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What Is Mild Dka?

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Mild Dka | Observation Medicine Protocols

Many studies have DKA resolving in under 16 hours with SQ insulin alone All orders and protocol assumes previous treatment in the ED setting ED work up must include VBG, CMP and evaluation for other causes of DKA if patient does not meet DKA criteria, please consider use of Hyperglycemia pathway Persistently abnormal vital signs after 2L NS (SBP<100, HR >130, RR>24; MAP<60) pH < 7.0 (pH values between 7.0 and 7.14 should be clinically evaluated prior to acceptance) Acute co-morbidity / precipitant (infection, MI, surgery, trauma) No direct admits to the unit. Definition of DKA must occur prior to placement in observation status. Electrolyte replacement protocols of magnesium and potassium BMP and Beta Hydroyxybutyrate on unit admission Q 4 hour BMP, beta hydroxybutyrate and VBG. When Blood Sugar is under 250 (but still in DKA) Fluids changed to D5 1/2NS at 125-250ml/hr Criteria: BS <250; pH >7.3; Anion gap normal (<14); Bicarbonate normal (>18) Patient received home long-acting insulin Transition to subQ home dosing of insulin 0.1u/kg novolog + patients home long acting insulin If patient has not eaten yet, should be given food If possible, dose home insulin and bolus before the n Continue reading >>

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Popular Questions

  1. Sleep

    How bad is it for your heart when you sleep 3-4 hours per day for 1 month?

  2. Vikas Patil

    Sadly I did it for more than a month.. around 4 to 5 months in a row and was doing it when needed (like up to 2 weeks a month) for past 7 years. I request nobody should do it for any damn reason in their life...
    immediate short term effects were, my blood pressure, cholesterol and weight went up. BP is normal after taking a month's break from work!
    But Cholesterol and weight are at border line high even after 3 years of that episode!
    In long term I have picked up an obsession for staying awake at night. This induced anxiety, panic, insomnia and hence gastric disorders. I am getting rid of all this with the help of medication, exercise and meditation. Now the great challenge for me everyday is to sleep for 8 hours. I have still not been able sleep 8 hours everyday for a week! But there is an improvement. Lot of money, efforts, time is spent! I am grateful for my family, friends and colleagues at work who are helping me to get better.

  3. Anshul Bhatia

    Not just heart, less sleep or irregular sleep timings will affect the whole body.
    I got this as a whatsapp message, it gives interesting perspective on the importance of sleep timings.
    What Time Should You Sleep?
    By James Pang
    Is there a best time to sleep? There is a saying that sleeping early and waking up early is good for your health. How true is that? Is it alright to sleep late and wake up late?
    You actually have an amazing biological clock ticking inside your body. It is very precise. It helps to regulate your various body functions including your sleeping time.
    From 11pm to 3am, most of your blood circulation concentrates in your liver. Your liver gets larger when filled with more blood. This is an important time when your body undergoes detoxification process. Your liver neutralizes and breaks down body toxins accumulated throughout the day.
    However if you don't sleep at this time, your liver cannot carry out this detoxification process smoothly.
    · If you sleep at 11pm, you have full 4 hours to detoxify your body.
    · If you sleep at 12am, you have 3 hours.
    · If you sleep at 1am, you have 2 hours.
    · And if you sleep at 2am, you only have 1 hour to detoxify.
    What if you sleep after 3am? Unfortunately, you won't have any time to actually detoxify your body. If you continue with this sleeping pattern, these toxins will accumulate in your body over time. You know what happens next.
    What if you sleep late and wake up late?
    Have you tried going to bed very late at night? Did you realize you feel very tired the next day no matter how much you sleep?
    Sleeping late and waking up late is indeed very bad for your health. Besides not having enough time to detoxify your body, you will miss out other important body functions too.
    From 3am to 5am, most blood circulation concentrates in your lung. What should you do at this moment? Well, you should exercise and breathe in fresh air. Take in good energy into your body, preferably in a garden. At this time, the air is very fresh with lots of beneficial negative ions.
    From 5am to 7am, most blood circulation concentrates in your large intestine. What should you do at this moment? You should poop! Pass out all unwanted poop from your large intestine. Prepare your body to absorb more nutrients throughout the day.
    From 7am to 9am, most blood circulation concentrates in your stomach. What should you do at this moment? Have your breakfast! This is your most important meal in a day. Make sure you have all the required nutrients from your breakfast. Not having breakfast causes lots of health problems for you in the future.
    That's the way to start your day
    There you are... the most ideal way to start your day. After fully detoxifying your blood during your sleep, you wake up fresh to inhale beneficial energy. Then you pass out unwanted poop from your large intestine. After that, you take in balanced nutrients to prepare your body for a new day.
    No wonder people living in villages or farms is healthier. They sleep early and wake up early. They follow their natural biological clock.
    Living in city, we have more difficulty in following this sleeping schedule. We have good lightning, TV and internet to delay our precious sleeping time.
    Following your natural timetable
    Once I know the importance of our biological clock, I try my best to follow it. If I wake up early, I usually start my day on the computer. But when I see the clock shows 7am, I know it's the best time for breakfast. So I'll try to have my breakfast before 9am for best absorption.
    What if you're offered a night shift job? I recommend you to reject it even the salary is higher. For long term, you may need to spend more money for your health problems.

