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What Precipitating Factors May Lead To Dka?

An Exceptional Case Of Diabetic Ketoacidosis

An Exceptional Case Of Diabetic Ketoacidosis

Copyright © 2017 Celine Van de Vyver et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmol/L, subsequently resulting in hyperkalaemia and life-threatening dysrhythmias. This is the first reported live case with such high values of blood glucose and a favourable outcome. 1. Introduction Diabetic ketoacidosis (DKA) is known as one of the most serious complications of diabetes, besides hyperosmolar hyperglycaemic syndrome (HHS), and it is associated with significant morbidity and mortality. The symptoms are often nonspecific and there are many diseases that mimic the presentation. The clinical course usually evolves within a short time frame (<24 h). DKA exists of a triad of uncontrolled hyperglycaemia, metabolic acidosis, and increased total body ketone concentration [1]. These three criteria are needed for diagnosis. The most common precipitating factors of DKA are infections and discontinuation of or inadequate insulin therapy. Mainstays of treatment are correction of hypovolemia and hyperglycaemia, rapid administration of insulin, and electrolyte management. Glycaemic values in DKA normally do not exceed 33 mmol/L. In contrast, blood glucose in HHS is often higher [2, 3]. We present a case of severe diabetic ketoacidosis with glycaemic values of almost 110 mmol/L, leading to neurologic sequelae and requiring more aggressive treatment. A similar case report detailing th Continue reading >>

Diabetes Mellitus - Hyperglycaemic States

Diabetes Mellitus - Hyperglycaemic States

Diabetes mellitus - Hyperglycaemic states Globally the incidence of diabetes is likely to exceed 250 million people by 2025 that is a measure of the scale of the problem this condition is likely to present in the future. It is evidence of how diabetes will be one of the foremost public health challenges facing the world in the decades ahead. Recently, the series has been focusing on some of the acute complications that can occur with diabetes and this month Rita Forde discusses problems that arise from hyperglycaemic states. The last module focused on hypoglycaemia and this article will address hyperglycaemic states. Hyperglycaemic states present in the form of diabetic ketoacidosis (DKA) or hyper osmolar non ketotic acidosis (HONK). DKA is associated with a mortality rate of less than 5% in experienced centres while HONK has a much high mortality rate of approximately 15%. The prognosis of both is worsened by age and in the presence of coma and hypotension.2 DKA is associated with people with type 1 diabetes. It is defined as the triad of hyperglycaemia, acidosis and ketosis. The primary cause of this is insulin deficiency. This metabolic disturbance is associated with type 2 diabetes. It is characterised by an increase in serum osmolality, extreme hyperglycaemia and dehydration and the absence of ketones. It is caused by inadequate insulin levels. The pathophysiology of severe hyperglycaemia should be considered in relation to the glucose metabolism, acid-base balance, electrolyte changes and ketone body metabolism (DKA). The underlying mechanism for both of these conditions is relatively similar; a reduction in the circulating insulin and an elevation of the counter regulatory hormones. The counter regulatory hormones are glucagon, adrenaline, nor adrenaline, cortis Continue reading >>

Precipitating Factors

Precipitating Factors

Once DKA or HHS is diagnosed, identification of the cause or precipitating factor(s) is an important next step as these conditions rarely occur de novo. Obtaining a thorough history and physical examination is essential to guide a diagnostic testing and treatment plan. DKA is most commonly caused by omission of insulin therapy, but both conditions may occur with concomitant infection or rarely with other clinical events such as silent myocardial infarction or cerebrovascular accident. Pancreatitis, trauma, alcohol abuse, and illicit drug (cocaine) use are other possible causes. Less often, drugs that affect carbohydrate metabolism may lead to DKA or HHS. These include the use of glucocorticoids, thiazide diuretics, sympathomimetic agents, or second-generation antipsychotics. In elderly patients, restricted access to water intake or altered thirst response increases risk of dehydration and, therefore, HHS. Identification of the cause of DKA or HHS may be complicated by the manifestations of the disease process itself. For example, while infection is an important trigger to consider, typical signs and symptoms may be masked in the setting of DKA. Due to peripheral vasodilatation, patients can often be normothermic or mildly hypothermic despite having an ongoing infection. Conversely, leukocytosis is often seen in DKA in the absence of infection. Thus, when infection is suspected, additional diagnostic testing such as chest x-rays, urinalysis, blood cultures, or analysis of cerebrospinal fluid must be obtained accordingly. Another important consideration is neurologic pathology. While patients with HHS and a serum osmolality of >320 mOsm/kg (320 mmol/kg) are often obtunded or comatose, altered mental status is rarely seen in patients with a lower serum osmolality. In such Continue reading >>

