What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis, or DKA, is a serious health problem that can happen to a person with diabetes. It happens when chemicals called ketones build up in the blood. Normally, the cells of your body take in and use glucose as a source of energy. Glucose moves through the body in the bloodstream. Insulin is a hormone that helps your cells take in the glucose from the blood. If you have diabetes, your cells can’t take in and use this glucose in a normal way. This may be because your body doesn’t make enough insulin. Or it may be because your cells don’t respond to it normally. As a result, glucose builds up in your bloodstream and doesn’t reach your cells. Without glucose to use, the cells in your body burn fat instead of glucose for energy. When cells burn fat, they make ketones. High levels of ketones can poison the body. High levels of glucose can also build up in your blood and cause other symptoms. Ketoacidosis also changes the amount of other substances in your blood. These include electrolytes, such as sodium, potassium, and bicarbonate. This can lead to other problems. Ketoacidosis happens most often in a person with type 1 diabetes. This is a condition where the body does not make enough insulin. In rare cases, ketoacidosis can happen in a person with type 2 diabetes. It can happen when they are under stress, like when they are sick, or when they have taken certain medicines that change how their bodies handle glucose. Diabetic ketoacidosis is pretty common. It is more common in younger people. Women have it more often than men do. What causes diabetic ketoacidosis? High levels of ketones and glucose in your blood can cause ketoacidosis. This might happen if you: Don’t know you have diabetes, and your body is breaking down too much fat Know you have dia Continue reading >>
Euglycemic Diabetic Ketoacidosis Sometimes Seen With Sglt2 Inhibitors
Craig Cocchio, PharmD, BCPS, is an Emergency Medicine Clinical Pharmacist at Trinity Mother Frances Hospital in Tyler, Texas. Follow on Twitter @iEMPharmD and on his blog at empharmd.blogspot.com Diabetic ketoacidosis (DKA) in patients with presenting serum blood glucose <200 mg/dL isn’t common. More often, it’s seen in patients with type 1 diabetes in conjunction with starvation and acute illness.1 It’s difficult to determine an incidence of euglycemic DKA (euDKA) among all DKA cases in the literature, given the migration of the serum glucose cutoff from ≤300 mg/dL to ≤200 mg/dL. The best estimation based on an analysis of case reports suggests an incidence anywhere between 0.8% and 7.5%.1 However, the sodium-glucose cotransporter-2 (SGLT2) inhibitors canagliflozin, dapagliflozin, and empagliflozin can apparently induce this once-rare form of DKA.2,3 SGLT2 inhibitors are a class of oral hypoglycemic drugs indicated only for type 2 diabetes. Their novel mechanism of action prevents glucose reabsorption from the proximal renal tubules, resulting in increased glucosuria and decreasing plasma glucose. SGLT2 inhibitors lower serum glucose and HBA1C levels, and even produce weight loss. However, the increased glucose concentration in the bladder is a terrific incubation environment for fungi and bacteria, so much so that the FDA stuck a post-marketing warning on the drug class for the increased risk of serious urinary tract infections and urosepsis, in addition to euglycemic DKA. The proposed mechanism suggests that while SGLT2 inhibitors lower serum glucose, they also reduce insulin secretion from pancreatic beta cells in a negative feedback fashion. The lower serum insulin coupled with lower serum glucose consequently shifts energy metabolism to antilipolytic act Continue reading >>
Symptoms Of Ketosis And Diabetic Ketoacidosis Warning Signs
Ketosis or nutritional ketosis is a perfectly healthy metabolic process in which the body burns stored fats for energy when it doesn’t have adequate glucose. Mild ketosis may help you lose weight and even be therapeutic. Unfortunately, there’s another less desirable condition that’s easily confused with ketosis – and that’s diabetic ketoacidosis (DKA). This is a high blood sugar-related emergency that accounts for over 100,000 hospital admissions every single year in the United States alone.1 DKA strikes those with diabetes and, if left unchecked, could even put you in a coma. Understanding ketosis and DKA and knowing how they’re different could save your life if you’re diabetic. Mild Ketosis Has Therapeutic Benefits People on diets like the ketogenic diet or Atkins diet cut down carb intake and switch to a diet that’s high in protein and fat instead. This sets your body up for ketosis, which is intended to help with weight loss. Some studies have even found that