Diabetic Ketoacidosis (DKA)

As part of my Medical Nutrition Therapy (MNT) rotation, my preceptor has asked me to create a summary sheet of certain illnesses and complications associated with various disease states. One of which, is diabetic ketoacidosis (DKA).

What is DKA?

DKA is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.
It develops when your body is unable to produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as an alternate fuel. This process produces a buildup of toxic acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

What causes DKA?

1. Not enough insulin

2. Not enough food

3. Low blood glucose

When cells don’t get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are acids that build up in the blood and appear in the urine when your body doesn’t have enough insulin. They are a warning sign that your diabetes is out of control or that you are getting sick. High levels of ketones can poison the body. When levels get too high, you can develop DKA. DKA may happen to anyone with diabetes, though it is rare in people with type 2. Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly. DKA usually develops slowly. But when vomiting occurs, this is life-threatening and can develop in a few hours.

Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, sugar enters your cells with the help of insulin. If you don’t have enough insulin in your body, your body won’t be able to use sugar properly for energy. This prompts the release of hormones that break down fat as an alternate fuel. In turn, this process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually “spill over” into the urine.

Early symptoms include:

– Polydypsia (increase of thirst)

– Polyuria (frequent urination)

– Hyperglycemia (high blood glucose levels)

– High level of ketones in the urine

– Fatigue, dry skin, nausea, difficulty breathing, fruity odor on the breath (caused from the presence of ketones)

When diagnosing DKA, a healthcare provider should pay close attention to the following lab values:

Blood Glucose: If there isn’t enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise.

Ketone level: When your body breaks down fat and protein for energy, toxic acids known as ketones enter your bloodstream.

Blood acidity: If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of various organs throughout your body.

– Blood electrolyte tests, Urinalysis, Chest X-ray, and an Electrocardiogram (ECG)

The treatment for DKA involves a three-pronged approach:

1. Fluid Replacement: receive fluids, orally or intravenously, until rehydrated. These fluids will replace those that have been lost through excessive urination and dilute the excess sugar in the blood.

2. Electrolyte Replacement: Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You’ll receive electrolytes through your veins to help keep your heart, muscles and nerve cells functioning normally.

3. Insulin Therapy: Insulin reverses the processes that cause diabetic ketoacidosis. Along with fluids and electrolytes, you’ll receive insulin therapy — usually through a vein. When your blood sugar level falls below 240 mg/dL (13.3 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.

Diabetic ketoacidosis is usually triggered by an illness or insulin therapy.

An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones work against insulin — sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits.

Missed insulin treatments or inadequate insulin therapy can leave you with too little insulin in your system, triggering an episode of diabetic ketoacidosis.

Other possible triggers of DKA could include:

– Stress

– Physical or emotional stress

– High fever

– Surgery

– Heart attack

– Alcohol or drug abuse, specifically cocaine

While DKA is being treated, there are complications that patients and healthcare providers need to be aware of as well. Complications could include:

Hypoglycemia: Insulin allows sugar to enter your cells. This causes your blood sugar level to drop. If your blood sugar level drops too quickly, you may develop low blood sugar.

Hypokalemia: Fluids and insulin used to treat diabetic ketoacidosis may cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves.

Cerebral Edema: Adjusting your blood sugar level too quickly can produce swelling in your brain. This complication appears to be more common in children, especially those with newly diagnosed diabetes.

American Diabetes Association- DKA

Mayo Clinic- DKA

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DKA2

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Managing Diabetes- It’s App-tastic!

Currently, a steadily increasing amount of people are using their phone as a source of knowledge and information. Honestly, it makes sense though. Your phone is always with you, it’s convenient, and it fits in your pocket. But, more specifically it’s helping people manage diseases like diabetes. Diabetes can be a mountain to manage, unless you have the right tools: knowledge and organization. According to the American Diabetes Association, nearly 19 million Americans, or more than 8% of the population, have diabetes. An estimated 7 million more are living with diabetes and have no idea they have it.

As discussed, with the rapid rising rates of diabetes, managing the condition is more important than ever! By incorporating the digital age of electronic devices, Smartphones, and more importantly phone applications, managing your diabetes can become second nature. So, here is an app that I recently came across that has been generating a substantial amount of “buzz”. Allow me to further investigate the characteristics of the diabetes app….

1.     Diabetes Companion by mySugr

This is the #1 diabetes app in 6 countries. The Companion is a charming, sometimes outspoken diabetes manager. The app is a new-twist on a diabetes logbook. It gives you immediate feedback in a fun package and helps you stay motivated for the long haul. You win points for every entry made which helps tame your diabetes “monster”. The goal is to tame your monster every day. Challenges are available to help you set and attain personal goals. It’s all the diabetes management you’re used to, with a side-order of context to make it meaningful.

You can use photos of your food along with smart searches to help make educated decisions on the go, use tags, notes, and locations to describe the situations and circumstances around your data, and choose from a variety of ever changing challenges to push yourself and your therapy to the next level of diabetes management nirvana.

Cost: FREE

Key Features include:

          Quick and easy logging

          Smart search

          Convenient data analysis

          Neat and clear graphs

          Handy photo functions (multiple pictures per entry)

          Exciting challenges

          Snappy reports (PDF, Excel)

          Smile-inducing feedback

          Secure data backup

           Social sharing functions

          Fast multi-device sync

          Practical glucose reminders

          Registered medical device (which is very important when looking into apps that help manage/regulate health-related diseases/illnesses)

mySugr Diabetes Manager App: The Companion

MySugrdm appdm

Fertility and a Woman’s Diet…

According to a new observational research study, the Mediterranean diet may improve a woman’s fertility. The study, completed in Spain, drew a conclusion to the connection between the Mediterranean diet and fertility based on insulin response. The American or Western diet is packed with sugars and processed foods. So, in order for the body to digest and use these foods correctly, an increased amount of insulin is needed. When the body has too much insulin, the other hormones in the body, like reproductive hormones, are not released accurately.

The Mediterranean diet, which is loaded with fruits, vegetables, healthy fats/oils, and whole grains, helps to control blood glucose. By helping to control the body’s blood glucose, or insulin response, this can assist fertility and reproductive hormones maintain a healthy balance.

Researchers studied more than 500 women who reported having trouble getting pregnant. Another 1,600 women with at least one successful pregnancy ending in live birth were also included in the study as a control group. The research split the group into Western diet and Mediterranean diet categories. The women in the Western diet category showed no difference in fertility whether they followed a Western diet strictly or loosely. The Mediterranean diet group, however, showed a significant difference in fertility based on how closely women followed the diet.

In contrast, approximately 17% of women who followed the Mediterranean diet firmly reported problems becoming pregnant. When women followed the diet loosely, that number jumped to 26%.

So, you can see that nothing is absolutely proven with the diet and fertility… yet.  Not all doctors are convinced about the connection. There isn’t enough information to show that this diet pattern can assist a woman at becoming pregnant.

Also found in a new research study, diets containing foods rich in monounsaturated fat, like green fruit, olive oil, peanuts, almonds, and cashews, could triple chances of women becoming pregnant via fertility treatment. Health professionals believe a diet similar to this could assist most women wanting to become pregnant naturally as well. In this study, it was clear that consuming a diet high in saturated fat, found in dairy and red meat, appeared to impair women’s fertility. Diets high in saturated fat have also been linked to lower sperm counts in men. The School of Public Health at Harvard looked at how the intakes of different types of fats affect success rates of IVF treatment in women mostly in their 30s. The study found the women who ate the most monounsaturated fat had up to 3x the chance of giving birth via IVF, compared to those who ate the least.

BabyMed

Med Diet and Fertility

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