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Why Do You Vomit In Dka?

Ketoacidosis - Complication From Atkins Diet

Ketoacidosis - Complication From Atkins Diet

...I just got out of the hospital yesterday evening. I started the Atkins Diet on Sunday and was doing induction - on Monday night/Tuesday morning I woke up *terribly* sick and continued vomiting at intervals of every 2 hours. When the frequency increased to every hour (and I was just throwing up water and bile) I went to my doctor, who advised me to go to the ER for some IV fluids and some intravenous Zofran to stop the vomiting. Once at the ER, the doctors ran some blood tests and found that I was in a severe state of ketoacidosis - the acid level of my blood had become dangerously high. This is similar to what happens to diabetics when they don't take their insulin. If I hadn't gone to the doctor when I did, I might've gone into a diabetic coma (even though I am *not* diabetic). The doctors believe this was purely a complication of the Atkins Diet and have advised me *never* to try it again, as it could be fatal for me. I'm an otherwise healthy, normal person, 34 years old. I've never had any major health problems before. I'm not overweight - I just wanted a more streamlined look, and I've known a lot of people who've supposedly done Atkins. Anyway, this diet scares the shit out of me. I just wanted to put my experience out there, so people are aware that serious complications can arise. Barely 36 hours on this shit almost killed me. You obviously were doing the Atkins diet of the 1970s which encourages a person to go into ketosis/ketoacidosis. If you read the new literature on Atkins induction allows a much higher portion of carbs which would make ketosis impossible. You took it too far. You can't eat bacon and cheese and eggs on induction and nothing else. Your breath probably also smelled like a shit sandwich. Glad you're alive. Now eat a tomato slice and 2 cups o Continue reading >>

Ketoacidosis

Ketoacidosis

Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter[1], 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)[2] 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[3] Positive. Common use: Treatment of epilepsy. Cefixime/Suprax[4] Positive with nitroprusside-based urine testing. Common use: Antibiotic. Levadopa Metabolites[5] Positive with high concentrations[6]. Tricyclic Ring Compounds[7][8] Positive. Commo Continue reading >>

Understanding The Link Between Diabetes And Appetite

Understanding The Link Between Diabetes And Appetite

Why Has My Appetite Changed? One of the odd things about diabetes is that it can cause people to lose their appetite, or conversely, can cause them to feel hungrier than usual. Both extremes are usually a warning sign of some possible issue to your health so it’s important (even if you have not been diagnosed with diabetes) to know about how your appetite can signify a potentially more serious health problem. Loss of Appetite Many people would be delighted to lose their appetite if that made it easier to lose some weight, but when appetite loss is linked to diabetes it can be dangerous. Gastrparesis One possible cause of loss of appetite is gastroparesis, a condition where food moves too slowly through the digestive tract. This happens when over time high blood glucose levels damage the vagus nerve — the nerve that supplies nerve fibers to the pharynx (throat), larynx (voice box), trachea (windpipe), lungs, heart, esophagus, and intestinal tract. When this occurs, the muscles in the gut can no longer move food easily out of the stomach into the small intestine to continue the digestion process. This state is called gastroparesis. As well as loss of appetite, symptoms of gastroparesis include weight loss, heartburn, abdominal bloating, reflux, nausea and vomiting undigested food. Additional symptoms might present as high or low blood glucose levels and stomach spasms. The condition makes blood glucose levels more difficult to control. Ketoacidosis Another diabetes-related condition that can cause appetite loss is diabetic ketoacidosis — a complication that occurs when hyperglycaemia (high blood sugar) goes untreated and high levels of ketones build up in the blood and urine. When your body does not produce enough insulin, the cells are unable to use glucose for fue Continue reading >>