ketosis can help lower levels of blood glucose, low-density lipoprotein cholesterol, and triglycerides, besides bringing down body weight and body mass index.2 Mild ketosis has also been explored for its therapeutic applications in diseases associated with free radical damage, hypoxia (oxygen deficiency in tissues), and insulin resistance.3 But There Are Still Some Side Effects Of Ketosis When you are on a low-carb diet or haven’t eaten for a long time, the body undergoes ketosis and you may experience some side effects.4 These are usually temporary and occur initially when your body is adjusting to burning fat and ketones instead of carbs. Some compare these ketosis symptoms to those you’d experience when you are coming down with flu, giving rise to the term “ketosis flu” or just “ket Continue reading >>
Diabetes And Weight Gain
Diabetes can be both the cause of weight gain and the result of weight gain. People with diabetes have an increased tendency to gain weight and those who are overweight have an increased chance of developing diabetes. Insulin is a natural, protein-based hormone produced by the pancreas in normal people. Its function is to promote the absorption of glucose into the cells to be used for cellular fuel. It also manages the absorption and storage of amino acids and fat by cells of the body that are sensitive to insulin (which are mainly the fat and muscle cells). Insulin has the above effects on the body, whether the pancreas releases it naturally or given as exogenous insulin to insulin-dependent diabetes. Diabetics who go on insulin therapy seem to have an increased tendency to gain weight. This is true of both type 1 diabetics and type 2 diabetics. Some of the gain is weight is due to the fact that, when insulin is in the bloodstream, it takes the glucose absorbed by the GI tract and puts in in storage rather than have the glucose be excreted by the kidneys. This causes a natural gain in weight. Some diabetics recognize the connection between insulin and weight gain. In order to lose weight, they often skip doses of insulin so that the blood sugar they take in is not stored but instead is flushed out by the kidneys. They don’t realize that this could be dangerous and can result in life-threatening side effects, such as diabetic ketoacidosis. The most effective way to strike a balance between insulin use and body weight is to take the insulin as directed and also to step up the amount of physical activity you engage in. This keeps the levels of insulin lower and you will lose weight. When you take less insulin and burn calories through exercise, your weight will naturall Continue reading >>
Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State
The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>
What Is The Ph Of The Blood In A Diabetic Patient When His Glucose Levels Are Appropriate?
Diabetes causes your body's pH levels to become more acidic and develop a condition called ketoacidosis, the American Diabetes Association explains. Your body's pH level refers to the acidity or alkalinity of the fluids in your body. Diabetes impairs your body's ability to properly utilize the glucose in your blood. Instead, your body is forced to convert fat into energy through a process that develops into ketoacidosis. Diagnosing ketoacidosis involves testing blood for the presence of ketones, the University of Maryland Medical Center explains. There are two main types of diabetes. Type 1 diabetes is congenital, and its symptoms appear as early as childhood, MayoClinic.com explains. Type 1 diabetes is characterized by your body's inability to produce insulin, the hormone needed for cells to metabolize glucose into energy. Type 2 diabetes is essentially defined by acquired insulin resistance that usually manifests in adulthood. Both types of diabetes cause increased thirst, frequent urination, unexplained weight loss, hypertension and ketoacidosis. Left untreated, both types of diabetes lead to complications that damage your cardiovascular system, kidneys and nerves due to the accumulated glucose in your blood. Complications due to diabetes such as ketoacidosis are fatal if not treated. Ketones are the acidic byproducts of fat breakdown that accumulate when your body uses fat instead of glucose as a source of fuel, MedlinePlus, a service of the National Institutes of Health, explains. As your ketone levels increase, your body becomes more acidic. Ketones are present in both types of diabetes but are generally more typical of type 1 diabetes. Ketones are also sometimes present in urine. Acetone and acetoacetic acid are examples of ketones. Ketoacidosis does not happen o Continue reading >>
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Ketosis: What Is Ketosis?
Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>
Study: Weight Loss With Diabetes Drug Invokana Increased Appetite
A study found people who lost weight with the Type 2 diabetes drug Invokana (canagliflozin) got hungrier and ate more, leading to a weight loss plateau. The study conducted by David Polidori and colleagues will publish in Obesity during Obesity Week 2016, which runs from Oct. 13 to Nov. 4. Researchers from the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) looked at findings from a placebo-controlled, double-blind trial with 242 people with Type 2 diabetes. Of the total participants, 153 received Invokana — an SGLT2 inhibitor drug that controls blood sugar by causing it to leave the body in urine. Participants who received the drug could eat and drink without restriction during the study, and they gradually lost 8 pounds because of urinating excess glucose. But, at the end of the study, they ate about 50 calories more per day for each pound lost than they were eating before the study. After about six months, the weight loss plateaued. While the focus of the study was not on weight loss with Invokana, the data may point to a more modest weight loss effect than Johnson & Johnson advertises. In 2015 alone, J&J spent $101.2 million on ads for the drug. One of the claims made in advertising is weight loss. “Although Invokana is not a weight-loss medicine, and each person is different, people can experience reduction in weight — on average 3%. Results may vary by dose and when used with certain other diabetes medications,” Johnson & Johnson’s Janssen Pharmaceuticals said on its Invokana website. Despite a number of FDA warnings linked to the drug and lawsuits filed by people who say the drug injured them, doctors continue to prescribe it. Invokana is the best-selling drug in its class, making $1.3 billion for Johnson & Johnson in 2015. “The m Continue reading >>
Take A Look And See For Yourself.
SYNJARDY and SYNJARDY XR are prescription medicines that contain 2 diabetes medicines, empagliflozin (JARDIANCE) and metformin. SYNJARDY and SYNJARDY XR can be used along with diet and exercise to improve blood sugar in adults with type 2 diabetes, and can be used in adults with type 2 diabetes who have known cardiovascular disease when both empagliflozin and metformin are appropriate and empagliflozin is needed to reduce the risk of cardiovascular death. SYNJARDY and SYNJARDY XR are not for people with type 1 diabetes, or for people with diabetic ketoacidosis (increased ketones in the blood or urine). IMPORTANT SAFETY INFORMATION What is the most important information I should know about SYNJARDY or SYNJARDY XR? SYNJARDY or SYNJARDY XR can cause serious side effects, including Lactic Acidosis (a build-up of lactic acid in the blood). Metformin, one of the medicines in SYNJARDY and SYNJARDY XR, can cause lactic acidosis, a rare but serious condition that can cause death. Lactic acidosis is a medical emergency and must be treated in a hospital. Call your doctor right away if you get any of the following symptoms of lactic acidosis: cold in your hands or feet; feel dizzy or lightheaded; slow or irregular heartbeat; feel very weak or tired; have unusual muscle pain; have trouble breathing; feel sleepy or drowsy; have stomach pains, nausea, or vomiting. You have a higher chance of getting lactic acidosis with SYNJARDY or SYNJARDY XR if you: have moderate to severe kidney problems or your kidneys are affected by certain x-ray tests that use injectable dye; have liver problems; drink alcohol very often, or drink a lot of alcohol in the short term (“binge” drinking); get dehydrated (lose a large amount of body fluids); have surgery; have a heart attack, severe infection, o Continue reading >>
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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 >>
Victoza Tested To Combat Dka For People With Type 1
Researchers look to see if GLP-1 drugs could be an add-on therapy. In recent years, we have seen increasing overlap between drugs used to treat Type 1 diabetes and those used to treat Type 2 diabetes. More people with Type 2 diabetes are going on insulin therapy than in previous years, while drugs like metformin and Invokana are being prescribed off-label for people with Type 1 diabetes. Researchers are exploring whether a class of drugs called GLP-1 agonists can be used to help people with Type 1 combat high blood glucose levels and lower their risk of diabetic ketoacidosis. GLP-1 drugs work by slowing the body’s glucagon production, increasing insulin production (when possible), and slowing the rate by which food leaves the stomach. sponsor A recent study conducted at the Diabetes and Endocrinology Center of Western New York examined whether the GLP-1 drug Victoza could curb the production of ketones that could lead to diabetic ketoacidosis (DKA). In the study, 26 participants with Type 1 diabetes who were overweight or obese were instructed to fast overnight while continuing regular basal insulin injections. They were then given either an injection of Victoza or an injection of saline. Researchers found that those who received Victoza had lower levels of glucagon, ghrelin (a hormone that increases appetite), and free fatty acids that could lead to diabetic ketoacidosis, according to a report in MedPage Today. The researchers are hoping the findings of this small study might be an indication that the drug may be able to help curb DKA risk in people with uncontrolled Type 1 diabetes. Researchers are exploring both GLP-1 drugs and SGLT2 drugs as add-on drug therapies to help curb high blood glucose levels. If GLP-1 drugs can achieve similar results with a reduced risk Continue reading >>
Type 1 Diabetes: What Are The Symptoms?
