Checking For Diabetic Ketoacidosis
How do you know if your child has diabetic ketoacidosis? The signs and symptoms can mimic or be triggered by other illnesses, like the flu. So, it’s very important to check your child’s blood sugar levels and urine ketones during illness especially if there are high blood sugar readings or if your child has symptoms of diabetic ketoacidosis.
Because high levels of ketones in the blood cause ketones to appear in the urine, ketones can be checked at home by testing a sample of your child’s urine. If the urine test for ketones is negative, it generally means that symptoms are not due to diabetic ketoacidosis. If the urine test is positive, contact your child’s diabetes health care team.
Tests done by a lab or hospital can confirm whether a child has diabetic ketoacidosis, if necessary. Some newer blood glucose meters also offer the option of testing blood for ketones. Ask the diabetes health care team if such a meter is a good idea for your child.
What Is Diabetic Ketoacidosis
Diabetic ketoacidosis is a condition resulting from high blood sugar and acid buildup, primarily affecting people with type 1 diabetes.
Despite significant improvement in diagnosis and treatment, DKA is still the number one cause of death in children, adolescents, and young adults with type 1 diabetes, according to Dr. Umpierrez. Overall, mortality is low, but its occurrence is common, and the number of diabetics with DKA has increased with the cost of insulin, which has risen 1200 percent since its initial price of $21 per vial in 1996. As of 2019, that same vial cost $275.
Though diabetic ketoacidosis is most common and serious with type 1 diabetes, it can also strike people with type 2 diabetes who are skipping or cant afford insulin, have prolonged uncontrolled blood sugar, or are very sick with a co-occurring illness or infection, according to Dr. Umpierrez.
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What Are The Symptoms Of Dka
Beware the fruity breath. This tell-tale sign of diabetic ketoacidosis is caused by the body breaking down ketones, which become acetone which we then excrete through breathing. If you see someone whos breathing rapidly and their breath smells like fruit or a nail salon, they probably have DKA, says Dr. Klonoff.
Heavy breathing, known as Kussmaul breathing, is a reflex to try to bring up the pH that has gotten to be too low, according to Dr. Klonoff. Its named after Adolph Kussmaul, a German physician who first observed it in his patients with severe diabetes in 1874. You could be breathing really hard, and not even realize necessarily that youre doing it, Klonoff says.
Diabetic ketoacidosis affects the brain, making it work through what feels like mental sludge, according to Dr. Christofides. Confusion and irritability are major signs to watch out for.
As a result of your brain swelling, DKA can make you feel as if youre drunk and act just as irrationally. Ive seen situations where people have gotten into fights, or have become a risk to themselves physically, or had an intervention by law enforcement while driving because they appear to be acting drunk or are incoherent when stopped, says Dr. Christofides.
The main warning signs of DKA are:
- Heavy breathing
- Blurred vision
- High blood-sugar levels
The three Ps of DKA:
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What Is The Difference Between Diabetes Insipidus And Diabetes Mellitus
Diabetes insipidus should not be confused with the much more common type of diabetes called diabetes mellitus. The two conditions are not related. Diabetes mellitus can also make you feel thirsty and pass lots of urine. It occurs when the level of sugar in your blood becomes higher than normal. In diabetes insipidus, there is no problem with the level of glucose in your blood. See the separate leaflets called Type 1 Diabetes and Type 2 Diabetes for more details.
Are There Any Possible Complications From Dka
As DKA is life-threatening, its important to seek emergency care as soon as you suspect youre suffering from the condition. Fluid loss from DKA can lead to kidney and organ damage, brain swelling that can eventually cause a coma, and fluid buildup in your lungs. The sooner youre treated for DKA, the less likely you are to suffer from these major complications.
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Initial Serum/plasma And Urine Investigations
In individuals with established hypotonic polyuria or in individuals with urine osmolality of 300 mOsm/Kg and < 800 mOsm/Kg, further evaluation must be undertaken through laboratory investigations. Serum sodium and plasma osmolality measurements could assist with indicating the type of the underlying polyuric state. A high serum sodium could point towards central or nephrogenic DI while a low normal or low sodium could indicate primary polydipsia as the underlying disorder . Similarly, a high plasma osmolality is typically seen in DI while a normal or low plasma osmolality is usually seen in primary polydipsia .
Any underlying renal dysfunction must be ruled out by measuring urine sodium, blood urea nitrogen and serum creatinine . Electrolyte abnormalities including hypokalemia and hypercalcemia can give rise to polyuria due to down-regulation of aquaporin-2 channels giving rise to a clinical picture of nephrogenic DI . Therefore, any serum potassium or calcium abnormalities must be appropriately corrected.
