sábado, 23 de marzo de 2019

Diabetic Ketoacidosis Causes

Diabetic Ketoacidosis Causes

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Diabetic Ketoacidosis Causes

Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes mellitus brought about by a lack of insulin in the body causing an inadequate uptake of glucose from the blood. It is characterized by a severe rise in blood sugar or hyperglycemia along with dehydration that may lead to shock and even loss of consciousness.
Insulin is an important hormone that helps the body uptake and utilize glucose present in blood, therefore reducing the blood sugar level. If there is a lack of insulin, the blood sugar is not used and instead body fats are broken down to provide an alternative energy source. This breakdown of fat however, causes the release of acidic by-products called ketones that build up in the blood and urine.
High glucose levels cause increased amounts of glucose to move into the urine, a process termed osmotic diuresis. During osmotic diuresis, water and solutes such as potassium and sodium also move into the urine. This leads to frequent excretion of large volumes of urine or polyuria, dehydration and compensatory thirst or polydypsia. Who is affected?
DKA is more common among people with type 1 diabetes or those with type 2 diabetes who take insulin to regulate their blood sugar levels. Nearly a quarter of all type 1 diabetics are admitted to hospital with DKA at some point in their lives. Young children with type 1 diabetes are at particular risk of developing the condition.

Causes

Common causes or triggers of DKA typically include situations that raise the body's requirement for insulin. Examples include:
Acute infection
During infection, the body has an increased need for glucose that may not be met by an adequate amount of insulin for stimulating the uptake of glucose from the blood. Examples of infections that can cause this problem include the flu, urinary tract infection, pneumonia and gastroenteritis.
Missing doses of insulin
Missed insulin doses may result in inadequate insulin levels, leading to DKA. This may also occur if an insulin pump is damaged or ineffective in delivering the required dose of insulin to a patient.
Major injuries or surgeries
Major injury or surgery can cause a rise in the levels of stress hormones that counteract the effects of insulin.
Major illnesses
Major illnesses such as stroke or heart attack can also raise levels of these insulin-counteracting hormones.
Alcohol or drug abuse
Binge drinking or the use of certain drugs such as ecstasy, cocaine or ketamine can increase the body's glucose requirements and raise the risk of DKA.
Patients who are unaware they are diabetic
Some patients with type 1 diabetes who have never been diagnosed may present with DKA, especially after exposure to DKA triggers such as infection, injury, surgery or illness.

Further Reading

Last Updated: Feb 26, 2019

What is Diabetic Ketoacidosis?

What is Diabetic Ketoacidosis?

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What is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus. It is characterized by a severe rise in blood sugar or hyperglycemia along with dehydration, shock and in some cases unconsciousness. The condition is brought about by a lack of insulin in the body.

Pathology of DKA

DKA is more common among people with type 1 diabetes or those with type 2 diabetes who take insulin for blood sugar control. Young children with type 1 diabetes are at the greatest risk of diabetic ketoacidosis.
As the blood sugar rises due to a relative lack of insulin, the body fails to upatake this glucose from the blood and instead enegy is provided through the breakdown of fats in the liver. This fat breakdown produces highly acidic compounds called ketones which accumulate in the body and cause the blood to become acidic (ketoacidosis).

Causes

DKA is commonly caused by factors that raise the requirement for insulin in the body. These include:
  • Acute infection
  • Missed doses of insulin
  • Major injury or surgery
  • Alcohol or drug abuse

Symptoms

The symptoms of DKA include:
  • Excessive thirst
  • Passing large volumes of urine
  • Abdominal cramps
  • Vomiting
  • Deep and rapid breathing or hyperventilation
  • In severe cases, skin may be cool and clammy and the person may seem dehydrated, have a rapid heart rate, shallow breathing, blurred vision or even loss of consciousness.
  • Fruity or pungent smelling breath due to the presence of acetone and ketones in the breath.

Diagnosis and treatment

In the case of DKA, blood has the following features:
  • pH of blood is below the usual 7.3
  • Blood and urine levels of ketones are high
  • Blood osmolarilty is low
  • There may be low blood potassium
In cases where DKA is diagnosed early, an insulin injection to correct the relative lack of insulin is usually enough to treat the condition. Individuals with more severe and advanced disease need to be hospitalized as there is a higher risk of life threatening complications such as coma, dehydration and brain damage. These individuals are given a combination of fluids to correct dehydration and insulin to correct hyperglycemia.