What Is Type 1 Diabetes (Juvenile)? Type 1 diabetes is a chronic condition that usually starts in childhood, but can occur in adults (30 to 40-year-olds). In type 1 diabetes, the pancreas produces very little insulin. Insulin helps cells in the body convert sugar into energy. When the pancreas cannot make enough insulin, sugar starts to build up in the blood, causing life-threatening complications. Individuals with type 1 diabetes must take some form of insulin for the rest of their lives. Unusual Thirst Symptoms Unusual thirst is a very common symptom of type 1 diabetes. This condition causes the kidneys to remove excess sugar in the blood by getting rid of more water. The water is removed through urinating, causing dehydration and dehydration causes you to drink more water. Weight Loss Symptoms Patient with type 1 diabetes develop unintentional weight loss and an increase in appetite because blood sugar levels remain high and the body metabolizes fat for energy. Disrupted glucose metabolism also causes patient to feel a lack of energy and drowsy for extended periods Excess urination also cause weight loss because many calories are leaving the body in urine. Skin Problems Symptoms The disruption in glucose metabolism in patient with type 1 diabetes causes skin changes. Type 1 diabetics are at a higher risk for bacterial infections and fungal infections. Poor blood circulation in the skin may also occur. Patient with type 1 diabetes are often infected with fungal infections caused by the yeast Candida albicans. Common fungal infections include athlete's foot, vaginal yeast infection in women, jock itch, ringworm, and diaper rashes in babies. Diaper rash caused by the yeast Candida albicans can spread to other areas of the body such as the stomach and legs. Other Dangero Continue reading >>
OVERVIEW potentially life-threatening complication of diabetes melitus resulting from the consequences of insulin deficiency Diagnostic criteria pH < 7.3 ketosis (ketonemia or ketonuria) HCO3 <15 mmol/L due to high anion gap metabolic acidosis (HAGMA) hyperglycemia (may be mild; euglycemic DKA can occur) PATHOGENESIS increased glucagon, cortisol, catcholamines, GH decreased insulin -> hyperglycaemia -> hyperosmolality + glycosuria -> electrolyte loss -> ketone production from metabolism of TG -> acidosis HISTORY dry, abdominal pain, polyuria, weight loss, coma risk factors: non-compliance, illness, newly diagnosed ROS to rule find out possible precipitant (infection, MI, pneumonia, GI illness) normal insulin regime diabetic control previous DKA’s/admissions previous ICU admissions EXAMINATION volume assessment signs of cause e.g. (infection) GCS work of breathing INVESTIGATIONS ABG electrolytes osmolality urinalysis: ketones pregnancy test standard investigations to rule out cause: FBC, ECG, CXR MANAGEMENT Goals (1) establish precipitant and treat (2) assess severity of metabolic derangement (3) cautious fluid resuscitation with replacement of body H2O (4) provision of insulin (5) replacement of electrolytes Resuscitate intubation for airway protection if required O2 as required IV access fluid boluses (20mL/kg boluses of NS/HMN) urinary catheter Acid-base and Electrolyte abnormalities will have a severe metabolic acidosis with probable incomplete respiratory compensation K+ may be normal but patient will have a whole body K+ deficiency -> needs to be replaced once < 5mmol/L -> use KH2PO4 Na+ may be deranged acidaemia rarely requires HCO3- therapy and will respond to other treatments Specific therapy start insulin infusion (avoid bolus) 0.1u/kg/hr aim to lower glucose Continue reading >>
Diabetic Ketoacidosis In Dogs
My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>
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 >>