Sick Day Management Tips When Your Child Has Type 1 Diabetes

Sick Day Management Tips When Your Child Has Type 1 Diabetes

Having a sick child can be challenging—getting time off work and securing a last-minute doctor's appointment isn't always easy. But when your sick child also happens to have type 1 diabetes, it presents a separate set of complications relating to insulin and blood glucose (blood sugar) management. This article covers some important considerations to keep in mind the next time your child with type 1 diabetes feels under the weather. Checking Blood Glucose and Ketones Even the most common ailments, such as a cold or flu, can cause your child's blood glucose levels to rise. Plus, some over-the-counter medications can cause blood glucose levels to increase even more. Complicating matters, your child's blood glucose levels may actually drop too low if he or she is vomiting or has stopped eating. You just can't be certain how an illness will affect your child's blood glucose—that's why it's important to check their levels more often than you normally would. A general guideline to shoot for is to check their blood glucose every 2 to 3 hours, but remember—that's a guideline. Your child may require more or fewer checks, depending on your health care professional's recommendations. In addition to checking blood glucose levels, you also need to check for the presence of ketones in the urine. In people with type 1 diabetes, common illnesses can lead to diabetic ketoacidosis, a condition characterized by acidic blood caused by the release of too many ketones. Ketones are released when your body doesn't have enough insulin, so it's important to check your child's urine regularly (usually every 4 hours) until there are no ketones detected. If ketones are still present, that's a sign that your child needs more insulin. There are 2 ways to check ketones: using urine ketone strips Continue reading >>

Ask The Diabetes Team

Ask The Diabetes Team

Question: From Cleveland, Ohio, USA: My son's pump malfunctioned last night in the middle of the night and we don't know exactly how long he was not receiving his insulin. He woke up with a "high" glucose and an episode of vomiting. Being on vacation, we did not have ketostix, but the smell of his breath gave evidence to his high ketones. We immediately bolused him via injection and changed his site. We continued frequent blood sugar checks and started pushing fluids. The vomiting continued for two more episodes and his blood sugar finally started coming down so he stopped vomiting and was able to keep fluids down. We were with extended family, who, of course, had questions. One of the questions was,"Why do high blood sugars and ketones cause vomiting?" I realized that even after dealing with my son's illness for eight years and working as an ICU nurse and treating DKA in patients, I don't know the pathophysiology of this process! My guess is it has something to do with the metabolic changes and the changeover to an acid state in the blood. I really don't know and I can't find the answer anywhere on the net. I appreciate any information and please be as technical as you'd like. Answer: First of all, a big thumbs-up to you for managing this degree of probable DKA in a levelheaded and successful way. But....a big thumbs down for traveling without ketone strips (blood - if you have the correct meter - or urine) or back-up insulin (other than fast acting insulin). I preach that if you have a pump, then there should be some insulin glargine (or other long-acting insulin) available in case of pump malfunction/misbehavior. I presume you travel with your emergency glucagon kit? All these things should be together. Your question, somewhat surprisingly to me, is not uncommon. Why Continue reading >>

