As a type 1 diabetic I am quite familiar (unfortunately) with the signs and symptoms of diabetic ketoacidosis. Diabetic ketoacidosis (DKA) results from lack of insulin associated with high blood levels and your body starts to produce high levels of blood acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body’s chemistry, which resolve with proper therapy.
This usually occurs in people with type 1 diabetes, but DKA can develop in any person with diabetes. Since type 1 diabetes typically starts before the age of 25, diabetic ketoacidosis is most common for this age group, but it may occur at any age with both males and females are equally affected. So is DKA something that we should be worried about? Lets take a closer look!
What Causes Ketoacidosis ?
So what’s the deal when our results come back showing ketones in urine? Circumstances arise for people with type 1 diabetes when the individual does not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When glucose is not available to feed our cells due to high blood sugars, fat is broken down and used as fuel vs glucose and this is particularly not a good thing. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are extremely poisonous. This condition is known as ketoacidosis.
Blood glucose levels rise (usually higher than 300 mg/dL) because the liver makes glucose to try to combat the problem. However, the cells cannot pull in that glucose without insulin.
DKA is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.
Although not common, people with type 2 diabetes can also develop DKA, but it is rare and typically triggered by a severe illness.
What Are The Warning Signs Of DKA?
DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms per the American Diabetes Association include the following:
- Thirst or a very dry mouth
- Frequent urination
- High blood glucose (blood sugar) levels
- High levels of ketones in the urine
Then, other symptoms appear:
- Constantly feeling tired
- Dry or flushed skin
- Nausea, vomiting, or abdominal pain
(Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than 2 hours, contact your health care provider.)
- Difficulty breathing
- Fruity odor on breath
- A hard time paying attention, or confusion
Any of these symptoms should immediately be discussed with your doctor and they will let you know the next course of action, including treatment options or better yet, a trip to the ER may be in order especially if you can flush them from your system. Speaking of treatment options, what can you expect? Lets take a closer look.
Most of you already know that I love to exercise. My day starts out at 4am, early yes, but its the only time that I get to myself during the day. As a stay at home dad of 4, I consider this a small sacrifice for my sanity as well as to benefit my bottom line as a type 1 diabetic, my health!
What makes exercise so important? Well I think we all know the answer to that question as there are so many benefits including better control of our overall blood sugars. There is a list of exercises you can do, but lets take a closer look at how you can exercise safely for better control!
Diabetes And Exercise:
Whether you have type 1 or type 2 diabetes, diabetes and exercise should go hand in hand, at least when it comes to the management aspect of the disease. Not only can exercise can help you improve your blood sugar control, boost your overall fitness, it can reduce your risk of heart disease, stroke, provide more stable blood sugar readings, and help lower blood pressure ~ all risk factors that we face.
While exercise is great for us and the benefits are well documented, as diabetics it also poses some unique challenges. To exercise safely, it’s crucial to track your blood sugar before, during and after physical activity. You’ll learn how your body responds to exercise, which can help you prevent potentially dangerous blood sugar fluctuations.
Exercise And High Blood Sugars?
This was one of the biggest hurdles for me when I was first diagnosed. My numbers would skyrocket after a workout or even during a gym session. The issue is that exercise triggers the body to release stress hormones, like adrenaline. Adrenaline tells the liver to release glucose, or cortisol which makes you more resistant to insulin, and since strenuous activity triggers an increase in these stress hormones, chances are (even temporarily) your blood sugars are often increased.
That being said different exercises affect us differently and we also know that we’re all very unique, and lets face it, type 1 diabetes effects everyone differently and no situations are ever the same. Our blood sugar response to exercise will also depend on our level of physical fitness and personal exertion. Generally speaking, 30-40 minutes of high intensity interval training will bring different results than an hour of running, doing the stair climber or even walking the dog so it will be important to closely monitor your blood sugars during exercise and see how these activity levels effect you.
