Diabetes: Diabetic Ketoacidosis
www.CardioSmart.org When you have diabetes (especially type 1 diabetes), you are at risk for diabetic ketoacidosis (DKA). This is a dangerous illness that happens when the body does not have enough insulin to use sugar for fuel, and so it breaks down fat and muscle instead. This process breaks down fat into fatty acids, which are turned into another type of acid called ketones. The ketones build up in your blood and change the chemical balance in your body. If not treated, DKA can lead to a coma or even death. DKA can happen if you have little or no insulin in your body and your blood sugar level gets too high. This can happen when you do not take enough insulin or when you have an infection or other illness such as the flu. Being severely dehydrated can also cause it. DKA occurs mostly in people with type 1 diabetes. It occurs less often in people with type 2 diabetes. Symptoms of DKA Symptoms include: â€¢ You have flushed, hot, dry skin. â€¢ You have a strong, fruity breath odor. â€¢ You have loss of appetite, belly pain, and vomiting. â€¢ You feel restless. â€¢ You have rapid, deep breathing. â€¢ You feel confused. â€¢ You feel very sleepy, or you have trouble waking up. Young children may not care about doing their normal activities. How to prevent DKA You can help prevent DKA if you: â€¢ Take your insulin and other diabetes medicines on time and in the right dose. â€¢ Test your blood sugar before meals and at bedtime. Or test as often as your doctor tells you to. This is the best way to know when your blood sugar is high so you can treat it early.Watching for symptoms is not as good. You may not notice them until you have already started making ketones and your blood sugar is very high. â€¢ Teach others at work, home, or scho Continue reading >>
How Dka Happens And What To Do About It
Certified Diabetes Educator Gary Scheiner offers an overview of diabetic ketoacidosis. (excerpted from Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin by Gary Scheiner MS, CDE, DaCapo Press, 2011) Diabetic Ketoacidosis (DKA) is a condition in which the blood becomes highly acidic as a result of dehydration and excessive ketone (acid) production. When bodily fluids become acidic, some of the body’s systems stop functioning properly. It is a serious condition that will make you violently ill and it can kill you. The primary cause of DKA is a lack of working insulin in the body. Most of the body’s cells burn primarily sugar (glucose) for energy. Many cells also burn fat, but in much smaller amounts. Glucose happens to be a very “clean” form of energy—there are virtually no waste products left over when you burn it up. Fat, on the other hand, is a “dirty” source of energy. When fat is burned, there are waste products produced. These waste products are called “ketones.” Ketones are acid molecules that can pollute the bloodstream and affect the body’s delicate pH balance if produced in large quantities. Luckily, we don’t tend to burn huge amounts of fat at one time, and the ketones that are produced can be broken down during the process of glucose metabolism. Glucose and ketones can “jump into the fire” together. It is important to have an ample supply of glucose in the body’s cells. That requires two things: sugar (glucose) in the bloodstream, and insulin to shuttle the sugar into the cells. A number of things would start to go wrong if you have no insulin in the bloodstream: Without insulin, glucose cannot get into the body’s cells. As a result, the cells begin burning large amounts of fat for energy. This, of course, Continue reading >>
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 >>
Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter, may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly. Diabetics of all species therefore need to be checked for ketones with urine testing stix, available at any pharmacy, whenever insulin level may be too low, and any of the following signs or triggers are present: Ketone Monitoring Needed: Little or no insulin in last 12 hours High blood sugar over 16 mmol/L or 300 mg/dL (though with low insulin, lower as well...) Dehydration (skin doesn't jump back after pulling a bit gums are tacky or dry) Not eating for over 12 hours due to Inappetance or Fasting Vomiting Lethargy Infection or illness High stress levels Breath smells like acetone (nail-polish remover) or fruit. Note that the triggers and signs are somewhat interchangeable because ketoacidosis is, once begun, a set of vicious circles which will make itself worse. So dehydration, hyperglycemia, fasting, and presence of ketones are not only signs, they're also sometimes triggers. In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above, are cause to call an emergency vet immediately, at any hour of the day. Possible False Urine Ketone Test Results Drugs and Supplements Valproic Acid (brand names) Depakene, Depakote, Divalproex Sodium Positive. Common use: Treatment of epilepsy. Cefixime/Suprax Positive with nitroprusside-based urine testing. Common use: Antibiotic. Levadopa Metabolites Positive with high concentrations. Tricyclic Ring Compounds Positive. Commo Continue reading >>
Were There Any American Citizens Living On Us Soil Who Died Because They Couldn't Afford Healthcare?
