An Approach to diabetic ketoacidosis in an emergency setting.

2020 ◽  
Vol 15 ◽  
Author(s):  
Dario Pitocco ◽  
Mauro Di Leo ◽  
Linda Tartaglione ◽  
Emanuele Gaetano Rizzo ◽  
Salvatore Caputo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Blood Glucose Concentration ◽  
Diabetic Complication ◽  
Emergency Setting ◽  
Online Activity

Background: Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon. Methods: Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter regulatory hormones. Results: Goals of therapy are to correct dehydration, acidosis and to reverse ketosis, gradually restoring blood glucose concentration to near normal. Conclusion: Furthermore it is essential to monitor potential complications of DKA and if necessary, to treat them and any precipitating events.

Causes of diabetic ketoacidosis: type 1 diabetes versus type 2 diabetes

2017 ◽  
Author(s):  
Marwa Omri ◽  
Rayene Ben Mohamed ◽  
Imen Rezgani ◽  
Sana Mhidhi ◽  
Aroua Temessek ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis

Advantages and Disadvantages of Realtime Continuous Glucose Monitoring in People with Type 2 Diabetes

2012 ◽  
Vol 08 (01) ◽  
pp. 22 ◽  
Author(s):  
M Susan Walker ◽  
Stephanie J Fonda ◽  
Sara Salkind ◽  
Robert A Vigersky ◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Glucose Levels ◽  
Advantages And Disadvantages ◽  
Blood Glucose Levels

Previous research has shown that realtime continuous glucose monitoring (RT-CGM) is a useful clinical and lifestyle aid for people with type 1 diabetes. However, its usefulness and efficacy for people with type 2 diabetes is less known and potentially controversial, given the continuing controversy over the efficacy of self-monitoring of blood glucose (SMBG) in this cohort. This article reviews theextantliterature on RT-CGM for people with type 2 diabetes, and enumerates several of the advantages and disadvantages of this technology from the perspective of providers and patients. Even patients with type 2 diabetes who are not using insulin and/or are relatively well controlled on oral medications have been shown to spend a significant amount of time each day in hyperglycemia. Additional tools beyond SMBG are necessary to enable providers and patients to clearly grasp and manage the frequency and amplitude of glucose excursions in people with type 2 diabetes who are not on insulin. While SMBG is useful for measuring blood glucose levels, patients do not regularly check and SMBG does not enable many to adequately manage blood glucose levels or capture marked and sustained hyperglycemic excursions. RT-CGM systems, valuable diabetes management tools for people with type 1 diabetes or insulin-treated type 2 diabetes, have recently been used in type 2 diabetes patients. Theextantstudies, although few, have demonstrated that the use of RT-CGM has empowered people with type 2 diabetes to improve their glycemic control by making and sustaining healthy lifestyle choices.

scholarly journals Incidence and associates of diabetic ketoacidosis in a community-based cohort: the Fremantle Diabetes Study Phase II

2020 ◽  
Vol 8 (1) ◽  
pp. e000983
Author(s):  
Timothy M E Davis ◽  
Wendy Davis
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Phase Ii ◽  
Negative Binomial ◽  
Study Phase ◽  
Community Based ◽  
Secondary Diabetes

ObjectiveTo assess the incidence and associates of diabetic ketoacidosis (DKA) in a representative community-based cohort.MethodsAll hospitalizations of 1724 participants in the Fremantle Diabetes Study Phase II for/with DKA (plasma glucose >13.8 mmol/L, urinary/serum ketones, serum bicarbonate <18 mmol/L and/or arterial/venous pH <7.30) were identified between study entry from 2008 to 2011 and end-2013. Details of each episode were categorized by chart review as confirmed/probable DKA, possible DKA or not DKA. Incidence rates by diabetes type were calculated. Cox proportional hazards modeling determined predictors of first episode, and negative binomial regression identified predictors of frequency.ResultsThere were 53 coded DKA episodes (41 first episodes, 12 recurrences), of which 19 (35.8%) were incorrectly coded, 9 (17.0%) had possible DKA and 25 (47.2%) had confirmed/probable DKA. Of this latter group, 44% had type 1 diabetes, 32% had type 2 diabetes, 12% had latent autoimmune diabetes of adults (LADA) and 12% had secondary diabetes. The overall incidence of confirmed/probable DKA (95% CI) was 35.6 (23.0 to 52.6)/10 000 person-years (178.6 (85.7 to 328.5)/10 000 person-years for type 1 diabetes, 13.3 (5.7 to 26.1)/10 000 person-years for type 2 diabetes, 121.5 (33.1 to 311.0)/10 000 person-years for LADA and 446.5 (92.1 to 1304.9)/10 000 person-years for secondary diabetes). Baseline ln(fasting serum C-peptide) (inversely), glycated hemoglobin and secondary diabetes predicted both incident first confirmed/probable DKA episode and the frequency of DKA (p<0.001).ConclusionsThese data highlight the contribution of poor glycemic control and limited pancreatic beta cell function to incident DKA, and show that people with types of diabetes other than type 1, especially secondary diabetes, are at risk.