Precipitating Factors, Outcomes, And Recurrence Of Diabetic Ketoacidosis At A University Hospital In Damascus

Precipitating Factors, Outcomes, And Recurrence Of Diabetic Ketoacidosis At A University Hospital In Damascus

Precipitating factors, outcomes, and recurrence of diabetic ketoacidosis at a university hospital in Damascus 1Department of Internal Medicine, Damascus University, Damascus, Syria 2Faculty of Medicine, Damascus University, Damascus, Syria 1Department of Internal Medicine, Damascus University, Damascus, Syria 2Faculty of Medicine, Damascus University, Damascus, Syria Address for correspondence: Dr. Zaynab Alourfi, Department of Internal Medicine, Damascus University, Damascus, Syria. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : Avicenna Journal of Medicine 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 study precipitating factors, outcomes, and recurrence of diabetic ketoacidosis (DKA) at a University hospital at Damascus, the capital of Syria. Medical records between 2006 and 2012 were reviewed. One hundred and fifteen admissions for 100 patients with DKA were included. All fulfilled the American Diabetic Association DKA diagnostic criteria. Of 115 admissions of DKA, there were 92 single admission and 23 recurrent admissions (eight patients). The order of precipitating factors of recurrent DKA or single admissions were the same with different percentage. The first and second factors were infection (74% and 48%) and treatment problems (17% and 24%), respectively. Complications rate was significantly higher in the intensive care unit (41.6%), compared to the ward admissions (14.2%). Overall in-hospital mortality rate was 11.3%. The severity of m Continue reading >>

Hyperglycemic Crises In Adult Patients With Diabetes

Hyperglycemic Crises In Adult Patients With Diabetes

Hyperglycemic Crises in Adult Patients With Diabetes Abbas E. Kitabchi, PHD, MD; Guillermo E. Umpierrez, MD; John M. Miles, MD; Joseph N. Fisher, MD The most common precipitating factor in the development of DKA and HHS is infection[ 1 , 4 , 10 ]. Other precipitating factors include discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and drugs[ 10 , 13 , 14 ]. In addition, new-onset type 1 diabetes or discontinuation of insulin in established type 1 diabetes commonly leads to the development of DKA. In young patients with type 1 diabetes, psychological problems complicated by eating disorders may be a contributing factor in 20% of recurrent ketoacidosis. Factors that may lead to insulin omission in younger patients include fear of weight gain with improved metabolic control, fear of hypoglycemia, rebellion against authority, and stress of chronic disease. Before 1993, the use of continuous subcutaneous insulin infusion devices had also been associated with an increased frequency of DKA[ 23 ]; however, with improvement in technology and better education of patients, the incidence of DKA appears to have reduced in pump users. However, additional prospective studies are needed to document reduction of DKA incidence with the use of continuous subcutaneous insulin infusion devices[ 24 ]. Underlying medical illness that provokes the release of counterregulatory hormones or compromises the access to water is likely to result in severe dehydration and HHS. In most patients with HHS, restricted water intake is due to the patient being bedridden and is exacerbated by the altered thirst response of the elderly. Because 20% of these patients have no history of diabetes, delayed recognition of hyperglycemic symptoms may h 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 >>