Ketoacidosis: A Diabetes Complication

Ketoacidosis: A Diabetes Complication

Ketoacidosis can affect both type 1 diabetes and type 2 diabetes patients. It's a possible short-term complication of diabetes, one caused by hyperglycemia—and one that can be avoided. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious complications of diabetes. These hyperglycemic emergencies continue to be important causes of mortality among persons with diabetes in spite of all of the advances in understanding diabetes. The annual incidence rate of DKA estimated from population-based studies ranges from 4.8 to 8 episodes per 1,000 patients with diabetes. Unfortunately, in the US, incidents of hospitalization due to DKA have increased. Currently, 4% to 9% of all hospital discharge summaries among patients with diabetes include DKA. The incidence of HHS is more difficult to determine because of lack of population studies but it is still high at around 15%. The prognosis of both conditions is substantially worsened at the extremes of age, and in the presence of coma and hypertension. Why and How Does Ketoacidosis Occur? The pathogenesis of DKA is more understood than HHS but both relate to the basic underlying reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counter regulatory hormones such as glucagons, catecholamines, cortisol, and growth hormone. These hormonal alterations in both DKA and HHS lead to increased hepatic and renal glucose production and impaired use of glucose in peripheral tissues, which results in hyperglycemia and parallel changes in osmolality in extracellular space. This same combination also leads to release of free fatty acids into the circulation from adipose tissue and to unrestrained hepatic fatty acid oxidation to ketone bodies. Some drugs ca Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. Treatment is IV saline solution and dextrose infusion. Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism. Alcohol diminishes hepatic gluconeogenesis and leads to decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis, causing an elevated anion gap metabolic acidosis. Counter-regulatory hormones are increased and may further inhibit insulin secretion. Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. Diagnosis requires a high index of suspicion; similar symptoms in an alcoholic patient may result from acute pancreatitis, methanol or ethylene glycol poisoning, or diabetic ketoacidosis (DKA). In patients suspected of having alcoholic ketoacidosis, serum electrolytes (including magnesium), BUN and creatinine, glucose, ketones, amylase, lipase, and plasma osmolality should be measured. Urine should be tested for ketones. Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurement. The absence of hyperglycemia makes DKA improbable. Those with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated Hb (HbA1c). Typical laboratory findings include a high anion gap metabolic acidosis, ketonemia, and low levels of potassium, magnesium, and phosphorus. Detection of acidosis may be com Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA; Ketoacidosis; Diabetes - ketoacidosis Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat is broken down to fuel the body, chemicals called ketones build up in the body. Causes 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. Symptoms Common symptoms can include: Dry skin and mouth Flushed face Fruity-smelling breath Headache Exams and Tests Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample. Ketone testing is usually done when DKA is suspected: Most often, urine testing is done first. If the urine is positive for ketones, most often beta-hydroxybutyrate is measured in the blood. This is the most common ketone measured. Other tests for ketoacidosis include: Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions) Blood glucose test Blood pressure measurement Treatment The goal of treatment Continue reading >>

What To Do If You Get Gastroenteritis:

What To Do If You Get Gastroenteritis:

Gastroenteritis causes diarrhea and vomiting, which can lead to dehydration and the loss of sodium and potassium (electrolytes). The disease puts a stress on your body and often causes an increase in blood glucose (sugar) levels. The two main culprits are stress hormones (cortisol, adrenaline) and lack of physical activity when you are ill. In rare cases, blood glucose (sugar) levels will fall. Measure your blood glucose (sugar) frequently; Continue to take your medication or insulin as usual (or as adjusted by your doctor while you are sick), even if your food intake is reduced because you’ve lost your appetite or are vomiting; Modify your diet: if you find it difficult to eat solid foods, try to eat the usual amount of carbohydrates in liquid form or, at the very least, satisfy your body’s minimum carbohydrate requirements of 150 g per day while you are ill. What are the signs of dehydration? Mild to Moderate Dehydration Severe Dehydration Dry, sticky mouth Extreme thirst Unusual sleepiness or tiredness Irritability and confusion Dry and cool skin Sunken eyes Headache Dry skin that doesn't bounce back when you pinch it Dizziness and lightheadedness Low blood pressure Rapid heartbeat and breathing Dark urine in smaller quantity Call a doctor or go to Emergency if: Signs of severe dehydration; Your blood glucose (sugar) levels are higher than 25 mmol / L accompanied by excessive drowsiness (type 2 diabetes), or 20 mmol / L with a moderate to high ketone level in your urine or blood (type 1 diabetes); You are vomiting continuously and unable to keep liquids down; Your fever stays above 38.5 ºC (101.3 ºF) for more than 48 hours; Diarrhea lasts more than 24 hours or occurs more than 5 times per day. How to avoid becoming dehydrated Here are some ways to avoid dehydra Continue reading >>

