels is not good for health and can affect quality of life or even lead to hospitalization. Advances in diabetes management have made this condition uncommon, and the term is not very commonly used. Some also refer to this condition as labile diabetes. Brittle diabetes is still a concern among diabetics. It is a sign that your blood sugar is poorly managed. All people with diabetes will experience at some stage of their diabetes, a certain level of blood glucose level fluctuation. But mostly these shifts are not extreme or over-frequent and people lead a normal life. In brittle diabetes, however, the fluctuations are more serious and tend to result in frequent hospital visits, interruption to employment and can often contribute to psychological issues such as stress. The best way to prevent brittle diabetes is to follow a health plan set forth by your doctor. Those who have psychological problems, including stress and depression, face a greater Continue reading >>

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  1. Steve Rapaport

    Correlation isn't causation, so the question's presupposition of high blood sugar 'resulting' in diabetic coma is wrong. They both result from common causes.
    Diabetic coma (advanced diabetic ketoacidosis or DKA) is not the result of high blood sugar, but of low insulin and water levels. Low insulin levels lead to high blood sugar AND to ketoacidosis. Hence there's no minimum blood sugar level to watch for (though there may be for a given individual).
    The best way to avoid DKA is to keep insulin levels steady in the bloodstream, keep well hydrated, and keep small amounts of food in the system at all times.
    DKA is a result of the body demanding sugar for fuel, and being denied it through lack of insulin. The body burns fat instead, which produces ketone bodies as a byproduct. The ketones build up in blood, making it acid and highly concentrated. Concentrated blood sucks water out of cells by osmosis. Dehydration makes this worse. The ketones signal the liver that glucose is desperately needed, so it dumps stored glucose to help out, but in the absence of insulin this just makes things worse -- now the blood is full of ketones AND glucose, and even more highly concentrated. Both of these conditions will get worse until fast-acting insulin and missing electrolytes are added in carefully controlled doses, including a drip-feed for hydration and frequent recheck and adjustment of all those values.

  2. Suhail Malhotra

    First we must know that there are 2 types of diabetes.
    IDDM(insulin dependent diabetes mellitus) aka Type 1
    NIDDM( non insulin dependent diabetes mellitus) aka Type 2.
    Type 1 is due to loss of insulin secretion by pancreas as in destruction of pancreas.
    Type 2 is due to insulin resistance that is insulin secretion is ok but body cells don't respond to it.
    Now the comas in these two types are different to the extent that they are named differently.
    The coma of type 1 is called the DKA(diabetic ketoacidosis) and that of type 2 is HONK( hyperosmotic non ketotic coma) now known as HHS(hyperglycemic hyperosmolar state).
    DKA occurs in type 1 diabetes or situations simulating type 1 mechanism like when a patient forgets to take his dose of insulin or in states when patient is regular with insulin but the body needs more than normal as in cases of surgery or illness or pregnancy.
    Blood glucose ranges in DKA from 250 to 600 mg/dl( 13 to 33 mmol/l) with increased ketones in blood which being acidic drive the blood ph to acidic levels ( <7.3). Symptoms include vomiting,increased urination, increased thirst, abdominal pain,increased rate of respiration(Kussumaul breathing) and in the end coma.
    HONK or HHS is caused by type 2 diabetes or situations similar to it like relative insulin deficiency combined with inadequate fluid intake and often precipitated in patients with type2 DM and a concurrent illness.
    Blood glucose ranges from 600 to 1200 mg/dl (33 to 66 mmol/l). The blood ph is normal (>=7.3) as ketones are absent. Patient is lethargic with increased thirst and increased urination leading to coma.
    Symptoms absent in HONK are nausea, vomiting, abdominal pain and increased rate of respiration which were very much a part of DKA.

  3. Jae Won Joh

    If you are asking what blood sugar levels are commonly seen in diabetic coma[1], there is a very wide range. Patients naive to the condition typically present with blood glucoses around the 300s, while those with chronic poorly-managed diabetes can present with blood glucoses over 1000.
    [1] As Steve Rapaport already pointed out in his answer, the high glucose level is not, in and of itself, the problem.