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 >>

Sa Fam Pract 2007:49(10) 15

Sa Fam Pract 2007:49(10) 15

Abstract Background Despite improvements in therapy and disease monitoring, diabetic ketoacidosis (DKA) remains a potentially fatal conse- quence of diabetes. This retrospective study was undertaken to establish and identify those risk factors that are responsible for the onset of DKA. Methods The medical records of 77 patients from Addington Hospital, who satisfied the criteria for inclusion in the study of DKA, were reviewed (60 type 1 diabetes mellitus (DM) patients and 17 type 2 DM patients). Results More juveniles were admitted for multiple DKA episodes (65%) than non-juveniles (35%). DKA was present in 23% of newly diagnosed type 1 DM patients on first presentation. Infection was present in 40% of type 1 DM patients with single DKA episodes, and in 45% of type 1 DM patients with multiple DKA episodes. A total of 23.2% of all admissions for single DKA involved non-compliance with medication usage and was implicated in 32% of multiple DKA episodes. Family and/or school problems presented in 7% of single DKA episodes and in 4% in multiple DKA episodes. In the present study, the overall mortality rate was 2.5% (n=2). Conclusions This study showed that the most important risk factors implicated in DKA are infection, non-compliance and newly diagnosed diabetes, followed by family and/or school problems, low socio-economic status and omission of insulin. SA Fam Pract 2007;49(10):15 The full version of this article is available at: www.safpj.co.za P This article has been peer reviewed Original Research An identification of the risk factors implicated in diabetic ketoacidosis (DKA) in type 1 and type 2 diabetes mellitus Mudly S, MMed Sc Department of Pharmacology, University of KwaZulu-Natal Rambiritch V, PhD Department of Pharmacology, University of KwaZulu-Natal Mayet L, Continue reading >>

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Together with hyperglycemic coma, diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of diabetes mellitus [ 1 ]. Defined by the triad hyperglycemia, acidosis, and ketonuria, DKA can be inaugural or complicate known diabetes [ 2 ]. Although DKA is evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient's requirements and the treatment, DKA-related mortality is low among patients who receive standardized treatment, which includes administration of insulin, correction of hydroelectrolytic disorders, and management of the triggering factor (which is often cessation of insulin therapy, an infection, or a myocardial infarction) [ 3–8 ]. Although there is no proof that diabetics are more susceptible to infection, they seem to have more difficulty handling infection once it occurs [ 9 , 10 ]. Indeed, several aspects of immunity are altered in diabetic patients: polymorphonuclear leukocyte function is depressed, particularly when acidosis is present, and leukocyte adherence, chemotaxis, phagocytosis, and bactericidal activity may also be impaired [ 11–15 ]. Joshi et al. [ 10 ] reported recently on the lack of clinical evidence that diabetics are more susceptible to infection than nondiabetic patients. Nevertheless, infection is a well-recognized trigger of DKA. Earlier studies have investigated the prevalence of infection as a trigger of DKA and the impact of antimicrobial treatment [ 2 , 15–18 ]. However, none of these studies were of intensive care unit (ICU) patients only. Furthermore, most were descriptive, included small numbers of patients, used univariate analysis only, and did not designate infection as the sole outcome variable of interest. Efforts to identify correlates of infection h Continue reading >>

Prime Pubmed | Sglt2 Inhibitors: A Systematic Review Of Diabetic Ketoacidosis And Related Risk Factors In The Primary Literatur

Prime Pubmed | Sglt2 Inhibitors: A Systematic Review Of Diabetic Ketoacidosis And Related Risk Factors In The Primary Literatur

Type your tag names separated by a space and hit enter SGLT2 Inhibitors: A Systematic Review of Diabetic Ketoacidosis and Related Risk Factors in the Primary Literature. Currently only minimal information is available regarding risk factors for the development of sodium glucose cotransporter-2 inhibitor (SGLT2i)-related diabetic ketoacidosis (DKA). We aim to identify individual patient characteristics associated with cases of SGLT2i-related DKA to better describe potential risk factors. Thirty-four case reports of patients with type 1 and type 2 diabetes mellitus who developed DKA while receiving an SGLT2i. This systematic review investigated the relationship between SGLT2i and DKA in patients with diabetes. The existing literature was reviewed with a primary outcome to identify patient-specific factors contributing to the incidence of ketoacidosis in patients with diabetes who were treated with a SGLT2i. Numerous databases were searched to identify appropriate primary literature. Search terms included canagliflozin, dapagliflozin, empagliflozin, SGLT2, sodium glucose cotransporter-2 inhibitor, diabetic ketoacidosis, ketoacidosis, metabolic acidosis, and acidosis. Primary literature was analyzed via descriptive statistics. Thirty-four individual case reports were identified via the primary literature search. Two-thirds (25 cases) involved patients with a diagnosis of type 2 diabetes mellitus (T2DM). The average blood glucose on presentation for SGLT2i-induced DKA was 265.6140.7mg/dl (14.77.8mmol/L), with common symptoms including nausea, vomiting, and abdominal pain. Common precipitating factors included patients who were diagnosed with T2DM and were subsequently found to have latent autoimmune diabetes of adulthood, patients who had recently undergone major surgery, o Continue reading >>