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis in cats at a glance Ketoacidosis is a serious complication of diabetes in which ketones and blood sugar levels build up in the body due to insufficient levels of insulin which is required to move glucose into the cells for energy. As a result, the body uses fat as an alternate energy source which produces ketones causing the blood to become too acidic. Common causes include uncontrolled diabetes, missed or insufficient insulin, surgery, infection, stress and obesity. Symptoms of ketoacidosis include increased urination and thirst, dehydration, nausea, diarrhea, confusion, rapid breathing which may later change to laboured breathing. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterised by metabolic acidosis (increased acids in the blood), hyperglycemia (high blood glucose) and ketonuria (ketones in the urine). It is caused by a lack of or insufficient amounts of insulin which is required to move glucose from the bloodstream and into the cells to be used for energy. When this occurs, the body begins to search for alternate sources of energy and begins to break down fat. When fat is broken down (metabolised) into fatty acids, waste products known as ketones (acetoacetate, beta-hydroxybutyrate, acetone) are released from the liver and accumulate in the bloodstream (known as ketonemia). This causes the blood to become too acidic (metabolic acidosis). As well as metabolic acidosis, ketones also cause central nervous depression.The body will try to get rid of the ketones by excreting them out of the body via the urine, increased urine output leads to dehydration, making the problem worse. Meanwhile, the unused glucose remains in the bloodstream, resulting in hyperglycemia (high blood sugar).Insulin Continue reading >>

Ketoacidosis: A Complication Of Diabetes

Ketoacidosis: A Complication Of Diabetes

Diabetic ketoacidosis is a serious condition that can occur as a complication of diabetes. People with diabetic ketoacidosis (DKA) have high blood sugar levels and a build-up of chemicals called ketones in the body that makes the blood more acidic than usual. Diabetic ketoacidosis can develop when there isn’t enough insulin in the body for it to use sugars for energy, so it starts to use fat as a fuel instead. When fat is broken down to make energy, ketones are made in the body as a by-product. Ketones are harmful to the body, and diabetic ketoacidosis can be life-threatening. Fortunately, treatment is available and is usually successful. Symptoms Ketoacidosis usually develops gradually over hours or days. Symptoms of diabetic ketoacidosis may include: excessive thirst; increased urination; tiredness or weakness; a flushed appearance, with hot dry skin; nausea and vomiting; dehydration; restlessness, discomfort and agitation; fruity or acetone smelling breath (like nail polish remover); abdominal pain; deep or rapid breathing; low blood pressure (hypotension) due to dehydration; and confusion and coma. See your doctor as soon as possible or seek emergency treatment if you develop symptoms of ketoacidosis. Who is at risk of diabetic ketoacidosis? Diabetic ketoacidosis usually occurs in people with type 1 diabetes. It rarely affects people with type 2 diabetes. DKA may be the first indication that a person has type 1 diabetes. It can also affect people with known diabetes who are not getting enough insulin to meet their needs, either due to insufficient insulin or increased needs. Ketoacidosis most often happens when people with diabetes: do not get enough insulin due to missed or incorrect doses of insulin or problems with their insulin pump; have an infection or illne Continue reading >>

Sick Day Rules For Type 1 Diabetes

Sick Day Rules For Type 1 Diabetes

Coping when you are Ill Treated With Multiple Daily Injections It is very important that you know what to do when you are ill. We refer to this as "sick day rules". Remember - Never stop taking your insulin. When you are ill your body becomes much more resistant to the insulin you produce or take by injection. This means your blood glucose levels can raise. You therefore need to monitor your blood glucose and ketone levels and decide if you need more insulin. It is likely that you will need to increase your insulin dose (see flow chart for guidance). Although you may not feel like it, it is very important to monitor your diabetes closely to prevent diabetic ketoacidosis developing. We divide the sick day rules into those for: Minor illness- where blood glucose may be within normal range or raised but ketones remain negative ( e.g. minor viral infection or minor injury) and those for Severe illness- where blood glucose is raised and ketones are present ( e.g. chest infection or high temperature). For advice on how to manage either of these conditions, see over. Tips for staying safe during Illness: If you are vomiting, you do not need to eat until you feel well enough to try, but keep sipping fluids to prevent dehydration. If you not feel like eating normal meals, try to eat foods that are easy to digest, e.g. soup, ice-cream, milk, puddings. If your blood glucose falls below the normal range, sip sugary drinks eg fruit juice, sweetened tea, lucozade or ice lollies. Adjusting you insulin doses will help to control blood glucose levels (see guidance in the flow charts below) If you have an infection that is not resolving, you should make an appointment to see your GP to determine whether you need further treatment. If you continue to vomit, are unable to keep fluids down, Continue reading >>