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Signs & Symptoms Of Diabetic Ketoacidosis
Symptoms of diabetic ketoacidosis usually don’t start all at once they usually come on slowly over several hours. Signs and symptoms include:
- excessive thirst/urination
- dry mouth and dehydration
These symptoms are caused by the sustained hyperglycemia that typically happens before someone develops diabetic ketoacidosis.
If the person isn’t treated, these symptoms can happen:
- abdominal pain
What Is Diabetes Insipidus And What Causes It
Diabetes insipidus is a condition in which your ability to control the balance of water within your body is not working properly. Your kidneys are not able to regulate as well as they normally do how much water passes out in your urine. This means that you pass large amounts of dilute urine. The medical term for passing large amounts of urine is polyuria.
Because you are passing more urine , to try to compensate for this, you become more thirsty and want to drink more. The medical term for this increased thirst and desire to drink more is polydipsia.
If you have diabetes insipidus you can become dehydrated easily. The levels of sodium and potassium salts in your blood can also become unbalanced and too high.
There are two different types of diabetes insipidus :
- Cranial diabetes insipidus.
Nephrogenic diabetes insipidus.
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Signs & Symptoms Of Hyperglycemia
The symptoms of hyperglycemia are similar to those that happen when someone is diagnosed with diabetes, such as:
- Frequent urination: The kidneys respond to high levels of glucose in the bloodstream by flushing out the extra glucose in urine . A child with diabetes who has hyperglycemia may need to pee more often and in larger volumes.
- Extreme thirst: Kids with hyperglycemia who lose a lot of fluid from urinating often become very thirsty and may drink a lot in an attempt to prevent dehydration.
- Weight loss despite increased appetite: Without enough insulin to help the body use glucose, the body breaks down muscle and stored fat in an attempt to provide fuel to hungry cells.
- Fatigue: Because the body can’t use glucose for energy properly, kids with hyperglycemia may be unusually tired.
Other Major Symptoms Include:
Blurred vision – a change in glucose absorption can bring about a change in the shape of the lens in the eye, leading to an altered vision quality. This can cause blurred vision, a common complaint that can indicate type 1 or type 2 diabetes.
Diabetic ketoacidosis – diabetic ketoacidosis occurs when the body begins to break down stores of fat as an alternative source of energy, leading to a build-up of acids in the blood known as ketones. This can result in weight loss and muscle wasting. Diabetic ketoacidosis is a rare and acute complication of diabetes, often requiring admission to ITU / HDU. Diabetic Ketoacidosis can result in coma and possibly death if left untreated. Symptoms of type 1 diabetes can develop quickly, over weeks or even days.
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Eating Disorders And Intentional Insulin Restriction
Among people with diabetes, the full syndrome eating disorders are rare. The most common disordered eating behaviours are binge eating and insulin restriction/omission but prevalence is not well established. Eating problems in people with diabetes are associated with sub-optimal diabetes self-management and outcomes, overweight and obesity, and impaired psychological well-being.
Intentional insulin restriction or omission for the purposes of weight loss is sometimes referred to a Diabulimia IIR is the preferred clinical term. Estimates of insulin omission have been reported in up to 40% of people with type 1 diabetes. People may also omit or restrict insulin for other reasons than weight loss . Eating disorders are associated with early onset of diabetes complications and higher morbidity and mortality.
Evidence for the management of eating disorders in combination with diabetes is very limited. Thus, in practise, generally eating disorder treatments are applied to address the needs of people who are living with both conditions.
Healthcare professionals in both primary and secondary care should:
Psychological Disorders And Diabetes
People with underlying mental health issues or psychological disorders are at higher risk of diabetes. Medications such as antipsychotics can increase the risk of type 2 diabetes by as much as 60% and many of the atypical antipsychotics have impaired glucose tolerance as a side effect, this is often due to weight gain caused by medications.
As patients get older the risk of diabetes also increases, meaning patients with dementia or Alzheimer’s are also often at risk. These conditions can be challenging as patients may lack insight into understanding their diagnosis of diabetes, meaning it is harder to get them to consent to any treatment or to accept treatment on a regular basis leading to increased risk of complications.
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Diagnosis And Treatment Of Type 1 Diabetes
Scenario 1: Lisa, an 8-year-old girl, recently moved from another state. She is being evaluated in a primary care clinic for the first time for a THSteps visit. Previous medical records are not available, but in the course of evaluating Lisa’s health and getting a family history, her mother tells you Lisa has been tired a lot and seems to always be thirsty.