scholarly journals Echinochrome pigment attenuates diabetic nephropathy in the models of type 1 and type 2 diabetes

2016 ◽  
Vol 19 (6) ◽  
pp. 464-470 ◽  
Author(s):  
Amel Mahmoud Soliman ◽  
Ayman Saber Mohamed ◽  
Mohamed-Assem Said Marie
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Diabetic Complication ◽  
Albino Rats ◽  
Glutathione S Transferase ◽  
Wistar Albino Rats

Background. The main complication of diabetes mellitus is diabetic nephropathy in both types, which is a main reason for renal failure. Echinochrome substance present in sea urchin shells and spines and possesses high antioxidant activity.Aim. is to evaluate the ability of Ech to suppress the progression of diabetic complication in kidney.Materials and methods. Thirty-six male Wistar albino rats were divided into two main groups, type 1 diabetes mellitus and type 2 diabetes mellitus. Both groups divided into control, diabetic and echinochrome subgroups. Type 1 diabetes was induced by single dose of streptozotocin (60 mg/kg, i.p), while type 2 was induced by high fat diet for 4 weeks before the injection with streptozotocin (30 mg/kg, i.p). The treated groups were administrated by echinochrome (1mg/kg body weight in 10% DMSO) daily for 4 weeks.Results. Echinochrome groups showed reduction in the concentrations of glucose, malondialdehyde, urea, uric acid and creatinine. While it caused general increase in glutathione-S-transferase, superoxide dismutase, catalase, glutathione reduced, nitric oxide and creatinine clearance. The histopathological investigation showed clear improvement in the kidney architecture.Conclusion. Administration of echinochrome improves renal function and ameliorates renal histopathological changes possibly by improvement of glucose metabolism and inhibition of lipid peroxidation process.

scholarly journals Non-immune-mediated versus immune-mediated type 1 diabetes diagnosis and long-term differences. Retrospective analysis.

2020 ◽  
Author(s):  
Diana Catarino ◽  
Diana Silva ◽  
Joana Guiomar ◽  
Cristina Ribeiro ◽  
Luísa Ruas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Ldl Cholesterol ◽  
Β Cell ◽  
Duration Of Symptoms ◽  
Immune Mediated ◽  
Significant Difference

Abstract Background: The American Diabetes Association proposed two subcategories for type 1 diabetes mellitus : type 1A or immune-mediated diabetes (IDM) and type 1B or idiopathic diabetes. The absence of β-cell autoimmune markers, permanent insulinopenia and prone to ketoacidosis define the second category, whose pathogenesis remains unclear. Only a minority of patients fall into this category, also designated non-immune-mediated (NIDM), which is considered by several authors similar to type 2 diabetes. The aim of this study is to evaluate differences at the diagnosis and ten years later of two categories. Methods: Retrospective cohort study of patients with β-cell autoimmune markers performed at diagnosis and undetectable c-peptide. Were excluded patients with suspicion of another specific type of diabetes. We obtained two groups: IDM (≥ 1 positive antibody) and NIDM (negative antibodies). Age, family history, anthropometry, duration of symptoms, clinical presentation, blood glucose at admission, A1C, lipid profile, arterial hypertension, total diary dose of insulin (TDDI), microvascular and macrovascular complications were evaluated. Results were considered statistically significant with p<0.05. Results: 37 patients, 29 with IDM and 8 patients with NIDM. The age of diagnosis of IDM group (23 years) was significantly different (p=0.004) from the NIDM group (38.1). The body mass index (BMI) at the diagnosis did not differ significantly (p=0.435). The duration of symptoms was longer in the NIDM (p=0.003). The disease presentation (p=0.744), blood glucose (p=0.482) and HbA1C (p=0.794) at admission and TDID at discharge (p=0.301) did not differ significantly. Total and LDL cholesterol levels were higher in NIDM group but did not differ significantly (p=0.585 and p=0.579, respectively). After ten years BMI did not differ between groups(p=0.079). Patients with IDM showed a significantly higher HbA1C (p=0,008) and TDID (p=0.017). Relative to the lipid profile, there was no significant difference, however the LDL cholesterol and triglycerides were higher on the NIDM group, as the percentage of hypertension. Microvascular complications were higher in the IDM group, but no significant difference was found. Conclusion: Patients with IDM had a poor metabolic control and higher insulin requirement. Patients with NIDM were older and showed higher cardiovascular risk, resembling a clinical phenotype of type 2 diabetes.

