diabetestalk.net

When Is Dka Diagnosed

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 >>

Diagnosis And Treatment Of Diabetic Ketoacidosis And The Hyperglycemic Hyperosmolar State

Diagnosis And Treatment Of Diabetic Ketoacidosis And The Hyperglycemic Hyperosmolar State

Go to: Pathogenesis In both DKA and HHS, the underlying metabolic abnormality results from the combination of absolute or relative insulin deficiency and increased amounts of counterregulatory hormones. Glucose and lipid metabolism When insulin is deficient, the elevated levels of glucagon, catecholamines and cortisol will stimulate hepatic glucose production through increased glycogenolysis and enhanced gluconeogenesis4 (Fig. 1). Hypercortisolemia will result in increased proteolysis, thus providing amino acid precursors for gluconeogenesis. Low insulin and high catecholamine concentrations will reduce glucose uptake by peripheral tissues. The combination of elevated hepatic glucose production and decreased peripheral glucose use is the main pathogenic disturbance responsible for hyperglycemia in DKA and HHS. The hyperglycemia will lead to glycosuria, osmotic diuresis and dehydration. This will be associated with decreased kidney perfusion, particularly in HHS, that will result in decreased glucose clearance by the kidney and thus further exacerbation of the hyperglycemia. In DKA, the low insulin levels combined with increased levels of catecholamines, cortisol and growth hormone will activate hormone-sensitive lipase, which will cause the breakdown of triglycerides and release of free fatty acids. The free fatty acids are taken up by the liver and converted to ketone bodies that are released into the circulation. The process of ketogenesis is stimulated by the increase in glucagon levels.5 This hormone will activate carnitine palmitoyltransferase I, an enzyme that allows free fatty acids in the form of coenzyme A to cross mitochondrial membranes after their esterification into carnitine. On the other side, esterification is reversed by carnitine palmitoyltransferase I Continue reading >>

Why Does Diabetes Cause Rapid Weight Loss?

Why Does Diabetes Cause Rapid Weight Loss?

So, I’m going to assume that you’re talking about type 1 diabetes. There are two types of diabetes that are distinctly different metabolic disorders. The answer to your question is the effects of insulin in the body. When type 1’s lose their production of insulin, their bodies no longer are able to store fat or even utilize what blood sugar is being produced by the body. This causes the body to basically consume first fat and then even lean muscle mass. If you look at left hand picture of this type 1 before the discovery of insulin you’ll see the emaciated look of someone starving. The picture on the right shows a more normal body weight after insulin injections were started. So, for type 1’s the lack of insulin can cause rapid weight loss. The lack of insulin causes the body to start basically eating itself. Type 2’s can lose weight if their bodies stop producing insulin; however, for most type 2’s things work in reverse. They have a problem of insulin resistance caused by too much insulin in their system. Too much insulin normally causes the type 2’s to store fat and gain weight. That’s the connection between type 2 diabetes and obesity. Continue reading >>

What Makes A Person?

What Makes A Person?

I’ve been in mental health treatment since August. I’m currently on my third psychopharmacological drug and am attending therapy. Therapy has mostly helped by making me understand how much I already know, which I had previously grossly underestimated, and by increasing consistency of application of that knowledge. It’s been slow but useful. Drugs have been a lot more interesting. Descartes determined his existence by asserting that he thought. His self was proven because he was capable of performing the action of thought himself. Meanwhile, I have watched chemicals I buy in a bottle change my thoughts. What force does a self have to think, when chemistry can change those thoughts more easily and completely, for good and ill alike, than I can through my will and choice alone? What self remains if chemistry has more impact upon the thoughts within my own mind than my own agency? According to modern understanding, the brain is the house of the mind, which emerges from the soupcon of chemical and electrical impulses that surge through our nervous system. It’s those impulses that allow our thoughts, feelings, and reactions alike. Beyond that is nothing. Dead, unconscious flesh that aims to organize its cells. Unthinking, unfeeling, mindless and selfless. It must be thus, or each cell would seek to preserve its own existence at the expense of the others, and the more complex organism would fail. Because there is no self, no person that minds the smallest parts of our body, we experience a sense of self, a sense of personhood. It is the self-sacrifice of the mindless, ignored by the mind, that allows the illusion of coherent identity in man. Without that systemic, constant march of death, we would not have a complex enough structure to support a brain evolved enough to Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Factors Associated With Newly Diagnosed Children With Diabetic Ketoacidosis