Various answers to answers (I guess coming from incredulous non-Americans) have asked why the American people would put up with such a system, or why anyone could think it is better than the “socialist” model. Some have mentioned the stigma associated with the word socialism which Americans have been indoctrinated with since the Cold War. While that is true, it’s important to consider where that message originated, and why it was spread. “Single payer” healthcare is paid for by tax revenue. Healthcare is expensive in any country compared to other parts of the federal budget like public building maintenance, forestry etc., so a significant percentage of all taxes collected go to pay for socialist healthcare. That applies to the taxes of a poor American who doesn’t pay any taxes (20% of zero is zero), just as it does to a wealthy “1%er”, or an ultra-wealthy billionaire like Trump or Koch. In the American private health insurance system, if your insurance for a family costs $20k per year, that’s your liability for private health insurance regardless of your income. Joe the Plummer or Mitt Romney or Bill Gates - That same insurance costs each of them $20k more or less. This is from the Fraser Institute (Conservative Canadian “think tank”): “The 10% of Canadian families with the lowest incomes will pay an average of about $477 for public health care insurance in 2015. The 10% of Canadian families who earn an average income of $59,666 will pay an average of $5,684 for public health care insurance and the families among the top 10% of income earners in Canada will pay $37,180.” For extremely high-income wealthy Americans like Koch or Trump, that number would be a lot higher. If 20% of tax revenue goes to pay for healthcare, and George Soros pays $100 Continue reading >>
What Causes Diabetic Ketoacidosis?
As a type 1 diabetic I am quite familiar (unfortunately) with the signs and symptoms of diabetic ketoacidosis. Diabetic ketoacidosis (DKA) results from associated with too little insulin (and usually high blood sugars as well) which leads to the product of organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body’s chemistry, which resolve with proper therapy. (And let’s clear up early that DKA and nutritional ketosis experienced in low-carb diets are two extremely different things…but more on that in a different article!) Diabetic ketoacidosis usually occurs in people with type 1 diabetes mellitus, but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. What Causes Ketoacidosis? People with type 1 diabetes do not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When glucose is not available, fat is broken down instead. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Blood glucose levels rise (usually higher than 300 mg/dL) because the liver makes glucose to try to combat the problem. However, the cells cannot pull in that glucose without insulin. Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin, or surgery can lead to diabetic ketoacidosis in people with type 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 >>
What Is The Smartest Thing Your Cat Has Ever Done?
My cat sits with me when I am programming, staring at the screen, looking at the details as I type. She has gotten so smart that every time I make a syntax error, and the code becomes highlighted, she says “meow”. If I don’t pay attention to the screen, I have a vocal cue of the bug. I give her a treat when she alerts me of each bug. My cat Moonpie has a brother, called Popcorn. But his IQ is 20 points lower than hers. He is always eating or sleeping and his only trick is waking me up in the morning when hungry. I guess that is good too, because it helps me discipline myself. Moonpie in the world of cats is no less smart than Linus Torvalds. Continue reading >>
A Preventable Crisis People who have had diabetic ketoacidosis, or DKA, will tell you it’s worse than any flu they’ve ever had, describing an overwhelming feeling of lethargy, unquenchable thirst, and unrelenting vomiting. “It’s sort of like having molasses for blood,” says George. “Everything moves so slow, the mouth can feel so dry, and there is a cloud over your head. Just before diagnosis, when I was in high school, I would get out of a class and go to the bathroom to pee for about 10–12 minutes. Then I would head to the water fountain and begin drinking water for minutes at a time, usually until well after the next class had begun.” George, generally an upbeat person, said that while he has experienced varying degrees of DKA in his 40 years or so of having diabetes, “…at its worst, there is one reprieve from its ill feeling: Unfortunately, that is a coma.” But DKA can be more than a feeling of extreme discomfort, and it can result in more than a coma. “It has the potential to kill,” says Richard Hellman, MD, past president of the American Association of Clinical Endocrinologists. “DKA is a medical emergency. It’s the biggest medical emergency related to diabetes. It’s also the most likely time for a child with diabetes to die.” DKA occurs when there is not enough insulin in the body, resulting in high blood glucose; the person is dehydrated; and too many ketones are present in the bloodstream, making it acidic. The initial insulin deficit is most often caused by the onset of diabetes, by an illness or infection, or by not taking insulin when it is needed. Ketones are your brain’s “second-best fuel,” Hellman says, with glucose being number one. If you don’t have enough glucose in your cells to supply energy to your brain, yo Continue reading >>
What Is Diabetic Ketoacidosis (dka)?