    What if you have assignment to do until late at night? Well, why not sleep early and wake up earlier to do it? Just shift your work time from late night to early morning. You get the same time. But your body will appreciate it.

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Managing Diabetic Ketoacidosis In Non-intensive Care Unit Setting: Role Of Insulin Analogs

Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs Department of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India. 1Department of Pharmacology, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India. Correspondence to: Dr. Ritu Karoli, E-mail: [email protected] Received 2010 Dec 6; Revised 2011 Jan 19; Accepted 2011 Apr 25. Copyright Indian Journal of Pharmacology This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. To compare the efficacy and safety of rapid acting insulin analog lispro given subcutaneously with that of standard low-dose intravenous regular insulin infusion protocolin patients with mild to moderate diabetic ketoacidosis. In this prospective, randomized and open trial, 50 consecutive patients of mild to moderate diabetic ketoacidosis were randomly assigned to two groups. The patients in group 1 were treated with intravenous regular i Continue reading >>

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Popular Questions

  1. Kingleonidas

    Metformin and DKA>>

    Just wondering, I have read that taking metformin without food can lead to dka, or does this usually pertain to people who eat absolutely nothing or very little all day?
    I am going to start my 850mg three times a day at about 4-5am, 9-10am, then again at the end of the day when I go to bed.
    Has anyone had a problem with metformin and dka?
    Thanks.

  2. MarkM

    no, metformin won't cause dka. its main action is to inhibit glycogenolysis. only insufficient insulin will cause dka. metformin can cause lactic acidosis, but it is not the same thing as ketoacidosis (dka).

  3. Ken S

    Studies have also shown that the risk of getting lactic acidosis with or without taking metformin is about the same. This is an extremely rare affliction that only really seems to affect patients with serious preexisting health problems. It's really not an issue to be concerned about.
    As for DKA, metformin is contradicted in cases where patients are experiencing symptoms of DKA, and therefore it may be surmised that it may worsen this condition, although it does not seem to cause it.

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high b

Diabetic Ketoacidosis: Should Current Management Include Subcutaneous Insulin Injections?

Diabetic ketoacidosis: Should current management include subcutaneous insulin injections? Diabetic ketoacidosis is a well-known acute complication in patients with both type 1 and type 2 diabetes mellitus. Although mortality has decreased considerably, it remains an important cause for admission to intensive care units. Medical management includes intravenous fluid therapy, insulin, correction of electrolyte abnormalities, and addressing the precipitating factor which in most cases is infection or non-compliance with insulin therapy. Usually patients with diabetic ketoacidosis are admitted to the intensive care unit for continuous infusion of insulin; however, the development of rapid acting insulin analogues has made it possible to treat mild to moderate diabetic ketoacidosis with subcutaneous insulin. Although studies using subcutaneous insulin include only a small number of patients, this approach seems as effective as intravenous insulin infusions in patients with mild to moderate diabetic ketoacidosis. Diabetic education and close follow-up for patients admitted for diabetic ketoacidosis remain essential to avoid recurrence and readmissions. Keywords: Diabetic ketoacidosis, a Continue reading >>