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If A Diabetic Person In A Remote Area Entered Dka, And Had A Vial Of Insulin But No Needles, What Other Methods Could Be Used To Provide Insulin? (type 1 Diabetes)

For those that don’t recognise the abbreviation DKA - it means Diabetic Keto-Acidosis, a serious imbalance brought on by very high blood glucose levels due to insufficient insulin, which the body uses to break down glucose in the blood to usable energy. In the absence of insulin the body begins breaking down fat for energy and releasing acids called ketones (principally acetone, just like the solvent used for nail polish remover.) This keto acid buildup starts playing havoc with the body’s systems, including the liver, the brain and the kidneys among others. If the level continues to increase, the body starts “shutting down” and one goes comatose and can eventually die. To partially answer the question, it’s reported that certain insulins can be absorbed through mucus membranes like under the tongue, the sinus walls in the nose and the anal mucosa. Opening the vial of insulin might prove to be rather tricky without breaking it, but I suppose it’s possible. Nonetheless, if the person is conscious a small amount of relief may be possible. If unconscious it’s going to be really rough, if at all possible. That person is in dire need of medical attention - quickly. Continue reading >>

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  1. Liang-Hai Sie

    Type I diabetic will develop a ketoacidotic hyperglycemic diabetic coma, and die if not getting their insulin, type 2 diabetics will have (very) high blood glucose levels, but most won’t develop a ketoacidotic hyperglycemic diabetic coma. While this isn’t good for their health, they aren’t in immediate danger of dying.

  2. Satyabrat Mahali

    Of adults with diabetes, only 14% use insulin, 13% use insulin and oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the CDC.

  3. Mags Hussey

    Originally Answered: What would happen if a type 1 diabetic did not take their insulin for an extended period of time?

    A person with type 1 diabetes, depending on length of time since diagnosis, has essentially no insulin production. I say essentially nil, because studies have shown that winners of 50 year medals (surviving 50 years T1 is rare enough you get a national award, ceremony and medal), about 75% of those with the least diabetic complications have been found to have a little C-peptide production. That means their bodies still battle to keep producing beta cells (beta cells producing insulin and c-peptide being a cleavage product off insulin which is easily measurable) and their bodies immune system keep killing them off. I digress. Even those with tiny c-peptide production will die without insulin, the question is when. Days would be my estimate. C- peptide is also used a medication nowadays to prevent diabetes complications.
    I've had T1 30 years. If I omit insulin for 12 hours (background/basal and bolus) and eat regular foods, my blood glucose level would be over 33.3 mmol on the meter i.e. Unreadable. I would have very high blood ketones (which means acidic blood and cells not able to access glucose for energy so fat has broken down uncontrollably to feed the body instead causing an unwelcome acidic environment). and I would now require hospitalisation. If I took no insulin but went without food, specifically avoiding carbohydrates which drive glucose higher, I might make it to 2–3 days instead before needing hospitalidation as low carb can stop the body reaching such high blood glucose levels so quickly. But it would get to >33.3 mmol unreadable in 2–3 days regardless. Restabilisation isn't just a matter of taking insulin at that point. We are often tempted to take a giant stick of insulin to deal with ourselves but this is not advised.
    The body is too dehydrated, the blood is thick and acidic, pH as low as 6.9-7.0 (normal 7.4). Bicarbonate is low, Potassium and sodium electrolytes are imbalanced due to excess urination so hourly blood arterial gases for Co2, bicarbonate, pH and potassium are forced upon you. A saline IV perhaps with bicarbonate and /potassium is inserted depending on your blood results. An ekg is on you non stop as the potassium and sodium imbalance has wrecked your heart rhythm. Your input of fluid by IV and output by vomit (there's a lot of that) and urine is tallied up and tried to be balanced out. With the IV drip. Your kidneys might have shut down. Temporarily or permanently. It would seem obvious that The big concern is of course to lower your blood glucose, but done too rapidly or not at all and the brain tissue swells, causing brain injury, coma and death. Look up kisses for kycie, whose t1 diabetes was misdiagnosed and thus endured brain swelling and passed tragically 7 months later. This happens all too often. But it is the cause of death in 3% of known t1s. A bout of no insulin for 2–3 days whether accidental or purposeful can mean death, a stay in ICU, a week in hospital to correct slowly. It is an ugly way to die.
    There are early signs a person is not taking sufficient insulin if a person is not checking their glucose or hasn't access to a meter or is not yet diagnosed - heavy breathing, acetone breath, stomach pains, vomiting. Weight loss (I lose 3kg in one day of no insulin). Frequent urination, incessant drinking and thirst. Fatigue, lethargy, stupor, coma. Kids being out of sorts, not growing, wetting the bed, soaked diapers, moodiness in teens and adults.

    If you have diabetes, don't mess with your insulin. You dice with death but risk being brain injured, on dialysis or comatose forever.