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Diabetic Ketoacidosis As First Presentation Of Latent Autoimmune Diabetes In Adult

Case Reports in Medicine Volume 2015 (2015), Article ID 821397, 3 pages Internal Medicine Department, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA Academic Editor: Christos D. Lionis Copyright © 2015 Omar Nadhem 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. A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis. 1. Introduction Latent autoimmune diabetes in adult (LADA) is an autoimm Continue reading >>

Diabetes: Loss Of Appetite

Diabetes: Loss Of Appetite

Diabetes mellitus is a chronic disease that interferes with the body’s ability to control the level of glucose in the blood. No matter what type of diabetes you have, symptoms develop as a result of high blood glucose levels, according to MayoClinic.com. Complications can cause a loss of appetite that lasts for more than a couple of days. Video of the Day When trying to determine the cause for your loss of appetite, your health care provider may ask whether you feel nauseous, have stomach pain or vomiting or are currently taking any medications. Your doctor may also ask if your loss of appetite came on gradually or suddenly and if you've recently lost weight. Mention how long it has been since you first noticed changes in your appetite. Tell your doctor if there is a family history of diabetes. Until your appetite returns to normal, you are at risk for malnutrition and other health problems; therefore, you need to find out the underlying cause for your decrease in appetite. Complications can occur when diabetes goes undiagnosed for an extended length of time. Suffering a loss of appetite for a few weeks or more can lead to malnutrition, a condition where your body does not get the nutrients it needs. Aside from possible malnutrition, if left untreated, diabetes can damage the eyes, kidneys and nerves. Undiagnosed diabetes can also cause circulation problems, heart attack and stroke. Although there is no cure for the disease, you can prevent complications from occurring by maintaining a healthy weight and controlling blood glucose levels. Monitoring blood pressure and cholesterol levels, eating a balanced diet, being physically active and seeing your doctor regularly are additional steps you can take to help manage your diabetes. If hyperglycemia goes untreated, diabet Continue reading >>

Ketones — The 6 Must-knows

Ketones — The 6 Must-knows

WRITTEN BY: Kyla Schmieg, BSN, RN Editor’s Note: Kyla Schmieg (BSN, RN) is a practicing pediatric endocrinology nurse in Cincinnati, OH, USA, and Type 1 Diabetic, working on the same unit she was diagnosed at 26 years ago. 1 – What are ketones? Ketones are chemicals that build up when your body starts to burn fat for energy. The most common cause of ketones in diabetics is insulin deficiency. Without enough insulin, glucose builds up in the blood stream and can’t enter cells. The cells then burn fat instead of glucose. This results in ketones forming in the blood and eventually spilling into urine. 2 – Why can ketones be dangerous? Having ketones can indicate that your body needs more insulin. (Always monitor your blood sugar levels to know how much insulin you need.) If you have a build up of ketones, this can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include moderate or large ketones, nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy. If left untreated, it can lead to a serious and life-threatening diabetic coma or death. High levels of ketones are toxic to the body and if you’re experiencing these, you should seek out medical attention. 3 – When should you check for ketones? You should be checked anytime your blood sugar is above 240 mg/dl (13.3 mmol/l) or any time you are sick. This includes any minor illness such as a cold. 4 – Can you get ketones with a high blood sugar? Ketones typically accompany high blood sugar. They indicate that your body needs more insulin. Most often if your body needs more insulin, it means you probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones Continue reading >>

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