From the family history, you learn that her father has type 1 diabetes. You suspect Lisa might have type 1 diabetes and order a plasma glucose test.
The results show that her fasting plasma glucose value is more than 126 mg/dl. You decide to prescribe additional blood tests. These include tests for islet cell antibodies , insulin auto-antibodies , and/or glutamic acid decarboxylase .
After you have confirmed that Lisa has type 1 diabetes by the presence of one or more autoantibodies, you schedule a follow-up visit. During this visit, you counsel Lisa and her mother and tell them that Lisa has type 1 diabetes. You explain that this means her body is no longer able to produce a sufficient amount of insulin that her body needs because of an autoimmune disorder, and that she must take insulin from now on.
Six months later, Lisa develops a 2-day history of fever, malaise and diarrhea. She is well hydrated, and her physical examination is normal. Her urine is positive for ketones, and the blood glucose level is 260 mg/dl. Electrolyte levels, including bicarbonate, are normal.
What Are The Causes Of Dka
Lets split the causes into two bucketsthe biological ones, and those triggered by behavioral/societal forces.
First up, whats actually happening in the body to trigger DKA?
So, what about those other forces we mentioned? To put it bluntly, many people cant afford insulin.
When someone has economic concerns, they might chronically underdose their insulin, thinking that theyre preserving it or stretching it out, but underdosing insulin is just as bad as not taking it at all, says Dr. Christofides. In fact, the number one risk factor for DKA is a lack of health coverage resulting in an inability to afford insulin.
Diabetic ketoacidosis is caused by a lack of insulin in the body which can lead to life-threatening results.
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Diabetic Ketoacidosis: Evaluation And Treatment
This is a corrected version of the article that appeared in print.
DYANNE P. WESTERBERG, DO, Cooper Medical School of Rowan University, Camden, New Jersey
Am Fam Physician. 2013 Mar 1 87:337-346.
This version of the article contains supplemental content.
Patient Information: A handout on this topic is available at .
Diabetic ketoacidosis continues to have high rates of morbidity and mortality despite advances in the treatment of diabetes mellitus. In a study of 4,807 episodes of DKA, 14 percent occurred in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years.1 In a second study of 28,770 persons younger than 20 years with diabetes, 94 percent had no episodes of DKA, 5 percent had one episode, and 1 percent had at least two episodes.2 Additionally, DKA occurred more often in females, in persons with a migration background, and in persons 11 to 15 years of age.2 DKA has a case fatality rate of 1 to 5 percent.3,4 Although the highest rate of mortality is in older adults and persons with comorbid conditions, DKA is the leading cause of death in persons younger than 24 years with diabetes, most often because of cerebral edema.1,4
What Is The Connection Between Polydipsia And Diabetes
Excessive thirst, called polydipsia, and diabetes can be connected in patients with poorly controlled or undiagnosed diabetic conditions, where metabolic imbalances cause the patient to become extremely thirsty. In these patients, the kidneys produce excessive amounts of urine in an attempt to flush blood sugar. This depletes the body of water, triggering feelings of dehydration and intense thirst. The medical term for frequent urination is polyuria these symptoms are usually seem together.
In patients who havent been diagnosed, high blood sugar can develop because they arent aware they are ill. Over time, the levels build up so high that the kidneys begin to function at higher than normal levels in an attempt to get rid of the excess glucose. They produce large quantities of dilute urine with a high sugar content. The more the patient urinates, the more the patient needs to drink to keep the kidneys functioning. People with polydipsia and diabetes may drink large amounts of water daily, and can experience extreme thirst when they havent had something to drink within several hours.
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Faqs: Frequently Asked Questions
Can DKA recur?
Yes, DKA will happen whenever insulin levels are too low and not enough glucose is being produced to provide energy to your muscles and other tissues. If you miss a dose, underdose, or suffer from trauma or illness that depletes your insulin, DKA can recur.
Can DKA cause a heart attack or stroke?
Complications of DKA can include a heart attack or stroke because of the buildup of ketones in your body, so take it seriously and get emergency treatment as soon as you recognize the signs.
What causes a coma in DKA?
When blood-sugar levels become too low, triggering hypoglycemia, severe dehydration can then cause a diabetic coma.
How long does it take to recover from diabetic ketoacidosis?
Finally, some good news! Once youre safely admitted to the hospital for DKA, recovery is usually complete in one to three days.
When To See Your Doctor
If you have diabetes and experience increased thirst for a number of days, you should make an appointment to see your doctor/healthcare team
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