Diabetic ketoacidosis in childhood and adolescence

2011 ◽  
pp. 1888-1894 ◽  
Author(s):  
M. Silink
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hispanic Americans ◽  
Viral Infections ◽  
Childhood And Adolescence ◽  
Oral Hypoglycaemic Agents ◽  
Obesity Epidemic

Diabetic ketoacidosis (DKA) may occur at the time of diagnosis of diabetes, or at any time subsequently. It is the cause of very significant morbidity and remains the most common cause of death in childhood and adolescent diabetes (1–3). For a discussion of DKA in adults, see Chapter 13.4.10.1. Type 1 diabetes occurs in childhood (see Chapter 13.4.7) with an incidence that varies from more than 40 per year per 1 00 000 children under the age of 15 years old (in Finland), to less than 1 per 1 00 000 (in Asia). The mean age at diagnosis is usually 10–12 years old, although, in a number of countries, this seems to be declining. The younger the child is at diagnosis, the more aggressive the autoimmune-mediated destruction of the pancreatic β‎ cell, and the more rapid the progression to complete insulin dependence (see Chapter 13.2.3). Children are thus more liable to DKA than adults. Furthermore, children experience more viral infections than do adults, and the metabolic stresses associated with these infections increase their risk of developing DKA. DKA has traditionally been considered to occur only in type 1 diabetes, but is now being reported in at least 25% of (usually obese) adolescents with newly diagnosed type 2 diabetes, especially when there are associated stress factors, such as infection (4, 5). Although the vast majority of diabetes in childhood and adolescence is type 1 diabetes, there has been a worldwide trend to the earlier development of type 2 diabetes in association with the overweight and obesity epidemic, especially in certain at-risk ethnic groups, e.g. Asians, African Americans, Hispanic Americans; see Chapter 13.4.3.1. The treatment of DKA in these patients is the same as for those with type 1 diabetes; however, the subsequent course of the treatment usually differs, and most patients are able to stop insulin and be treated with oral hypoglycaemic agents, weight reduction, exercise, and an appropriate food plan.

Diabetes Drugs

2006 ◽  
Author(s):  
Jie Jack Li
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Sugar Content ◽  
Multisystem Disease ◽  
Oral Medications ◽  
High Sugar Content

Diabetes mellitus is a multisystem disease associated with the loss of control of physiological glucose concentrations in the blood. The disease is broadly broken down into two types based on factors that include age, acuteness of onset, underlying glucose-handling deficit, and therapy. Type 1 diabetes usually manifests acutely in the young, secondary to some underlying insult (possibly infectious) to the islet cells of the pancreas, resulting in an absolute lack of insulin. Type 2 diabetes is more frequently associated with maturity, obesity, and gradually increasing blood glucose concentrations; it may be asymptomatic for some time and discovered on routine glucose screening. In fact, as weight increases among the general population of the developed world, type 2 diabetes is becoming an epidemic. Type 1 diabetes always requires insulin replacement therapy, whereas type 2 can frequently be controlled with diet, weight loss, and oral medications that enhance residual pancreatic function. Diabetes has been known since antiquity. In fact, the term diabetes mellitus comes from the Greek meaning “siphon and honey” due to the excess excretion (siphon or faucet) of hyperglycemic (sweetened, or honeyed) urine. In ancient times, most cases of diabetes were of type 1, with acute onset in the young, which was often fatal. Type 2 diabetes was extremely rare when sources of nutrition were scarce and obesity was not prevalent. Diabetes was also known as “wasting” because diabetics were not able to metabolize the sugar content of food and eventually died from wasting away. Because of the effect of excess blood glucose, the blood of the diabetic is hyperosmolar (concentrated), and this triggers compensatory thirst (in an attempt to dilute the hyperglycemia and return the blood to a normal concentration). This excess thirst results in the common diabetic symptom of polydipsia (excessive drinking secondary to thirst, resulting in the urge to drink frequently) and polyuria (excess urination). Even before many modern diagnosis tools became available, savvy doctors could diagnose diabetic men just by looking at their shoes for the telltale white spots from urine with high sugar content. In fact, tasting urine samples of diabetics was a routine diagnostic tool for diabetes. Even the breath of a severe diabetic was sweet—a sickly smell as a result of acidosis. In addition, it has been mentioned that ants would track to the urine of diabetics.