Factors Associated With Newly Diagnosed Children With Diabetic Ketoacidosis

Background: Diabetes mellitus type 1 is one of the most prevalent endocrine diseases in pediatrics. Diabetic ketoacidosis is considered as one of the most threatening clinical pictures of DM1, especially if occurred as the first presentation of DM1 in children. Objectives: The current study aimed to identify factors which may play a role in DKA onset in children. Methods: This case-control study included all patients under 18 years old who referred to department of pediatrics endocrinology at Mashhad University Hospital (Imam Reza) from January 2013 to December 2015 as newly diagnosed patients with DM1. Patients who fulfilled DKA criteria at diagnosis were considered as DKA group and those who referred with other presentations were considered as control group (non-DKA group). Data were analyzed by SPSS software ver. 16. Results: During the study period, 97 (39.2% male) newly diagnosed patients were included as DKA group. Accordingly 97 gender- and age-matched patients were added as non-DKA group. The most prevalent symptoms in both groups were polyuria (91.88%) and polydipsia (88.66%). Fever and cold symptoms were significantly higher in the DKA group (P < 0.001 and P =0.005, respectively). Hemoglobin A1c level was significantly higher in the DKA group (P = 0.001), while body mass index was significantly lower in the DKA group (P = 0.045). Fever and father’s education level were the most important risk and protective factors in the DKA onset in newly diagnosed patients with DM1 (adjusted OR = 10.1, 95% CI = 2.9-35.3; P < 0.001 and adjusted OR = 0.5, 95% CI = 0.3 - 0.9 and P = 0.019, respectively). Conclusions: In conclusion, a recent febrile illness was found as the strongest risk factor and father’s education level as the main protective factor in the DKA to diagno Continue reading >>

The Scary Experience Of Diabetic Ketoacidosis

The Scary Experience Of Diabetic Ketoacidosis

Today, we’re excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company’s philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it. Throughout this past year, I’ve had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much. In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.) Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. – and I thought it was 11:00 a.m. The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walke Continue reading >>

Diabetic Ketoacidosis (dka)

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 >>

Presence Of Diabetic Ketoacidosis At Diagnosis Of Diabetes Mellitus In Youth: The Search For Diabetes In Youth Study

Presence Of Diabetic Ketoacidosis At Diagnosis Of Diabetes Mellitus In Youth: The Search For Diabetes In Youth Study

Abstract OBJECTIVE. The purpose of this work was to determine the prevalence and predictors of diabetic ketoacidosis at the diagnosis of diabetes in a large sample of youth from the US population. PATIENTS AND METHODS. The Search for Diabetes in Youth Study, a multicenter, population-based registry of diabetes with diagnosis before 20 years of age, identified 3666 patients with new onset of diabetes in the study areas in 2002–2004. Medical charts were reviewed in 2824 (77%) of the patients in a standard manner to abstract the results of laboratory tests and to ascertain diabetic ketoacidosis at the time of diagnosis. Diabetic ketoacidosis was defined by blood bicarbonate <15 mmol/L and/or venous pH < 7.25 (arterial/capillary pH < 7.30), International Classification of Diseases, Ninth Revision, code 250.1, or listing of diabetic ketoacidosis in the medical chart. RESULTS. More than half (54%) of the patients were hospitalized at diagnosis, including 93% of those with diabetic ketoacidosis and 41% without diabetic ketoacidosis. The prevalence of diabetic ketoacidosis at the diagnosis was 25.5%. The prevalence decreased with age from 37.3% in children aged 0 to 4 years to 14.7% in those aged 15 to 19 years. Diabetic ketoacidosis prevalence was significantly higher in patients with type 1 (29.4%) rather than in those with type 2 diabetes (9.7%). After adjusting for the effects of center, age, gender, race or ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education. CONCLUSION. At the time of diagnosis, 1 in 4 youth presents with diabetic ketoacidosis. Those with diabetic ketoacidosis were more likely to be hospitalized. Diabet Continue reading >>

Diabetic Ketoacidosis At Diagnosis In Austrian Children In 1989–2008: A Population-based Analysis

Diabetic Ketoacidosis At Diagnosis In Austrian Children In 1989–2008: A Population-based Analysis

Abstract The aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20 years (1989–2008) on a population basis in the whole of Austria. A prospective population-based incidence study (1989–2008) was performed. The registered data set comprised blood glucose, pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH < 7.3 and severe DKA as pH < 7.1. Time trends were estimated using linear regression models. During the study period, 3331 children <15 years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one patient died at onset. DKA frequency was negatively associated with age at onset (p < 0.0001). In children <2 years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p < 0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/100,000 (p < 0.0001), no significant change in the prevalence of DKA at manifestation was observed. The overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during the last 20 years despite a clear increase in the manifestation rate. In particular, children less than 2 years of age have a high risk of DKA at onset. Notes The study was supported by Novo Nordisk Austria. The authors declare that there is no duality of interest associated with this manuscript. Continue reading >>

Diabetic Ketoacidosis (dka) - Topic Overview

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 >>

Diabetic Ketoacidosis Workup

Diabetic Ketoacidosis Workup

Approach Considerations Diabetic ketoacidosis is typically characterized by hyperglycemia over 250 mg/dL, a bicarbonate level less than 18 mEq/L, and a pH less than 7.30, with ketonemia and ketonuria. While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L. [17] In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L. Laboratory studies for diabetic ketoacidosis (DKA) should be scheduled as follows: Repeat laboratory tests are critical, including potassium, glucose, electrolytes, and, if necessary, phosphorus. Initial workup should include aggressive volume, glucose, and electrolyte management. It is important to be aware 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 >>

Severe Diabetic Ketoacidosis In A Newly Diagnosed Child With Type 2 Diabetes Mellitus: A Case Report

