Diabetic Ketoacidosis Explained
Twitter Summary: DKA - a major complication of #diabetes – we describe what it is, symptoms, who’s at risk, prevention + treatment! One of the most notorious complications of diabetes is diabetic ketoacidosis, or DKA. First described in the late 19th century, DKA represented something close to the ultimate diabetes emergency: In just 24 hours, people can experience an onset of severe symptoms, all leading to coma or death. But DKA also represents one of the great triumphs of the revolution in diabetes care over the last century. Before the discovery of insulin in 1920, DKA was almost invariably fatal, but the mortality rate for DKA dropped to below 30 percent within 10 years, and now fewer than 1 percent of those who develop DKA die from it, provided they get adequate care in time. Don’t skip over that last phrase, because it’s crucial: DKA is very treatable, but only as long as it’s diagnosed promptly and patients understand the risk. Table of Contents: What are the symptoms of DKA? Does DKA occur in both type 1 and type 2 diabetes? What Can Patients do to Prevent DKA? What is DKA? Insulin plays a critical role in the body’s functioning: it tells cells to absorb the glucose in the blood so that the body can use it for energy. When there’s no insulin to take that glucose out of the blood, high blood sugar (hyperglycemia) results. The body will also start burning fatty acids for energy, since it can’t get that energy from glucose. To make fatty acids usable for energy, the liver has to convert them into compounds known as ketones, and these ketones make the blood more acidic. DKA results when acid levels get too high in the blood. There are other issues too, as DKA also often leads to the overproduction and release of hormones like glucagon and adrenaline Continue reading >>
What You Should Know About Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>
Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>
Can People With Type 1 Diabetes Develop Dka Without High Blood Sugar?
“Can people with type 1 diabetes develop DKA without high blood sugar?” DKA is short for diabetic ketoacidosis and is a life threatening condition. I’ve seen the question pop up a lot lately so I asked two endocrinologists to answer this question. Experts Weigh In Dr. Richard Steed, an endocrinologist from Georgia with 25 years of experience explained that, “Ketoacidosis will occur in anyone when insulin levels drop low enough. In people with diabetes, falling insulin levels will usually trigger a high sugar well before ketoacidosis starts, causing high blood sugar to typically go hand in hand with ketoacidosis.” Dr. Brad Eilerman, an endocrinologist from Kentucky explained that “Ketoacidosis occurs when the body over produces ketone bodies, typically in response to a lack of available glucose to use as intracellular fuel. In diabetic ketoacidosis, the rationale for the lack of intracellular glucose is a relative lack of insulin. Typically, this is associated with a high serum glucose because glucose taken in or produced by the liver has nowhere to go. If the patient has had a prolonged period of fasting to the point of protein calorie malnutrition, there may not be calories in order to produce glucose from the liver. This can lead to ketosis by itself. When combines with a lack of insulin, it can cause ketoacidosis,” writes Dr. Eilerman. Caution With Alcohol Dr. Steed writes that, “under the right circumstances, ketoacidosis can occur even in people without diabetes. Perhaps the commonest situation is starvation plus alcohol intake. In this situation, the starvation causes the body’s store of glucose as glycogen to become depleted. Then the body must depend on gluconeognesis (making glucose from protein) to sustain normal blood sugar levels. Alcohol w Continue reading >>
Diabetic Ketoacidosis In Type 1 And Type 2 Diabetes Mellitusclinical And Biochemical Differences
Background Diabetic ketoacidosis (DKA), once thought to typify type 1 diabetes mellitus, has been reported to affect individuals with type 2 diabetes mellitus. An analysis and overview of the different clinical and biochemical characteristics of DKA that might be predicted between patients with type 1 and type 2 diabetes is needed. Methods We reviewed 176 admissions of patients with moderate-to-severe DKA. Patients were classified as having type 1 or type 2 diabetes based on treatment history and/or autoantibody status. Groups were compared for differences in symptoms, precipitants, vital statistics, biochemical profiles at presentation, and response to therapy. Results Of 138 patients admitted for moderate-to-severe DKA, 30 had type 2 diabetes. A greater proportion of the type 2 diabetes group was Latino American or African American (P<.001). Thirty-five admissions (19.9%) were for newly diagnosed diabetes. A total of 85% of all admissions involved discontinuation of medication use, 69.2% in the type 2 group. Infections were present in 21.6% of the type 1 and 48.4% of the type 2 diabetes admissions. A total of 21% of patients with type 1 diabetes and 70% with type 2 diabetes had a body mass index greater than 27. Although the type 1 diabetes group was more acidotic (arterial pH, 7.21 ± 0.12 vs 7.27 ± 0.08; P<.001), type 2 diabetes patients required longer treatment periods (36.0 ± 11.6 vs 28.9 ± 8.9 hours, P = .01) to achieve ketone-free urine. Complications from therapy were uncommon. Conclusions A significant proportion of DKA occurs in patients with type 2 diabetes. The time-tested therapy for DKA of intravenous insulin with concomitant glucose as the plasma level decreases, sufficient fluid and electrolyte replacement, and attention to associated problems remai Continue reading >>
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 >>
Diabetic Ketoacidosis (dka)
Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>
What Are The Common Symptoms Of Diabetes?