Further Reading

Last Updated: Feb 26, 2019

Animals That Can Detect Hypoglycemia

Animals That Can Detect Hypoglycemia

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Animals That Can Detect Hypoglycemia

Hypoglycemia is a condition where the blood level of glucose drops to below normal. Among most individuals with type 1 diabetes, the response of the hormone glucagon to low blood sugar is impaired. When these individuals use insulin to lower blood sugar levels, the absence of a normal glucagon response means the low blood sugar is not corrected, raising the risk of hypoglycemia.


The extent of hypoglycemia may be worsened by an overdose of anti-diabetes medication, vigorous exercise which depletes the body of sugar, excess alcohol intake or missed meals or snacks. Most diabetic patients have become used to recognizing the symptoms of low blood sugar which typically include tremors, sweating, palpitations, anxiety and restlessness. Some diabetics however, do not experience any symptoms of hypoglycemia at all, called hypoglycemia unawareness.
Some experts suggest that animals such as dogs can help detect hypoglycemia in patients. Researchers say that owing to their acute sense of smell, dogs may be able to detect changes in the composition of their owner’s sweat that occur when they are becoming hypoglycemic. Another theory is that visual cues such as the owner looking disorientated or trembling may alert the dog.
Previous research has shown that dogs owned by individuals with diabetes exhibit behavioral changes in response to their owner’s blood sugar falling to below normal levels. Examples of these behaviours include nudging and licking their owner, especially around the mouth, and whining, barking or howling.
In March 2008, a consumer magazine published by the American Diabetes Association called Diabetes Forecast featured an article about medical assistance dogs that are trained to recognise hypoglycemic episodes and alert their owner. The dogs are trained at a center in California which places such dogs with people who have type 1 diabetes. The dogs are trained to sense when a dangerous fall in the blood glucose is about to occur, allowing the owner to work together with the dog to prevent a hypoglycemic episode altogether.
It is not yet clear exactly how these dogs are able to sense the changes in their owners before an episode of hypoglycemia occurs but researchers believe the dogs react to scents that are created when chemical changes occur in the body as a result of glucose imbalance.
Currently, in the U.S, only a few centers exist for training assistance dogs to help diabetics. The training is time consuming and costly, meaning only a minimal number of dogs are available to be paired with an owner. At one such center called “Dogs4Diabetes,” dogs are trained to become diabetic alert dogs, dogs that have been trained to sense and respond to identifiable changes in blood chemistry that take place when their owner’s blood glucose level suddenly drops. This alerts the owner that they need to treat their hypoglycemia before they start to become symptomatic.
In order to train the dog, the animal is presented with various scents, one of which is the scent obtained from a diabetic person while they were experiencing a hypoglycemic episode. The dog is then taught to find and pick out the hypoglycemic scent. As the dog learns to recognize that scent, it is trained to respond to its owner in certain ways such as sitting and staring at the person, jumping on them or touching them with their nose.
Dogs such as Labrador Retrievers have more than 200 million sensors that can detect individual elements in parts per trillion. This compares with the parts per million detected by current technology. A rapid fall in blood glucose produces unique chemical elements that the dog can pick up on a person’s breath or skin. Evidence suggests that these changes in a diabetic’s chemistry derived from sweat or breath occur 15 to 30 minutes before there is a measurable change in the blood sugar level that can be detected by a glucose monitor. The dog can therefore be trained to respond to the changes in sweat and breath and alert their owner before they experience any symptoms of hypoglycemia.

