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Ketoacidosis
Kinds of Ketoacidosis Selected AbstractsOutcome of Dogs with Diabetic Ketoacidosis: 127 Dogs (1993,2003)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2006Daniel Z. Hume The aim of this study was to retrospectively describe the outcome of 127 dogs with naturally occurring diabetic ketoacidosis (DKA) and to examine the association between outcome of canine DKA and clinical and clinicopathologic findings. Eighty-two (65%) dogs were diagnosed with DKA at the time of initial diagnosis of diabetes mellitus (DM). Eighty-seven dogs (69%) had one or more concurrent disorders diagnosed at the time of hospitalization. Commonly identified concurrent conditions included acute pancreatitis (52, 41%), urinary tract infection (21, 20%), and hyperadrenocorticism (19, 15%). Dogs with coexisting hyperadrenocorticism were less likely to be discharged from the hospital (P= .029). Of 121 treated dogs, 89 dogs (70%) survived to be discharged from the hospital, with a median hospitalization of 6 days. Nonsurvivors had lower ionized calcium concentration (P <.001), lower hematocrit (P= .036), lower venous pH (P= .0058), and larger base deficit (P= .0066) than did survivors. Time from admission to initiation of subcutaneous insulin therapy was correlated with lower serum potassium concentration (P= .0056), lower serum phosphorus concentration (P= .0043), abnormally high white blood cell count (P= .0060), large base deficit (P= .0015), and low venous pH (P <.001). Multivariate analysis showed that base deficit was associated with outcome (P <.021). For each unit increase in the base deficit, there was a 9% greater likelihood of discharge from the hospital. In conclusion, the majority of dogs with DKA were not previously diagnosed with DM. Concurrent conditions and electrolyte abnormalities are common in DKA and are associated with length of hospitalization. Survival was correlated to degree of anemia, hypocalcemia, and acidosis. [source] Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosisDIABETES OBESITY & METABOLISM, Issue 3 2005M. Maldonado Aim:, To derive predictors of good glycaemic control in patients presenting with diabetic ketoacidosis (DKA) followed prospectively in a specialized clinic. Methods:, One hundred and sixty-one adult patients were admitted during a 31-month period and followed for at least 12 months. After 1 year, the patients were classified into three groups: good control (GC) (HbA1c , 7%), intermediate control (IC) (HbA1c 7,9%) and poor control (PC) (HbA1c > 9%). Characteristics of patients in the three groups were compared both at baseline and during follow-up. Results:, At 12 months, 36% of the patients were classified as GC, 27% as IC and 37% as PC. GC patients had higher fasting serum C-peptide levels 0.7 ± 0.54 compared to 0.38 ± 0.29 and 0.16 ± 0.21 nmol/l, respectively, for the IC and PC patients (p < 0.0001). A higher proportion GC patient had a C-peptide level greater than 0.33 nmol/l than that for IC and PC patients (86, 61 and 19%, respectively; p < 0.0001). Exogenous insulin was safely discontinued in 50, 30 and 3% of patients, respectively, in the GC, IC and PC groups (p < 0.0001). Compliance with life-style interventions was higher in the GC than that in IC and PC patients (87, 41 and 5%, respectively; p < 0.0001). In the logistic regression analysis, predictors of good glycaemic control were having baseline fasting serum C-peptide value ,0.33 mmol/l, OR: 3.01 (95% CI 1.07,8.55, p = 0.03) and compliance with life-style interventions OR 12.66 (95% CI 3.73,51.57, p = 0.0001). Conclusion:, Among adult patients with DKA, significant predictors of good glycaemic control are preserved ,-cell function and compliance with life-style modifications. [source] Self glucose monitoring and physical exercise in diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2009G. Pugliese Abstract Cardiorespiratory fitness, which is determined mainly by the level of physical activity, is inversely related to mortality in the general population as well as in subjects with diabetes, the incidence of which is also increased by low exercise capacity. Exercise is capable of promoting glucose utilization in normal subjects as well as in insulin-deficient or insulin-resistant diabetic individuals. In diabetic subjects treated with insulin or insulin secretagogues, exercise may also result in complications, with too much insulin causing hypoglycaemia and not enough insulin leading to hyperglycaemia and possibly ketoacidosis; both complications may also occur several hours after exercise. Therefore, self-monitoring of blood glucose before, during (for exercise duration of more than 1 h) and after physical exercise is highly recommended, and also carbohydrate supplementation may be required. In the Italian Diabetes Exercise Study (IDES), measurement of blood glucose and systolic and diastolic