Severe Diabetic Ketoacidosis In A Newly Diagnosed Child With Type 2 Diabetes Mellitus: A Case Report

Abdulmoein E Al-Agha1* and Mohammed A Al-Agha2 1Department of Pediatric Endocrinology, King Abdul-Aziz University Hospital, Saudi Arabia 2Faculty of Medicine, King Abdul-Aziz University, Saudi Arabia Citation: Abdulmoein E Al-Agha1, Mohammed A Al-Agha (2017) Severe Diabetic ketoacidosis in a Newly Diagnosed Child with Type 2 Diabetes Mellitus: A Case Report. J Diabetes Metab 8:724. doi:10.4172/2155-6156.1000724 Copyright: © 2017 Al-Agha AE, 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 Abstract Background: Diabetes ketoacidosis (DKA) is an acute complication of both type 1 and type 2 diabetes mellitus (DM). DKA is characterized by the presence of hyperglycemia, ketosis, ketonuria, and metabolic acidosis. Cerebral edema is a rare but rather a serious complication of DKA. Case presentation: An obese 12-year-old, Egyptian boy, previously medically free, presented to the emergency room (ER) of King Abdulaziz university hospital, with two weeks' histories of dizziness, shortness of breath, polyuria, polydipsia & nocturia. His symptoms were deteriorating with a change in sensorial and cognitive functions at the time of presentation. He was diagnosed with type 2 DM based upon clinical background, namely the presence of obesity (weight+7.57 Standard Deviation Score (SDS), height+1.4 SDS, and body mass index (BMI) of 34.77 kg/m2 (+3.97SDS) together with the presence of Acanthosis nigricans and biochemically based on, normal level of serum insulin, normal serum level of connecting peptide and negative autoantibodies. H Continue reading >>

Diagnosis Of Diabetic Ketoacidosis, Type 1 Diabetes Results In Poor Disease Control

Diagnosis Of Diabetic Ketoacidosis, Type 1 Diabetes Results In Poor Disease Control

Children diagnosed with diabetic ketoacidosis and type 1 diabetes may have higher HbA1C levels. Findings from a new study published by Diabetes Care suggests that pediatric patients who are diagnosed with diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis may have an increased risk of poor disease control. Included in the study were 3364 children living in Colorado who were diagnosed with type 1 diabetes between 1998 and 2012. At baseline, 39% (1297) patients had DKA at diagnosis of type 1 diabetes. The authors found that ethnicity and health insurance status were linked to presenting DKA at diagnosis. Additionally, they discovered that these patients had higher HbA1C levels over a 15-year follow-up period, according to the study. After accounting for age, ethnicity, family history of diabetes, insurance status, and insulin pump use, 40% of patients with a dual diagnosis had poor blood glucose control. Compared with children without DKA, HbA1c was 1.4% higher among patients with severe DKA and 0.9% higher among patients presenting mild or moderate DKA at diagnosis, according to the study. The authors concluded that worsening of beta cell death that results from hyperglycemia and inflammation related to DKA may worsen blood glucose control, according to the study. They also noted that DKA can have an effect on cognitive function, which may be a factor in decreased self-care. "I think people do not realize the long-term implications of DKA. We've shown it persists for at least 15 years," study co-author Arleta Rewers, MD, told Medscape Medical News. “This is how long we had data, but I'm pretty sure the effect lasts even beyond 15 years.” These results highlight the need to recognize the signs and symptoms of type 1 diabetes and immediately begin tre Continue reading >>

Our Dka Campaign

Our Dka Campaign

Support the DKA Campaign by donating to Beyond Type 1 and help make this life-saving work possible! Editor’s Update, 12/2017: This piece focuses on the launch of the campaign in Pennsylvania. Since publication, the campaign has been distributed in 18 states to over 22,000 pediatric offices, serving 90 million patients annually. The campaign is currently approved in 4 additional states and we are actively working to reach other states throughout the US in 2018. This campaign rolled out in New Zealand in September, 2017. The first step is admitting that we have a problem — a DKA (diabetic ketoacidosis) problem. When people in the United States are diagnosed with Type 1 diabetes, approximately 42% of them are in DKA, a dangerous and sometimes deadly consequence of diabetes. Four in every ten people are at such a critical state, that their lives are in jeopardy. That means four in every ten T1D cases had the signs and symptoms of T1D misunderstood or ignored. And in a number of these cases, by the time T1D was properly diagnosed, it was too late. No one should ever die because of a missed diagnosis. From the beginning days of Beyond Type 1, the problem of DKA has been one that we wanted to solve. Our CEO & Co-Founder’s open letter on the topic in September of 2015 has been shared thousands of times. Our first T1D Warning Signs campaign put thousands of flyers into schools across the country. These efforts have been good, but at the end of the day, they were the equivalent of dangling our feet in the water. In July 2016, we began discussions with the Pennsylvania Chapter of the American Academy of Pediatrics (PAAAP) about what an awareness campaign to reach every single pediatrician’s office in the state would look like. We ultimately built a campaign that featured d Continue reading >>

More in ketosis