Further Reading

Last Updated: Aug 23, 2018

Hypoglycemic Unawareness

Hypoglycemic Unawareness

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Hypoglycemic Unawareness

Hypoglycemia or low blood sugar is a problem that arises in the management of diabetes. Diabetes mellitus usually describes a persistently high blood sugar. However, various factors can cause blood sugar to plummet such as taking too much antidiabetic medication, engaging in vigorous exercise which can deplete the body of sugar, drinking too much alcohol or missing meals or snacks.
However, the majority of diabetic patients experience symptoms that indicate when their blood sugar is becoming too low. Most diabetics learn to recognize and act upon such warning signs, examples of which include:
  • Tremors
  • Sweating
  • Palpitations
  • Anxiety and feeling of dread
  • Restlessness
In some people, these symptoms do not necessarily manifest and the diabetic individual may not recognise that their blood sugar has fallen too low. This is called hypoglycemia unawareness. Individuals with long-standing insulin-dependent (type 1) diabetes are at the greatest risk of hypoglycemia unawareness but type 2 diabetics who are taking insulin due to advanced disease are also at risk.
In healthy individuals or type 2 diabetics with less advanced disease, a fall in blood sugar gives rise to the release of glucagon and epinephrine which stimulate the liver to convert glycogen to glucose and release this into the blood to normalize glucose levels. In addition, epinephrine secretion causes the physical symptoms such as palpitations and tremors that can alert a person to their low blood sugar level.
In diabetic patients who are reliant on insulin, a fall in blood glucose is not accompanied by a fall in insulin nor does it trigger the usual counter-regulatory systems such as glucagon and epinephrine secretion. In the absence of the release of these hormones, blood sugar levels are not normalized and the patient is not alerted to the fact that the sugar levels are low. Hypoglycemia unawareness in these patients can also arise due to diabetic neuropathy blunting the effects mediated by the autonomic nervous system in response to hypoglycemia.
The brain may also be desensitized to the symptoms of hypoglycaemia as it becomes "used to" low blood sugar levels. With repeated hypoglycemia, the brain increases the number of glucose transporters in neurons to enable the brain to receive a constant supply of glucose, even when blood sugar levels are low. This lowers the hypoglycemic threshold at which epinephrine is released, therefore increasing the likelihood of hypoglycemia unawareness.
In addition, certain medications may mask the symptoms of hypoglycemia. For example, certain blood pressure medications such as beta blockers may blunt the effects of epinephrine so that the typical warning signs are not experienced.

Further Reading

Last Updated: Feb 26, 2019

Diabetic Hypoglycemia Treatments

Diabetic Hypoglycemia Treatments

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Diabetic Hypoglycemia Treatments

People with diabetes are at an increased risk of diabetic hypoglycemia. This is most commonly caused by an overdose of insulin or other hypoglycemic agents, particularly if the overdose coincides with a delayed or missed meal, alcohol intake, or more physical exertion than usual. Hypoglycemia needs to be identified and treated early, before it progresses to diabetic coma.
A general outline for the treatment of diabetic hypoglycaemia is given below:

Symptoms

The signs and symptoms of hypoglycaemia vary between individuals. Most people with diabetes learn to identify their individual symptoms of hypoglycemia and know when to seek help. Symptoms usually include sweating, palpitations, and nervousness followed in the later stages by confusion, delirium, loss of consciousness, coma and even death.

Treatment

Individuals who have a blood sugar level below 70mg/dL are advised to consume some food and drink rich in glucose and people with diabetes are advised to carry such food items on them at all times for consuming if they recognize symptoms of hypoglycaemia. Some of these foods include:
    • 4 ounces of any fruit juice
    • 4 ounces of non-diet soft drink
    • 1 tablespoon of sugar or honey
    • 8 ounces of milk
    • 5 to 6 pieces of hard candy
    • 3 or 4 glucose  tablets
    • Glucose gel amounting to around 15g of carbohydrate
Around 15 minutes after consuming any of the above foods, the blood sugar should be checked and if it is still below 70mg/dL, another serving of one of the items should be eaten. If the next proper meal is around an hour away, a snack can be eaten to raise the blood sugar.
Among people with moderate-to-severe hypoglycaemia, there is a risk of losing consciousness. These individuals can be given an injection of glucagon to rapidly raise the blood sugar. Feeding a person while they are unconscious should not be attempted however, as it may lead to choking. If a person has lost consciousness, intravenous glucose may be given, often in the form of 5% dextrose solution.