blood pressure levels before and after supervised sessions of combined (aerobic + resistance) exercise in type 2 diabetic subjects with the metabolic syndrome showed significant reductions of these parameters, though no major hypoglycaemic or hypotensive episode was detected. The extent of reduction of blood glucose was related to baseline values but not to energy expenditure and was higher in subjects treated with insulin than in those on diet or oral hypoglycaemic agents (OHA). Thus, supervised exercise training associated with blood glucose monitoring is an effective and safe intervention to decrease blood glucose levels in type 2 diabetic subjects. Copyright © 2009 John Wiley & Sons, Ltd. [source] Diabetes classification: grey zones, sound and smoke: Action LADA 1DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 7 2008R. D. G. Leslie Abstract Diseases gain identity from clinical phenotype as well as genetic and environmental aetiology. The definition of type 1 diabetes is clinically exclusive, comprising patients who are considered insulin dependent at diagnosis, whilst the definition of type 2 diabetes is inclusive, only excluding those who are initially insulin dependent. Ketosis-prone diabetes (KPD) and latent autoimmune diabetes in adults (LADA) are each exclusive forms of diabetes which are, at least initially, clinically distinct from type 2 diabetes and type 1 diabetes, and each have a different natural history from these major types of diabetes. KPD can be diagnosed unequivocally as diabetes presenting with the categorical clinical feature, ketoacidosis. In contrast, LADA can be diagnosed by the co-occurrence of three traits, not one of which is categorical or exclusive to the condition: adult-onset non-insulin-requiring diabetes, an islet autoantibody such as glutamic acid decarboxylase autoantibodies (GADA) or cytoplasmic islet cell autoantibodies (ICA), and no need for insulin treatment for several months post-diagnosis. But while some would split diabetes into distinct subtypes, there is a strong case that these subtypes form a continuum of varying severity of immune and metabolic dysfunction modified by genetic and non-genetic factors. This article discusses the nature of disease classification in general, and KPD and LADA in particular, emphasizing the potential value and pitfalls in classifying diabetes and suggesting a need for more research in this area. Copyright © 2008 John Wiley & Sons, Ltd. [source] Common infections in diabetes: pathogenesis, management and relationship to glycaemic controlDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2007Anton Y. Peleg Abstract Specific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hypo-responsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community- and hospital-acquired infections. Copyright © 2006 John Wiley & Sons, Ltd. [source] Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectivenessDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 3 2004Régis Pierre Radermecker Abstract Portable insulin infusion devices are effective and safe insulin delivery systems for managing diabetes mellitus, especially type 1 diabetes. Rapidly absorbed insulin analogues, such as insulin lispro or insulin aspart, may offer an advantage over regular human insulin for insulin pumps. Several open-label randomised crossover trials demonstrated that continuous subcutaneous insulin infusion (CSII) with insulin lispro provided a better control of postprandial hyperglycaemia and a slightly but significantly lower glycated haemoglobin level, with lower daily insulin requirement and similar or even less hypoglycaemic episodes. A CSII study comparing insulin lispro and insulin aspart demonstrated similar results with the two analogues, and better results than those with regular insulin. Because these analogues have a quicker onset and a shorter duration of action than regular insulin, one might expect an earlier and greater metabolic deterioration in case of CSII interruption, but a more rapid correction of metabolic abnormalities after insulin boluses when reactivating the pump. These expectations were confirmed in randomised protocols comparing the metabolic changes occurring during and after CSII interruption of various durations when the pump infused either insulin lispro or regular insulin. The extra cost resulting from the use of CSII and insulin analogues in diabetes management should be compensated for by better metabolic control and quality of life. In conclusion, CSII delivering fast-acting insulin analogues may be considered as one of the best methods to replace insulin in a physiological manner by mimicking meal and basal insulin requirements, without higher risk of hypoglycaemia or ketoacidosis in well-educated diabetic patients. Copyright © 2004 John Wiley & Sons, Ltd. [source] The DPT-1 trial: a negative result with lessons for future type 1 diabetes preventionDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2002Professor Paolo Pozzilli Abstract The author comments on the DPT-1 Trial and why the observed negative outcome in preventing diabetes in first-degree relatives of type 1 diabetic patients by parenteral insulin administration may have occurred and what can be gathered from this large study. There were three main lessons to be learned from the DPT-1 Trial as follows. (1) Large preventive trials of type 1 diabetes are feasible in first-degree relatives of type 1 diabetic patients and other preventive approaches may be now envisaged. (2) The natural history of type 1 diabetes, at least in its final years before clinical onset, has been elucidated and reiterates the relevance of our present predictive tools (autoantibodies) for identifying individuals at risk for the disease. (3) Strict follow-up of enrolled subjects in trials permits an earlier diagnosis of the disease with less frequency of ketoacidosis and implementation of insulin therapy when higher C-peptide levels are present. DPT-1 has paved the way on how to proceed and new trials will be planned benefiting from such experience. Copyright © 2002 John Wiley & Sons, Ltd. [source] Diabetes management in the new millennium using insulin pump therapyDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2002Bruce W. Bode Abstract Current goals of therapy of type 1 and 2 diabetes are to achieve near normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, improve quality of life and delay or prevent late vascular complications. As discussed in this review, insulin pump or continuous subcutaneous insulin infusion (CSII) therapy provides a treatment option that can dramatically aid in achieving all of these goals. In comparison to multiple daily injections (MDI), CSII uses only rapid-acting insulin, provides greater flexibility in timing of meals and snacks, has programmable basal rates to optimize overnight glycemic control, can reduce the risk of exercise-induced hypoglycemia, and enhances patients' ability to control their own diabetes. Most important, in adults and adolescents with type 1 diabetes, CSII has been shown to lower HbA1c levels, reduce the frequency of severe hypoglycemia and limit excessive weight gain versus MDI without increasing the risk of diabetic ketoacidosis. Similarly positive results are being seen with CSII in adults with type 2 diabetes. The effectiveness of CSII and improvements in pump technology have fueled a dramatic increase in the use of this therapy. Practical guidelines are presented for selection of patients, initiation of treatment, patient education, follow-up assessments and troubleshooting. The recent introduction of methods for continuous glucose monitoring provides a new means to optimize the basal and bolus capabilities of CSII and offers the hope of the development of a feedback-controlled artificial pancreas. Copyright © 2002 John Wiley & Sons, Ltd. [source] Childhood growth and age at diagnosis with Type 1 diabetes in Colorado young peopleDIABETIC MEDICINE, Issue 10 2009K. Vehik Abstract Objective, Studies have suggested that the age at diagnosis of Type 1 diabetes (T1D) is decreasing over time. The overload hypothesis postulates that risk factors, such as accelerated growth, may be responsible for this decrease. We assessed changes in age, body mass index (BMI), weight and height at diagnosis with T1D in non-Hispanic white (NHW) and Hispanic (HISP) young people from Colorado, using data from the IDDM Registry and SEARCH Study. Methods, In three time periods, 656 (1978,1983), 562 (1984,1988) and 712 (2002,2004) young people aged 2,17 years were newly diagnosed with T1D. Age, weight, height and presence of diabetic ketoacidosis (DKA) at diagnosis with T1D were obtained from medical records. Trends over the three time periods were assessed with regression analyses. Results, Age at diagnosis decreased by 9.6 months over time (P = 0.0002). Mean BMI standard deviation score (SDS), weight SDS and height SDS increased over time (P < 0.0001), while prevalence of DKA decreased (P < 0.0001). Increasing height over time accounted for 15% (P = 0.04) of the decreasing age at diagnosis with T1D. Conclusions, Our study provides evidence that increased linear growth, but not increased BMI or weight over time, may account, at least in part, for the younger age at diagnosis of T1D in Colorado children. This finding supports the hypothesis that increasing environmental pressure resulting from changes in potentially preventable risk factors may accelerate the onset of T1D in children. [source] Pneumorrhachis: a rare complication of diabetic ketoacidosisDIABETIC MEDICINE, Issue 5 2009D. P. Ripley No abstract is available for this article. [source] A 10-year (1996,2005) prospective study of the incidence of Type 1 diabetes in Moscow in the age group 0,14 yearsDIABETIC MEDICINE, Issue 8 2008E. A. Pronina Abstract Aims To