Over the past couple of days, we’ve been discussing several diabetes related topics but what about one of the most important ones, especially when it comes to keeping us type 1 diabetics alive. No I’m not talking about okra, some exotic fruit, cinnamon, or essential oil I’m talking about insulin!
Before we go there though, for those of you who make these claims (especially about okra and cinnamon) in regards to treating or as many of you like to say “cure” type 1 diabetes, you really need to stop. Over the past year I’ve been getting bombarded with sales pitches and I’m honestly tired of it. Cinnamon is a great antioxidant and comes with some fantastic health benefits but when it comes to type 1 diabetes, don’t you think if it was that easy, it would be mainstream information and the millions of us that battle with this disease day in and day out would avoid the BS that we deal with daily?
Or perhaps the miracle lies within the specially formulated product you are trying to sell me? Its utterly ridiculous, and the fact that you know nothing about the disease itself or how it works, you need to take a step back and take your products with you.
I mean, you realize that you produce insulin naturally, its a normal human bodily function. What makes you think that okra, cinnamon, or your essential oil is going to magically wake up my dead beta cells (these are the cells that actually produce insulin, feel free to google, its a fascinating read). Perhaps your cinnamon, shake or oil defies all science and type 1 diabetes research?
Or perhaps you have magic okra that you purchased from the same person who sold Jack his beanstalk beans? Perhaps the laws of physics cease to exist in your potent concoction? Either way you need to stop before you seriously put someone in a very bad predicament.
Now I can only talk about type 1 diabetes as this is what I eat, breath and live with daily. With type 1 diabetes, the body’s immune system attacks part of its own pancreas. Scientists are not sure why, but the immune system mistakenly sees the insulin-producing cells in the pancreas as foreign, and destroys them. This attack is known as autoimmune disease.
Insulin is vital for survival because without it, simply put, life would cease to exist (including yours). So what is insulin and why is it so important for type 1 diabetics, lets take a look!
What Is Insulin?
So the most basic question, what is insulin? When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin (zero in the case of type 1, unless your in your honeymoon phase) or can’t use it properly, so the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems.
All people who have type 1 and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal is to keep your blood sugar level in a normal range as much as possible so you’ll stay healthy. Insulin can’t be taken by mouth. It is usually taken with injections (shots). It can also be taken with an pre filled syringe or an insulin pump.
Types Of Insulin:
Manufactured insulin comes in several types that differ in the way in which they act inside the body. Each type differs in three ways:
- Onset: The length of time after injection that the insulin begins to work
- Peak: the length of time after injection that the insulin takes to reach its maximum effectiveness
- Duration: the length of time in which it remains effective
The four basic types and their respective onset, peak and duration are as follows:
- Rapid Acting: begins to work after 15 minutes, peaks in 30 to 90 minutes, and has a duration of three to four hours.
- Short Acting: begins to work in 30 to 60 minutes, peaks in two to three hours, and has a duration of three to six hours.
- Intermediate Acting: begins to work in 90 minutes to six hours, peaks in four to 14 hours, and has a duration of up to 24 hours.
- Long Acting: begins to work in six to 14 hours and remains effective for 24 to 36 hours.
As diabetics chances are we’ve all experienced those dreaded lows, but what are they? What can we do as type 1 diabetics to avoid them and more importantly, what can we do to prevent them? Lets take a closer look and examine hypoglycemia!
The body’s most important fuel is glucose, a type of sugar. When you digest most foods, sugar is released, and that sugar ends up in your bloodstream as glucose.
Your body, particularly your brain and nervous system, needs a certain level of glucose to function — not too much, and not too little. If your blood glucose level isn’t right, your body will react by showing certain symptoms.
Hypoglycemia occurs when a person’s blood sugar levels are abnormally low, and it’s a potentially serious condition. If you know someone who has diabetes, you may have heard them talk about “insulin shock,” which is the common name for a severe hypoglycemic reaction.