Further Reading

Last Updated: Feb 26, 2019

Diabetic Hypoglycemia Etiology

Diabetic Hypoglycemia Etiology

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Diabetic Hypoglycemia Etiology

Hypoglycemia or low blood sugar refers to when blood levels of glucose drop to a below normal level.
Insulin deficiency is one of the main causes of diabetes. When food enters the bloodstream, insulin moves glucose out of blood and into cells where it is used as a source of energy. In type 1 diabetes, the cells responsible for producing insulin are damaged and no insulin is produced, leading to a rise in blood sugar levels. In type 2 diabetes, the blood sugar levels remain high because the amount of insulin produced is inadequate.
On the other hand, people with diabetes may also have an impaired glucagon response to blood sugar levels that have become low, meaning that the usual signal to the liver to break down glycogen and provide glucose is not made. People who take insulin or other antidiabetic medications to lower their blood sugar may therefore lack the ability to normalize their blood sugar once it has become low, putting them at an increased risk of severe hypoglycemia and coma.

Causes of hypoglycemia

The causes of hypoglyaemia in diabetic patients include:
  • Diabetic medications
    Hypoglycemia most commonly occurs as a side effect of antidiabetic medications. Insulin use is the most common cause of hypoglycemia which is particularly likely to occur if an overdose of insulin has been taken or if the drug is administered without food intake.
    Examples of oral medications that work by increasing insulin production include chlorpropamide, glimepiride, glipizide and glyburide. Other oral drugs that may cause a fall in blood sugar include repaglinide, nateglinide and sitagliptin. A combination of these diabetes medications may also cause hypoglycemia. However, some antidiabetic treatments such as metformin, acarbose, pioglitazone and miglitol do not cause hypoglycemia.
  • Meal times
    The timing of meals and eating is very important among people taking insulin and other blood sugar lowering medications. The amount of insulin taken needs to be balanced with the amount of food eaten if a normal or near-normal level of blood glucose is to be maintained. Hypoglycemia is likely if insulin is not taken as advised and if there is little or no carbohydrate intake. Most commonly, it occurs due to delayed or missed meals or snacks.
  • Alcohol intake
    The risk of hypoglycemia is raised in individuals who have drunk excess amounts of alcohol, especially without food.
  • Vigorous exercise
    Vigorous exercise, especially without adequate food intake, depletes the glycogen levels and there may be a severe fall in blood sugar.

Further Reading

Last Updated: Feb 26, 2019

What is Diabetic Hypoglycemia?

What is Diabetic Hypoglycemia?

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What is Diabetic Hypoglycemia?

Hypoglycemia or low blood sugar is a condition where blood levels of glucose drop below a critical level. Glucose provides energy for various bodily functions and is therefore vital for survival.
Glucose is one of the most important sources of energy derived from the foods that we ingest. One of the main sources of glucose is the carbohydrate food group. Rice, potatoes, bread, milk, cereal, sweets, fruits and vegetables are important sources of glucose and other sugars.
Once ingested, glucose is absorbed from food into the blood which carries it into the cells of the body to provide energy for various cell functions. This uptake of glucose is regulated by a hormone called insulin which is produced in the beta cells of the pancreas in the abdomen. Insulin helps the liver and skeletal tissue take up glucose where it is stored in the form of glycogen. Fat cells also take up the glucose and store it as triglycerides. As blood glucose becomes lower, another hormone called glucagon is released by the pancreas to stop glucose levels becoming too low. Glucagon counteracts the effects of insulin by stimulating the liver to convert stored glycogen into glucose which is then released into the blood.

Glucose in diabetes

In type 1 diabetes, the pancreatic cells that release insulin have been destroyed through autoimmune attack and the body is unable to produce any insulin. Glucose therefore remains in the blood rather than being taken up and utilized by cells. In type 2 diabetes, the blood sugar levels are higher than usual because the amount of insulin produced is too low to enable cells to uptake adequate levels of glucose from the blood. Therefore, type 1 diabetes is caused by a "true" deficiency and type 2 diabetes by a relative deficiency of insulin.
People with diabetes also have an impaired glucagon response to blood sugar levels that have become too low. If diabetics take insulin to lower their blood sugar, this impaired glucagon response may mean blood glucose is not normalized once it has become too low, therefore putting them at risk of hypoglycemia.

Symptoms

Just as hypoglycemia may manifest suddenly, it can also be rapidly corrected by consuming a small amount of glucose-rich food. If left untreated, however, it can lower blood glucose in the brain leading to confusion and unconsciousness, convulsions or even hypoglycemic coma and death. Some of the symptoms include trembling, palpitations, anxiety, sweating, hunger, light headedness, confusion, slurring of speech and fatigue.