What You'll Learn Here: Diabetic Ketoacidosis (DKA) is a dangerous, potentially life-threatening complication of diabetes that many people are unaware of. Also known as diabetic acidosis, DKA is a condition in which the chemical balance of the body (pH) becomes exceedingly acidic, leaving the body vulnerable to a diabetic coma and death. The body must maintain a pH balance of 7 to 7.25. Any reading lower than 7 is too acidic. DKA develops when dangerously high numbers of ketones (poisonous acidic chemicals produced by the liver in response to insulin deficiency) accumulate in the body’s tissues and fluids, resulting in a loss of water, potassium, ammonium, and sodium. When there isn’t enough insulin present to transport glucose to the body’s cells, fat – instead of glucose – is burned to make energy. Ketones are produced during this process, resulting in an abnormal decrease in blood plasma volume, electrolyte imbalance, extremely high blood glucose levels, and the breakdown of free fatty acids. There are three major components to DKA: hyperketonemia (an overproduction of ketones); hyperglycemia (excessively high blood sugar kevels); and acidosis (the blood has become too acidic). Diabetic Ketoacidosis Warning Signs and Symptoms While DKA normally develops slowly, once vomiting begins onset of this dangerous condition can happen rapidly…within just a few hours: Abdominal pain Blurred or unclear vision Coma Confusion Dehydration Difficulty breathing; rapid, deep breathing; shortness of breath Dry mouth Excessive thirst Fatigue and lethargy Flushing Frequent urination Fruity odor to breath High blood sugar levels High keytone levels Hot, dry skin Loss of appetite Muscle stiffness or aching Nausea Perspiration Restlessness, discomfort, agitation Unconsciousness Continue reading >>
How To Treat Diabetic Ketoacidosis
1 Call emergency services. Diabetic ketoacidosis can be a life-threatening condition. If you are experiencing symptoms like your blood sugar not lowering, you should immediately call emergency services or visit the emergency room. Symptoms that require you to call emergency services include severe nausea, being nauseous for four or more hours, vomiting, being unable to keep fluids down, inability to get your blood sugar levels down, or high levels of ketones in your urine. Leaving DKA untreated can lead to irreparable damage and even death. It is important to seek medical care as soon as you suspect you are having a problem. 2 Stay in the hospital. Ketoacidosis is usually treated in the hospital. You may be admitted to a regular room or treated in ICU depending on the severity of your symptoms. During the first hours you are there, the doctors will work on getting your fluids and electrolytes balanced, then they will focus on other symptoms. Most of the time, patients remain in the hospital until they are ready to return to their normal insulin regimen. The doctor will monitor you for any other conditions that may cause complications, like infection, heart attack, brain problems, sepsis, or blood clots in deep veins. 3 Increase your fluid intake. One of the first things that will be done to treat your diabetic ketoacidosis is to replace fluids. This can be in the hospital, a doctor’s office, or home. If you are receiving medical care, they will give you an IV. At home, you can drink fluids by mouth. Fluids are lost through frequent urination and must be replaced. Replacing fluids helps balance out the sugar levels in your blood. 4 Replace your electrolytes. Electrolytes, such as sodium, potassium, and chloride, are important to keep your body functioning p Continue reading >>
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 >>
> Hyperglycemia And Diabetic Ketoacidosis
When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>
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: 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. 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. 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 >>
As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>