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  1. Remy

    I was blown away by the presentation of Dr Richard Veech on Bulletproof Radio a few months ago.
    He studies ketones, specifically ketone esters which are super fascinating (and would be a much better use for all this crap corn than high fructose corn syrup but that is a story for another day).
    Some of you probably know that ketones are another kind of fuel for the body. They are a fuel that can be especially well-utilized in a state of hypoxia...when the body is trying to product ATP mostly through anaerobic metabolism which isn't very efficient at all compared to glycolysis.
    Higher ketone levels are also used to prevent seizures and to treat Alzheimer's disease and Parkinson's but it is difficult to get to the levels required through diet alone.
    Nutritional ketosis is about 1.0-1.5 on a blood meter optimally but a lot of these therapeutic effects happen at higher levels like 3-4.
    One way to increase ketone levels in the body is by consuming C8 oil like Brain Octane.
    Another way is by consuming beta-hydroxybutyrate in the form of a ketone salt like KetoCaNa or KetoOS.
    Dr Veech is very much against consuming these ketone salt products. He explains it much better in the video but basically they are racemic mixtures of ketones. A racemic mixture means a molecule is chiral (handed) and the mixture contains both "hands". Examples of this are amino acids which are often differentiated by the letter L or D which refers to their handedness - think of L-carnitine.
    In nature, typically only one hand is active (usually the L) and has metabolic function. The D form may fit but it may or may not have the same metabolic activity. The drugs Zyrtec/Xyzal are an example (Zyrtec is racemic, Xyzal is the L form only) but there are many others. Drug makers exploit this handedness to produce two drugs that do the same thing but get double the patent time out of it. First they produce the racemic mixture and then they produce the "clean" form next.
    So Dr Veech says that we shouldn't consume racemic ketone salts like the beta-hydroxybutyrate because they will interfere with our body using the active form. He goes as far to say that it may be dangerous and he makes a convincing argument.
    But another ketone expert, Dominic D'Agostino, was also interviewed on this subject and has a totally different view on exogenous ketone salts. He makes the argument that they are no different than other racemic mixtures like Ringer's lactate which works exactly the same in the D and the L form.
    https://thequantifiedbody.net/ketone-bodies-dominic-dagostino/
    Frankly, I'm not at all sure who is right on this topic. I don't think that science has answered this definitely one way or another.
    Dr Veech's theory makes sense to me because I do believe that chiral molecules have different metabolic effects. But Dr D'Agostino is certainly no slouch either in the qualifications department.
    He is clearly perturbed by Dr Veech and Dave Asprey and it's kind of funny to listen to him go on about other people's opinions not backed up by science. He seems to think that Dave Asprey and Dr Veech both may have conflicting interests (which may very well be true) but who really knows? I think they are all probably acting in good faith, personally.
    Dr D'Agostino may also have conflicting interests. He may (or may not!) be involved with the company that makes Keto OS. And he would like to partner with companies making ketone salts so that they can help fund his research.
    In the meanwhile, I may experiment some more with exogenous ketone salts (if I can find some that don't taste like powdered sugar, @SanDiego!) and see how they affect me personally. I'd personally rather use ketone esters but until they are commercially available, the salts (or the C8 oil) will have to do.
    Anyway, I highly recommend anyone who is interested in using higher levels of exogenous ketones to promote mitochondrial health and energy levels to listen to these two podcasts. There is a wealth of information to be had.

  2. Remy

    @San Diego, I tried to tag you but I got your name wrong.

  3. San Diego

    Remy said: ↑
    @San Diego, I tried to tag you but I got your name wrong. Thanks for tagging me! This might be just what I need.
    I’ve been in ketosis for a couple of months and easily stay there with a combo of MCT oil, ghee, and olive oil. There’s so much confusing information out there and I’m slowly sifting through it.

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