provide data on the incidence of Type 1 diabetes (T1D) in Moscow, determined prospectively from 1996 to 2005 for a total of > 10 million subjects aged < 15 years. Methods Data on T1D incidence in patients with newly discovered T1D resident in Moscow diagnosed between 1 January 1996 and 31 December 2005 were analysed. Primary ascertainment was based in endocrinology departments of children's hospitals in Moscow. A secondary source were the archives of Moscow Region where patients are registered to obtain exemption from paying for medication. Results We identified 2031 new cases of T1D patients with a degree of ascertainment through primary and secondary sources of 94%. Overall the incidence rate of the disease was 12.9 per 100 000 per year (95% confidence interval 12.3, 13.4). The cumulative risk of the disease was 0.28 per 1000 in the age group 0,4 years, 0.84 in the age group 5,9 years and 1.8 in the age group 10,14 years. The incidence rate in girls increased by a mean of 6% per year in all age groups (P < 0.05 for all comparisons), whereas in boys it increased by a mean of 7% in the age group 10,14 years. Thirty percent of cases presented with diabetic ketoacidosis and coma at diagnosis, whereas hyperglycaemia without ketonuria was present in 20% of patients. Conclusions This is the first study to report on validated incidence data for T1D in Moscow. We conclude that the incidence of T1D in Moscow is comparable to that of those European countries having intermediate incidence rates, and that the incidence is increasing. [source] Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation studyDIABETIC MEDICINE, Issue 5 2008A. Sämann Abstract Aims To assess the outcome of a Diabetes Treatment and Teaching Programme (DTTP) on glycated haemoglobin (HbA1c), severe hypoglycaemia (SH) and severe ketoacidosis (SKA) in adolescents and young adults with Type 1 diabetes. Methods Quality-assurance project with assessment of participants 1 year after participation in a DTTP (5-day inpatient course, groups , 10 patients, fixed curriculum of education/training, introduction of dietary freedom). Before,after analyses of participants aged 12,15, 15,18, 18,21 and 21,24 years. Main outcome measures were HbA1c, SH and SKA. Results For the 1592 participants, aged 12 to 24 years, mean age at enrolment was 19 ± 3 years, mean duration of diabetes was 7.3 ± 5.4 (range 0.3,24) years, mean baseline HbA1c declined from 8.8 ± 2.3% to 8.1 ± 2.0%. The incidence of SH was 0.31 vs. 0.11 events/patient/year; the incidence of SKA 0.17 vs. 0.07 events/patient/year. In mixed effects models taking into account effects of centres, age and diabetes duration, the mean difference was ,0.64%[P < 0.001, 95% confidence interval (CI) ,0.79 to ,0.5] for HbA1c, ,0.2 events/patient/year (P < 0.0001, 95% CI ,0.28 to ,0.12) for SH and ,0.1 events/patient/year (P < 0.0001, 95% CI ,0.14 to ,0.06) for SKA. Conclusions Adolescents and young adults with Type 1 diabetes benefit from participation in a standard DTTP for flexible, intensive insulin therapy and dietary freedom. [source] Comparison of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in paediatric Type 1 diabetes: a multicentre matched-pair cohort analysis over 3 yearsDIABETIC MEDICINE, Issue 1 2008B. I. Jakisch Abstract Aims To conduct a multicentre, matched-pair cohort analysis comparing glycaemic control and adverse events of continuous subcutaneous insulin infusion (CSII) with multiple daily injections (MDI) in paediatric patients. Methods Using standardized computer-based prospective documentation, HbA1c, insulin dose, body mass index,standard deviation score (BMI,SDS), rate of hypoglycaemia, rate of diabetic ketoacidosis (DKA) and intensity of care were analysed in 434 matched pairs during a follow-up period of 3 years after initiation of MDI or CSII. Results HbA1c was significantly lower in the CSII group during the first year of new regimen (CSII 7.5 ± 0.05 vs. MDI 7.7 ± 0.06; P < 0.05), but rose to the same level as in the MDI group during year 3. Insulin requirement remained significantly lower in the CSII group. The BMI,SDS increased in both study groups, with no significant difference. The rate of severe hypoglycaemia decreased significantly after the change of regimen (CSII 17.87 ± 2.85 vs. MDI 25.14 ± 3.79; P < 0.05) and during year 3 of the regimen, particularly when compared with baseline (,21% vs. ,16%). The rate of DKA was lower at baseline in the CSII group and remained significantly lower over all 3 years. Intensity of care was the same in both subsets. Conclusions Employing a large cohort, this matched-pair analysis has demonstrated over a 3-year study period that CSII is a safe form of intensive insulin therapy with similar glycaemic effects, but with significantly reduced rates of hypoglycaemia and DKA and a lower insulin requirement when compared with MDI. [source] Type 1 (distal) renal tubular acidosis in a patient