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than 100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for <1% of all primary diabetic admissions.1 Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness.2 Contrary to popular belief, DKA is more common in adults than in children.1 In community-based studies, more than 40% of African-American patients with DKA were >40 years of age and more than 2 Continue reading >>

Comparison Of Incidences, Hospital Stay And Precipitating Factors Ofdiabetic Ketoacidosis In Ramadan And The Following Month In Threemajor Hospitals In United Arab Emirates. A Prospective Observationalstudy

Comparison Of Incidences, Hospital Stay And Precipitating Factors Ofdiabetic Ketoacidosis In Ramadan And The Following Month In Threemajor Hospitals In United Arab Emirates. A Prospective Observationalstudy

Received date January 25, 2015; Accepted date February 21, 2015; Published date February 28, 2015 Citation: Abdelgadir EIE, Hafidh K, Basheir AMK, Afandi BO, Alawadi F, et al. (2015) Comparison of Incidences, Hospital Stay and Precipitating Factors of Diabetic Ketoacidosis in Ramadan and the Following Month in Three Major Hospitals in United Arab Emirates. A Prospective Observational Study. J Diabetes Metab 6:514. doi:10.4172/2155-6156.1000514 Copyright: 2015 Abdelgadir EIE, 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. 1.7 billion Muslims worldwide obey religious commands of fasting for a month. This may increase morbidity in people with diabetes. Objective: Comparing the rate and duration of admissions with diabetic ketoacidosis and the leading precipitating factors during Ramadan and in the following month (Shawal) were our primary and secondary endpoints, respectively. Design and methods: This was a prospective study that included all Muslims who were admitted with DKA to three major hospitals in United Arab Emirates during Ramadan and Shawal. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points. Results: 48 patients were admitted during the study duration, 20 were admitted during Ramadan and 28 in Shawal. All those admitted during Ramadan were people with type1 diabetes while 4 of those admitted during Shawal were people with type 2 diabetes. 75% of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Urinary tract infections represented the commonest Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Acute hyperglycemia, or high blood glucose, may be either the initial presentation of diabetes mellitus or a complication during the course of a known disease. Inadequate insulin replacement (e.g., noncompliance with treatment) or increased insulin demand (e.g., during times of acute illness, surgery, or stress) may lead to acute hyperglycemia. There are two distinct forms: diabetic ketoacidosis (DKA), typically seen in type 1 diabetes, and hyperosmolar hyperglycemic state (HHS), occurring primarily in type 2 diabetes. In type 1 diabetes, no insulin is available to suppress fat breakdown, and the ketones resulting from subsequent ketogenesis manifest as DKA. This is in contrast to type 2 diabetes, in which patients can still secrete small amounts of insulin to suppress DKA, instead resulting in a hyperglycemic state predominated simply by glucose. The clinical presentation of both DKA and HHS is one of polyuria, polydipsia, nausea and vomiting, volume depletion (e.g., dry oral mucosa, decreased skin turgor), and eventually mental status changes and coma. In patients with altered mental status, fingerstick glucose should always be checked in order to exclude serum glucose abnormalities. Several clinical findings pertaining only to DKA include a fruity odor to the breath, hyperventilation, and abdominal pain. HHS patients, in contrast to those with DKA, will present with more extreme volume depletion. The treatment of both DKA and HHS is primarily IV electrolyte and fluid replacement. Insulin for hyperglycemia may be given with caution and under vigilant monitoring of serum glucose. Other treatment options depend on the severity of symptoms and include bicarbonate and potassium replacement. Osmotic diuresis and hypovolemia Hypovolemia resulting from DKA can lead to acute Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

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