scholarly journals Islet Transplantation to the Anterior Chamber of the Eye—A Future Treatment Option for Insulin-Deficient Type-2 Diabetics? A Case Report from a Nonhuman Type-2 Diabetic Primate

2020 ◽  
Vol 29 ◽  
pp. 096368972091325
Author(s):  
Sai Bo Bo Tun ◽  
Minni Chua ◽  
Riasat Hasan ◽  
Martin Köhler ◽  
Xiaofeng Zheng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Anterior Chamber ◽  
Islet Transplantation ◽  
Fasting Blood Glucose ◽  
Fasting Blood Glucose Level ◽  
Metabolic Markers

Replacement of the insulin-secreting beta cells through transplantation of pancreatic islets to the liver is a promising treatment for type-1 diabetes. However, low oxygen tension, shear stress, and the induction of inflammation lead to significant islet dysfunction and loss. The anterior chamber of the eye (ACE) has gained considerable interest and represents an alternative therapeutic islet transplantation site because of its accessibility, high oxygen tension, and immune-privileged milieu. We have previously demonstrated the feasibility of intraocular islet transplant in mouse and nonhuman primate models of type-1 diabetes and are now assessing its efficacy on glucose homeostasis in a nonhuman primate model of type-2 diabetes. We transplanted allogeneic donor islets (1,500 islet equivalents/kg) into the anterior chamber of one eye in a cynomolgus monkey with high-fat-diet-induced type-2 diabetes. Repeated examinations of the anterior and posterior segments of both eyes were done to monitor the engrafted islets and assess the overall ocular health. Fasting blood glucose level, blood biochemistry, and other metabolic parameters were routinely evaluated to determine the function of the islet graft and diabetes status. The transplanted islets were rapidly engrafted onto the iris and became vascularized 1 month after transplantation. We did not detect changes in intraocular pressure, cataract formation, ophthalmitis, or retinal vessel deformation. A significant lower fasting blood glucose level was observed while the graft was in place, and the transplantation reverts the progression of diabetes. The metabolic markers, hemoglobin A1C and fructosamine, demonstrated improvement following islet transplantation. As a conclusion, intraocular islet transplantation in one eye of a cynomolgus monkey with type-2 diabetes improved its overall plasma glucose homeostasis, as evidenced by short-term measures and long-term metabolic markers. These results further support the future application of the ACE as an alternative site for clinical islet transplants in the context of type-2 diabetes.

scholarly journals Diabetes and Sports

2016 ◽  
Vol 11 (1) ◽  
pp. 58-63
Author(s):  
Michael Yurkewicz ◽  
Michael Cordas ◽  
Amy Zellers ◽  
Michael Sweger
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Signs And Symptoms ◽  
The United States ◽  
Care Plan ◽  
Type I ◽  
Adequate Hydration

More than 29 million people in the United States have diabetes mellitus, including both type 1 and type 2 diabetes. The CDC also estimates that upward of 86 million people can be classified as prediabetic, with as many as 30% of these people transitioning into diabetes within the next 5 years. Individuals with type 1 diabetes account for roughly 5% of those patients. Dating back to 2008 and 2009, roughly 18 000 youth were diagnosed with type 1 diabetes each year. The prevalence of diabetes is well known; most of the studies that are completed today relate to the progression and/or treatment of those with type 2 diabetes. Yet most physicians will have to take care of a type 1 diabetic patient who will want to be active. Having a fundamental knowledge of how exercise affects insulin and blood glucose and how to manage these patients is important. Time must be taken to modify each treatment regimen for each individual. One cannot stress enough the importance of providing patient education, ensuring adequate hydration, recognizing signs and symptoms of hypoglycemia/hyperglycemia, and how to treat and prevent these serious complications. All patients must have a care plan and access to supplies during exercise. It is known that poorly controlled blood glucose can have detrimental consequences in the long term. The question is if type I diabetic athletes who are allowed to have higher blood glucose during exercise are at the same risk for these potential complications.

scholarly journals Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

2021 ◽  
Vol 9 (2) ◽  
pp. e002451
Author(s):  
Emma Ooi ◽  
Katrina Nash ◽  
Lakshmi Rengarajan ◽  
Eka Melson ◽  
Lucretia Thomas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care ◽  
Final Analysis ◽  
Care Hospital ◽  
Hospital Data ◽  
Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

Sign in / Sign up

Export Citation Format

Share Document