with Type 1 diabetes mellitus,not all cases of metabolic acidosis in Type 1 diabetes mellitus are due to diabetic ketoacidosisDIABETIC MEDICINE, Issue 1 2008J. A. Dymot No abstract is available for this article. [source] Ethnic differences in the timely diagnosis of children with Type 1 diabetes mellitus in the Netherlands: clinical presentation at onsetDIABETIC MEDICINE, Issue 3 2007J. J. N. Van Laar Abstract Aims Little is known about ethnic differences in the timely diagnosis of Type 1 diabetes mellitus (Type 1 DM). This study aimed to assess ethnic inequalities in the timely diagnosis of Type 1 DM, as indicated by a more adverse clinical condition at onset. In addition, we assessed whether these differences could be explained by differences in socio-economic status. Methods From a national register, we selected 3128 children aged < 15 years with newly diagnosed Type 1 DM. Ethnic differences in serum glucose, blood pH, bicarbonate, presence of ketonuria, level of consciousness, hydration status, and diabetic ketoacidosis were assessed by logistic regression. A measure of socio-economic status based on postal codes was used as an explanatory variable. Results The risk of adverse clinical presentation was 1.5,2 times higher in non-Western immigrants than Dutch children, while Western immigrant children did not differ from Dutch children. Blood pH, bicarbonate level, and level of consciousness were lower in Turkish and Antillean children in particular. The adverse socio-economic position of immigrant children contributed very little to these differences in clinical presentation. Conclusions Non-Western children were likely to be sicker at first presentation of Type 1 DM, and thus diagnosis may have been delayed. These disparities were not accounted for by differences in socio-economic status. Possible explanations may be difficulties in recognition of symptoms, failure of GPs to take symptom reporting seriously and lack of awareness of the fact that Type 1 DM occurs more often in certain ethnic groups. [source] Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trialDIABETIC MEDICINE, Issue 3 2006L. M. B. Laffel Abstract Aims Diabetic ketoacidosis (DKA), a life-threatening acute complication of Type 1 diabetes, may be preventable with frequent monitoring of glycaemia and ketosis along with timely supplemental insulin. This prospective, two-centre study assessed sick day management using blood 3-hydroxybutyrate (3-OHB) monitoring compared with traditional urine ketone testing, aimed at averting emergency assessment and hospitalization. Methods One hundred and twenty-three children, adolescents and young adults, aged 3,22 years, and their families received sick day education. Participants were randomized to receive either a blood glucose monitor that also measures blood 3-OHB (blood ketone group, n = 62) or a monitor plus urine ketone strips (urine ketone group, n = 61). All were encouraged to check glucose levels , 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (, 13.9 mmol/l on two consecutive readings), or when symptoms of DKA were present. Frequency of sick days, hyperglycaemia, ketosis, and hospitalization/emergency assessment were ascertained prospectively for 6 months. Results There were 578 sick days during 21 548 days of follow-up. Participants in the blood ketone group checked ketones significantly more during sick days (276 of 304 episodes, 90.8%) than participants in the urine ketone group (168 of 274 episodes, 61.3%) (P < 0.001). The incidence of hospitalization/emergency assessment was significantly lower in the blood ketone group (38/100 patient-years) compared with the urine ketone group (75/100 patient-years) (P = 0.05). Conclusions Blood ketone monitoring during sick days appears acceptable to and preferred by young people with Type 1 diabetes. Routine implementation of blood 3-OHB monitoring for the management of sick days and impending DKA can potentially reduce hospitalization/emergency assessment compared with urine ketone testing and offers potential cost savings. [source] Pathophysiology of ketoacidosis in Type 2 diabetes mellitusDIABETIC MEDICINE, Issue 10 2005P. Linfoot Abstract Aims Despite an increasing number of reports of ketoacidosis in populations with Type 2 diabetes mellitus, the pathophysiology of the ketoacidosis in these patients is unclear. We therefore tested the roles of three possible mechanisms: elevated stress hormones, increased free fatty acids (FFA), and suppressed insulin secretion. Methods Forty-six patients who presented to the Emergency Department with decompensated diabetes (serum glucose > 22.2 mmol/l and/or ketoacid concentrations , 5 mmol/l), had blood sampled prior to insulin therapy. Three groups of subjects were studied: ketosis-prone Type 2 diabetes (KPDM2, n = 13) with ketoacidosis, non-ketosis-prone subjects with Type 2 diabetes (DM2, n = 15), and ketotic Type 1 diabetes (n = 