Further Reading

Last Updated: Feb 26, 2019

Causes of Foot Pain

Causes of Foot Pain

News-Medical

Causes of Foot Pain

There are many possible causes of foot pain. Some of the most common causes, from foot injuries to arthritis, are described in this article.

Injuries

An injury to the foot is one of the most common causes of foot pain.
Fractured foot x-ray
X-ray showing fracture of proximal phalange at first toe
There are several types of foot injuries that may cause pain, including:
  • Sprains or strains: stretching or tearing of the ligaments in the foot leads to inflammation and tenderness.
  • Fractures: broken or cracked bones in the feet can be very painful.
  • Achilles tendon rupture or tendinitis: a torn or ruptured Achilles tendon in the heel leads to pain and stiffness in the heel.
  • Embedded objects: an object, such as a splinter or thorn, when lodged in a foot, can cause pain.
Sprains and strains commonly affect individuals who play sports. They usually occur with quick changes of direction or speed, or when an individual lands awkwardly on their feet. Injuries are also more common for people who spend long periods of time on their feet.

Gout

Gout is a type of arthritis that involves the formation of crystals in the body due to an excessively high concentration of uric acid in the blood. When these crystals form near the joints in the foot, it can cause severe foot pain and inflammation, which may last for several days.


Verrucas

Also known as a wart, a verruca is a small white growth that can present on the feet. As they usually develop on the soles, they can be very painful during weight-bearing exercise such as walking or running.

Ill-fitting shoes

Shoes that do not properly fit the feet can cause damage to the skin and result in foot pain. Ill-fitting shoes may lead to the development of blisters, corns or calluses, which can be uncomfortable or painful, particularly when walking.

Bunions

A bunion is a bony growth that presents at the base of the big toe. This can make it difficult to fit shoes correctly. Foot pain can result from the bunion rubbing against footwear.
Bunion
Bunion in right foot.

Ingrown toenails

An ingrown toenail involves the growth of a toenail into the surrounding skin, which can be very painful. The nail can pierce the skin, causing inflammation and tenderness in the area. The toe may also become infected and lead to a build-up of pressure inside the toe, resulting in more severe pain.

Plantar fasciitis

Pain in the heel of the foot may be caused by plantar fasciitis, a condition involving damage to the fascia, the tissue under the sole. This commonly affects middle-aged people who spend long periods of time on their feet, particularly if they are overweight.

Morton’s neuroma

Morton’s neuroma involves the development of fibrous tissue around the nerves that run between the toes. This can lead to irritation and compression of the nerves, and severe burning foot pain can result.

Arthritis

Osteoarthritis and rheumatoid arthritis may also be responsible for causing foot pain. Osteoarthritis is more common and involves inflammation of the tissues around the joints in the foot, such as the ankles and toes. Rheumatoid arthritis involves an autoimmune response which damages the tissues surrounding the joints, which become inflamed and painful.

Edema

Swelling of the feet, known as edema, can cause foot pain. This involves a build-up of fluid in the feet and lower legs. In most cases, this can lead to discomfort or, in severe cases, actual pain.

Diabetic foot

Individuals with other medical conditions, such as diabetes, are more likely to experience foot problems and pain. Uncontrolled diabetes has the potential to damage the nerves and blood vessel in the feet, which can lead to neuropathic pain. This refers to the occurrence of tingling or odd sensations in the feet.

References

  1. http://www.nhs.uk/conditions/foot-pain/pages/introduction.aspx
  2. http://www.nhs.uk/conditions/heel-pain/Pages/Introduction.aspx
  3. http://www.arthritis.org/about-arthritis/where-it-hurts/foot-heel-and-toe-pain/causes/foot-diseases.php
  4. http://www.arthritis.org/about-arthritis/where-it-hurts/foot-heel-and-toe-pain/causes/foot-injury.php
  5. https://medlineplus.gov/ency/article/003183.htm
  6. http://www.arthritisresearchuk.org/arthritis-information/conditions/foot-pain/what-causes-foot-pain.aspx
  7. http://www.healthinaging.org/aging-and-health-a-to-z/topic:foot-problems/info:causes-and-symptoms/

Further Reading

Last Updated: Feb 26, 2019