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What Are The Short-term Consequences Of Not Controlling Type 1 Diabetes?

Death. Well, that depends on just how poorly controlled you're talking, but if you mean not treating at all, then you can progress through some serious consequences ending in death over the course of a day or so. Unlike the more common Type 2 Diabetes Mellitus, people with Diabetes mellitus type 1 do not produce insulin on their own, and need an external source of insulin to survive. That is because cells cannot take in sugar from the bloodstream to fuel themselves without insulin, so once the sugar in there is used up the cells have to start breaking down fatty acids to stay alive, but that produces ketones, which are toxic. At the same time, all the sugar that's stuck, unusable, in the bloodstream interferes with kidney function, causing dehydration. Its a combination that leads to Diabetic ketoacidosis, which can kill a person within 24 hours of their first symptoms. Ok, so now lets consider a person who is still taking some insulin, but not really paying attention to their blood sugar. It is still possible for them to undertreat themselves, which can potentially still lead to diabetic ketoacidosis. Or, they can overtreat themselves, causing hypoglycaemia, which if only slight m Continue reading >>

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  1. Steve Rapaport

    Correlation isn't causation, so the question's presupposition of high blood sugar 'resulting' in diabetic coma is wrong. They both result from common causes.
    Diabetic coma (advanced diabetic ketoacidosis or DKA) is not the result of high blood sugar, but of low insulin and water levels. Low insulin levels lead to high blood sugar AND to ketoacidosis. Hence there's no minimum blood sugar level to watch for (though there may be for a given individual).
    The best way to avoid DKA is to keep insulin levels steady in the bloodstream, keep well hydrated, and keep small amounts of food in the system at all times.
    DKA is a result of the body demanding sugar for fuel, and being denied it through lack of insulin. The body burns fat instead, which produces ketone bodies as a byproduct. The ketones build up in blood, making it acid and highly concentrated. Concentrated blood sucks water out of cells by osmosis. Dehydration makes this worse. The ketones signal the liver that glucose is desperately needed, so it dumps stored glucose to help out, but in the absence of insulin this just makes things worse -- now the blood is full of ketones AND glucose, and even more highly concentrated. Both of these conditions will get worse until fast-acting insulin and missing electrolytes are added in carefully controlled doses, including a drip-feed for hydration and frequent recheck and adjustment of all those values.

  2. Suhail Malhotra

    First we must know that there are 2 types of diabetes.
    IDDM(insulin dependent diabetes mellitus) aka Type 1
    NIDDM( non insulin dependent diabetes mellitus) aka Type 2.
    Type 1 is due to loss of insulin secretion by pancreas as in destruction of pancreas.
    Type 2 is due to insulin resistance that is insulin secretion is ok but body cells don't respond to it.
    Now the comas in these two types are different to the extent that they are named differently.
    The coma of type 1 is called the DKA(diabetic ketoacidosis) and that of type 2 is HONK( hyperosmotic non ketotic coma) now known as HHS(hyperglycemic hyperosmolar state).
    DKA occurs in type 1 diabetes or situations simulating type 1 mechanism like when a patient forgets to take his dose of insulin or in states when patient is regular with insulin but the body needs more than normal as in cases of surgery or illness or pregnancy.
    Blood glucose ranges in DKA from 250 to 600 mg/dl( 13 to 33 mmol/l) with increased ketones in blood which being acidic drive the blood ph to acidic levels ( <7.3). Symptoms include vomiting,increased urination, increased thirst, abdominal pain,increased rate of respiration(Kussumaul breathing) and in the end coma.
    HONK or HHS is caused by type 2 diabetes or situations similar to it like relative insulin deficiency combined with inadequate fluid intake and often precipitated in patients with type2 DM and a concurrent illness.
    Blood glucose ranges from 600 to 1200 mg/dl (33 to 66 mmol/l). The blood ph is normal (>=7.3) as ketones are absent. Patient is lethargic with increased thirst and increased urination leading to coma.
    Symptoms absent in HONK are nausea, vomiting, abdominal pain and increased rate of respiration which were very much a part of DKA.

  3. Jae Won Joh

    If you are asking what blood sugar levels are commonly seen in diabetic coma[1], there is a very wide range. Patients naive to the condition typically present with blood glucoses around the 300s, while those with chronic poorly-managed diabetes can present with blood glucoses over 1000.
    [1] As Steve Rapaport already pointed out in his answer, the high glucose level is not, in and of itself, the problem.

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