If you have any of the following diabetes symptoms, see your doctor about getting your blood sugar tested: Urinate (pee) a lot, often at night Are very thirsty Lose weight without trying Are very hungry Have blurry vision Have numb or tingling hands or feet Feel very tired Have very dry skin Have sores that heal slowly Have more infections than usual People who have type 1 diabetes may also have nausea, vomiting, or stomach pains. Type 1 diabetes symptoms can develop in just a few weeks or months and can be severe. Type 1 diabetes usually starts when you’re a child, teen, or young adult but can happen at any age. Type 2 diabetes symptoms often develop over several years and can go on for a long time without being noticed (sometimes there aren’t any noticeable symptoms at all). Type 2 diabetes usually starts when you’re an adult, though more and more children, teens, and young adults are developing it. Because symptoms are hard to spot, it’s important to know the risk factors for type 2 diabetes and visit your doctor if you have any of them. Disclaimer: I am the co-founder of DeeveHealth. DeeveHealth is a mobile platform to prevent Type 2 diabetes. Based on the scientific behavior of human and science of prevention using data points. For more information check out our web-site Continue reading >>
Victoza Tested To Combat Dka For People With Type 1
Researchers look to see if GLP-1 drugs could be an add-on therapy. In recent years, we have seen increasing overlap between drugs used to treat Type 1 diabetes and those used to treat Type 2 diabetes. More people with Type 2 diabetes are going on insulin therapy than in previous years, while drugs like metformin and Invokana are being prescribed off-label for people with Type 1 diabetes. Researchers are exploring whether a class of drugs called GLP-1 agonists can be used to help people with Type 1 combat high blood glucose levels and lower their risk of diabetic ketoacidosis. GLP-1 drugs work by slowing the body’s glucagon production, increasing insulin production (when possible), and slowing the rate by which food leaves the stomach. sponsor A recent study conducted at the Diabetes and Endocrinology Center of Western New York examined whether the GLP-1 drug Victoza could curb the production of ketones that could lead to diabetic ketoacidosis (DKA). In the study, 26 participants with Type 1 diabetes who were overweight or obese were instructed to fast overnight while continuing regular basal insulin injections. They were then given either an injection of Victoza or an injection of saline. Researchers found that those who received Victoza had lower levels of glucagon, ghrelin (a hormone that increases appetite), and free fatty acids that could lead to diabetic ketoacidosis, according to a report in MedPage Today. The researchers are hoping the findings of this small study might be an indication that the drug may be able to help curb DKA risk in people with uncontrolled Type 1 diabetes. Researchers are exploring both GLP-1 drugs and SGLT2 drugs as add-on drug therapies to help curb high blood glucose levels. If GLP-1 drugs can achieve similar results with a reduced risk Continue reading >>
Diabetic Ketoacidosis (dka) - Topic Overview
Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolyt Continue reading >>
Type 1 Diabetes Mellitus With Ketoacidosis Without Coma
E10.10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This is the American ICD-10-CM version of E10.10 - other international versions of ICD-10 E10.10 may differ. Approximate Synonyms Diabetes type 1 with ketoacidosis Ketoacidosis in type 1 diabetes mellitus Ketoacidosis in type i diabetes mellitus ICD-10-CM E10.10 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0): Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016): No change 2018 (effective 10/1/2017): No change Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Continue reading >>
What Are The Best New Products Or Inventions That Most People Don't Know About?
This list contains 25 of them. take few minutes and be amazed. 1. Hourglass Traffic Lights 2.Easy-to-pack Shoes 3. Toothpaste Squeezer 4. Fence Window 5. Mirror Wiper 6. Drivemotion LED Car Sign 7. Pizza Scissors 8. Onion Holder 9. Rotating Bench That Guarantees a Dry Place to Sit 10. Faucet Thermometer 11. Citrus Spritzer 12. Ironing Board Mirror 13. Scooter Stroller 14. Lego Key Holder 15. Baby Bath Visor 16. Spaghetti Fork 17. Word Search Wrapping Paper 18. Lockable Mug 19. Umbrella with a Cupholder 20. Laser Bike Lane 21. Ice Cream Lock 22. Meat Scanner 23. Zipper Sneakers 24. Leftover Vegetable/Fruit Seal 25. Nightlight with Portable Glowing Orbs Source: Here Are 25 Incredibly Brilliant Inventions You Didn’t Even Know You Needed. #1 Changes Everything! UPDATE 1 Here are few more but from India this time. These are the finest of examples of what we in India call Jugaad Technology ;) Source:: 10 Pictures That Prove Indians Are One Of The Most Innovative People In The World 1. Probably the best load carrier for manual labour ever created. Vikram Dinubhai Panchal of The National Institute of Design (NID), created this masterpiece and priced it at a miniscule cost of Rs. 300. 2. We charge our mobile phones using Peepal Leaves. Unbelievable? Yes. Does it work? Yes. Astonishingly innovative? Absolutely! 3. We made a Rickshaw Powered-Lighting System. Now this is called "Man-power." Literally. 4. And here's a people carrier that blurs the fine line between mode of transportation and circus act. Although the thing looks a little dicey, you can't help but marvel at the guy's ingenuity. 5. We came up with the "Mitti-Cool" village fridge. Here's a fridge for the common man that doesn't require electricity. Indian inventor Mansukhbhai Prajapati poses with his "Mitti-Cool (Mud Continue reading >>
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 >>
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 risk of developing this condition. This can be as simple as psychological problems causing neglect of diabetes care (such as negligence of eating healthy food, taking medication or exercising regularly). P'ԗ. Continue reading >>
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 might just make them a little woozy, but if severe can lead to unconsciousness and death if they are not found and treated. Easing up a little more, we can imagine a person who's a bit more careful. They still take their insulin, they check their blood sugars relatively often, but they can be a little forgetful about just how many helpings of dessert they had. Their sugars will run high, but there should be enough getting into the cells to prevent DKA. Most of the consequences of that are going to be long-term, like peripheral vascular disease, kidney damage and retinopathy. In the short term, Continue reading >>