18). Results All three groups had similar mean plasma glucose concentrations. The degree of ketoacidosis (plasma ketoacids, bicarbonate and anion gap) in Type 1 and 2 subjects was similar. Mean levels of counterregulatory hormones (glucagon, growth hormone, cortisol, epinephrine, norepinephrine), and FFA were not significantly different in DM2 and KPDM2 patients. In contrast, plasma C-peptide concentrations were approximately three-fold lower in KPDM2 vs. non-ketotic DM2 subjects (P = 0.0001). Type 1 ketotic subjects had significantly higher growth hormone (P = 0.024) and FFA (P < 0.002) and lower glucagon levels (P < 0.02) than DM2. Conclusions At the time of hospital presentation, the predominant mechanism for ketosis in KPDM2 is likely to be greater insulinopenia. [source] Cerebral metabolic alterations in children with diabetic ketoacidosisDIABETIC MEDICINE, Issue 5 2005N. S. Glaser No abstract is available for this article. [source] Insights into the acute cerebral metabolic changes associated with childhood diabetesDIABETIC MEDICINE, Issue 5 2005F. J. Cameron Abstract Aims Type 1 diabetes is a prevalent chronic disease in childhood with the commonest single cause of death being cerebral oedema in the context of diabetic ketoacidosis (DKA). The nature of the alterations in cerebral metabolism that may result in vulnerability to neuronal injury remains unknown. The aim of this study was to analyse the magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) brain data from eight children with diabetes following acute presentation with hyperglycaemia with or without ketoacidosis, to determine the nature and timing of any alterations in cerebral structure and metabolism. Methods This study used MRI and MRS to investigate regional cerebral abnormalities in a small series of diabetic patients with and without DKA. Changes were compared with the clinical and biochemical features of the patients studied. Results Our small series of patients all demonstrated abnormal signal changes in the frontal region on fluid attenuated inversion recovery (FLAIR) MR imaging, suggestive of oedema, and spectroscopic abnormalities of increased taurine, myoinositol and glucose levels. The MR abnormalities varied in severity but did not correlate with any clinical or biochemical parameters. Conclusions These changes indicate that many diabetic children, particularly at presentation, may have alterations in cerebral metabolism with implications for the pathogenesis and treatment of the cerebral complications of DKA. In addition, our findings suggest that increased taurine may be one of the important differentiating factors in the response of the brain of diabetic children to DKA that may reflect an increase in their vulnerability to cerebral oedema compared with diabetic adults. [source] Near patient blood ketone measurements and their utility in predicting diabetic ketoacidosisDIABETIC MEDICINE, Issue 2 2005S. Harris Abstract Aim To assess the utility of near patient blood ketone measurements in predicting diabetic ketoacidosis (DKA) among a group of hyperglycaemic unwell patients presenting to a hospital emergency department. Methods Near patient blood ,-hydroxybutyrate (,-OHB) testing has recently been introduced as a new tool in our hospital Accident and Emergency department (A&E) for patients with a finger-prick glucose of > 11 mmol/l. We reviewed the records of the first 50 patients to have a ,-OHB measurement to establish if they developed DKA or received treatment with intravenous insulin within 48 h of presentation. We then compared the diagnostic power of ,-OHB measurements with other clinical, physiological and biochemical markers of DKA. Results Nine patients had DKA, eight had a compensated metabolic acidosis secondary to raised serum ketones, and 33 had no evidence of DKA during the following 48 h. The median (range) ,-OHB levels in each group were 6.0 (3.1,6.0) mmol/l, 3.4 (1.2,5.7) mmol/l, and 0.1 (0.0,1.2) mmol/l, respectively. A ,-OHB level of , 3.0 mmol/l had a sensitivity of 100% and specificity of 88% for DKA. All those with ,-OHB level > 3.0 mmol/l required treatment with intravenous insulin. Conclusion Measuring ,-OHB when a hyperglycaemic patient is identified could offer a simple method of identifying at an early stage those patients at highest risk of DKA (,-OHB > 3.0 mmol/l), and redirecting the search for a diagnosis in others (,-OHB < 1.0 mmol/l). [source] Evaluation of a bedside blood ketone sensor: the effects of acidosis, hyperglycaemia and acetoacetate on sensor performanceDIABETIC MEDICINE, Issue 7 2004A. S. A. Khan Abstract Aims To assess the performance of a handheld bedside ketone sensor in the face of likely metabolic disturbances in diabetic ketoacidosis, namely: pH, glucose and acetoacetate. Methods The effects of pH (7.44,6.83), glucose (5,50 mmol/l) and acetoacetate (0,5 mmol/l) were examined in venous blood to investigate the accuracy of betahydroxybutyrate measurement (0,5 mmol/l) by a handheld ketone sensor. Sensor results were compared with a reference method. Linear regression models were fitted to the difference between the methods with the concentration of metabolite as the explanatory factor. Results Decreasing pH and increasing glucose had no effect on the accuracy of the handheld ketone sensor; the gradients of the fitted lines were ,0.14 and ,0.003, respectively. The 95% confidence intervals were ,0.7,0.4 and ,0.01,0.004, respectively (P = 0.59 and 0.4, respectively). In the acetoacetate study, a positive relationship between the sensor and reference method results was found, the gradient was 0.09. The 95% confidence interval was 0.05,0.14 (P , 0.001), indicating that high concentrations of acetoacetate interfere with the sensor performance. Conclusions Acidosis and hyperglycaemia have minimal effects on the sensor performance. However, high concentrations of acetoacetate result in some overestimation of betahydroxybutyrate. This bedside ketone sensor provides useful data over a broad range of conditions likely to be encountered during moderate to severe diabetic ketoacidosis. [source] Discontinuing insulin therapy after diabetic ketoacidosis,is its cause worth considering?DIABETIC MEDICINE, Issue 4 2003L. Czupryniak No abstract is available for this article. [source] Marked hyperphosphataemia in a patient with diabetic ketoacidosisDIABETIC MEDICINE, Issue 10 2002E. Liberopoulos No abstract is available for this article. [source] Extreme altitude mountaineering and Type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro ExpeditionDIABETIC MEDICINE, Issue 9 2001K. Moore Abstract Aims To examine the effects of extreme altitude mountaineering on glycaemic control in Type 1 diabetes, and to establish whether diabetes predisposes to acute mountain sickness (AMS). Methods Fifteen people with Type 1 diabetes and 22 nondiabetic controls were studied during the Diabetes Federation of Ireland Expedition to Kilimanjaro. Daily insulin requirements, blood glucose estimations and hypoglycaemic attacks were recorded in diaries by the people with diabetes. The performance of blood glucose meters at altitude was assessed using standard glucose solutions. Symptoms of acute mountain sickness were recorded daily by people with diabetes and by the nondiabetic controls using the Lake Louise Scoring Charts. The expedition medical team recorded the incidence of complications of altitude and of diabetes. The final height attained for each individual was recorded by the expedition medical team and verified by the expedition guides. Results The final altitude ascended was lower in the diabetic than the nondiabetic group (5187 ± 514 vs. 5654 ± 307 m, P= 0.001). The mean daily insulin dose was reduced from 67.1 ± 28.3,32.9 ± 11.8 units (P < 0.001), but only 50% of recorded blood glucose readings were within the target range of 6,14 mmol/L. There were few hypoglycaemic attacks after the first two days of climbing. Both blood glucose meters tested showed readings as low as 60% of standard glucose concentrations at high altitude and low temperatures. The Lake Louise questionnaires showed that symptoms of AMS occurred equally in the diabetic and nondiabetic groups. There were two episodes of mild diabetic ketoacidosis; two of the diabetic group and three of the nondiabetic group developed retinal haemorrhages. Conclusions People with Type 1 diabetes can participate in extreme altitude mountaineering. However, there are significant risks associated with this activity, including hypoglycaemia, ketoacidosis and retinal haemorrhage, with the additional difficulties in assessing glycaemic control due to meter inaccuracy at high altitude. People with Type 1 diabetes must be carefully counselled before attempting extreme altitude mountaineering. Diabet. Med. 18, 749,755 (2001) [source] Towards an understanding of the high death rate among young people with diabetes in UkraineDIABETIC MEDICINE, Issue 1 2001M. Telishevka SUMMARY Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. Methods Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers. [source] Bilateral optic atrophy following diabetic ketoacidosisDIABETIC MEDICINE, Issue 5 2000S. H. Song Summary Diabetic ketoacidosis (DKA) can result in neuropathic abnormalities of the somatic and the autonomous nervous systems. We report the case of a 50-year-old man with Type 1 diabetes of 20-year duration who after severe DKA lost vision in his right eye and only retain partial vision in his left. This case demonstrates that optic neural tissue is vunerable to haemodynamic and metabolic complications of DKA. [source] Macular oedema with associated uveitis and cataract following presentation of Type 1 diabetes mellitus in severe ketoacidosisDIABETIC MEDICINE, Issue 4 2000D. Gordon Abstract We present a case of cystoid macular oedema presenting in a newly diagnosed diabetic teenager. She had developed anterior uveitis prior to diabetes and whether this contributed to the subsequent ocular complications remains speculative. The macular changes resolved spontaneously over 6 months without the use of grid laser photocoagulation. [source] Review article: Hypertonic saline use in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2008Colin J Banks Abstract Hypertonic saline (HS) is being increasingly used for the management of a variety of conditions, most notably raised intracranial pressure. This article reviews the available evidence on HS solutions as they relate to emergency medicine, and develops a set of recommendations for its use. To conclude, HS is recommended as an alternative to mannitol for treating raised intracranial pressure in traumatic brain injury. HS is also recommended for treating severe and symptomatic hyponatremia, and is worth considering for both recalcitrant tricyclic antidepressant toxicity and for cerebral oedema complicating paediatric diabetic ketoacidosis. HS is not recommended for hypovolaemic resuscitation. [source] The case for venous rather than arterial blood gases in diabetic ketoacidosisEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Anne-Maree Kelly Abstract Objectives:, For patients with diabetic ketoacidosis (DKA), arterial blood gas (BG) sampling for measurement of pH and bicarbonate has been considered an essential part of initial evaluation and monitoring of progress. There is growing evidence that venous values can be clinically acceptable alternatives to arterial measurements. This article summarizes the recent evidence regarding the validity of venous BG sampling in DKA. Methods:, Medline search for the years 1995 to present, hand search of reference lists, search of on-line evidence-based medicine sites. Results:, In patients with DKA the weighted average difference between arterial and venous pH was 0.02 pH units (95% limits of agreement ,0.009 to +0.021 pH units) and between arterial and venous bicarbonate was ,1.88 mEq/L. Conclusions:, There is reasonable evidence that venous and arterial pH have sufficient agreement as to be clinically interchangeable in patients with DKA who are haemodynamically stable and without respiratory failure. There is some evidence that venous and arterial bicarbonate also agree closely in DKA but this requires confirmation. [source] Experiences of alcohol drinking among Swedish youths with type 1 diabetesEUROPEAN DIABETES NURSING, Issue 1 2009A Leger RN Diabetes Nurse Abstract Background: Alcohol consumption in Europe and North America is greatest in 18,25-year-olds. This behaviour can be seen as a transitional stage from childhood to adulthood, where consuming alcohol is perceived as a typical feature of adult behaviour. Youths often start to consume alcohol when they are 14,15 years of age, and one in five youngsters around 15 years of age report binge drinking. Studies of alcohol consumption among youths with type 1 diabetes have not been undertaken but it is well known that, in these people, alcohol drinking can cause hypoglycaemia and worsen the capacity to feel and interpret the symptoms of hypoglycaemia. Aim: The overall aim was to explore experiences of alcohol consumption among youths with type 1 diabetes. Another objective was to identify strategies as to how they deal with situations when they drink alcohol. Methods: Semistructured interviews with ten 18-year-old youths with type 1 diabetes, using Burnard's content analysis method. Results: This study illustrates that informants strive for security, independence and control. Frequency of binge drinking did not seem to differ from rates in other teenagers. Informants exposed themselves to considerable risks and many had met with serious incidents. Moreover, the result exemplifies how symptoms of diabetic ketoacidosis (such as nausea and vomiting) can easily be misinterpreted as a hang-over or gastroenteritis. Informants lacked age-appropriate knowledge about diabetes and the effects of alcohol, but had tested things out themselves; some involved their friends in their diabetes treatment. Moreover, three strategies occurred with the aim of normalisation and security: the 'low-consumption' strategy, the ,ambitious' strategy and the ,rather-high-than-dead' strategy. Fear of hypoglycaemia was a significant concern and the consequence was poor diabetes control. Conclusion: To increase youths' independence and security, the diabetes care team should provide adequate and relevant information about alcohol. Treatment plans might contain practical steps such as advice about responsible alcohol intake and adjustments of insulin and meals, and could also encourage young people with diabetes to carry diabetes ID and inform friends about hypoglycaemia (and how to handle situations involving alcohol). Copyright © 2009 FEND [source] | |||||||||||||||||||||||||||||||