People with diabetes may experience hypoglycemia if they don’t eat enough or if they take too much insulin — the medicine most commonly used to treat diabetes with those who suffer from type 1.
Causes Of Hypoglycemia:
Most cases of hypoglycemia in adults happen in people with diabetes mellitus. Diabetes has two forms, type 1 (loss of all insulin production) and type 2 (inadequate insulin production due to resistance to the actions of insulin).
People with type 1 diabetes must take insulin to control their glucose level; if they skip meals or have a decreased appetite without changing their insulin dose, BAM, you guessed it, bring on the low!
Insulin is also used to treat some people with type 2 diabetes. If a person with type 1 diabetes accidentally takes too much insulin, or a person with type 2 diabetes accidentally takes too much of their oral medications or insulin, he or she may develop hypoglycemia.
Even when a diabetic patient takes medications correctly, improper meals, odd mealtimes, or excessive exercise may result in hypoglycemia.
Classic Signs Of Hypoglycemia:
Symptoms of a low blood sugar will vary depending on the individual, but here is a list of most of the common ones that I’ve personally experienced. It should be noted that low blood sugars can occur suddenly and the most common low sugar symptoms include:
- blurry vision
- rapid heartbeat
- sudden mood changes
- sudden nervousness
- unexplained fatigue
- pale skin
- difficulty sleeping
- skin tingling
- trouble thinking clearly or concentrating
- loss of consciousness
If you have hypoglycemic unawareness, a condition in which you do not know your blood sugar level is dropping, your blood sugar can drop so quickly you may not even have warning symptoms. When this occurs, you can faint, experience a seizure, or even go into a coma. I had the unfortunate experience of a seizure a couple of years ago, definitely not something that I want to deal with again.
As diabetics, we are all well aware of fast acting insulin and the vital role it plays when it comes to keeping us alive and upright, but for those newly diagnosed diabetics (type 1 and type 2), Insulin is secreted by the beta cells in the islets of Langerhans in the pancreas, a small organ between the stomach and liver. This hormone regulates the sugar levels in the human body. When the pancreas stops secreting insulin, it results in hyperglycemia which is a common and lethal symptom of diabetes.
There are several rapid acting insulin brands, and as a type 1 diabetic, I am extremely reliant upon fast acting insulin, Novolog in particular. When discussing a topic over on The Organic Diabetic Facebook page, we got onto the subject of all the negative side effects associated with insulin and blood sugar regulation. So for all you newly diagnosed type 1’s, lets take a peek at some of the most dangerous side effects associated with fast acting insulin. Also, what drives the cost of insulin and are there programs to help defer the costs? Lets take a closer look!
Diabetes And Insulin:
Less common, but potentially more serious, is generalized allergy to fast acting insulin, which may cause rash (including pruritus) over the whole body, shortness of breath, wheezing, reduction in blood pressure, rapid pulse, or sweating. Severe cases of generalized allergy, including anaphylactic reaction, may be life threatening. Localized reactions and generalized myalgias have been reported with the use of cresol as an injectable excipient (preservative to keep insulin potent).
Fast Acting And Hyperglycemia:
Hyperglycemia, diabetic ketoacidosis, or diabetic coma may develop if the patient takes less fast acting insulin than needed to control blood glucose levels. This could be due to insulin demand during illness or infection, neglect of diet, omission or improper administration of prescribed fast acting insulin doses.
A developing ketoacidosis will be revealed by urine tests which show large amounts of sugar and acetone. The symptoms of polydipsia, polyurea, loss of appetite, fatigue, dry skin and deep and rapid breathing come on gradually, usually over a period of some hours or days. Severe sustained hyperglycemia may result in diabetic coma or death.
Fast Acting Insulin And Lipodystrophy
Long-term use of fast acting insulin, can cause lipodystrophy at the site of repeated insulin injections or infusion. Lipodystrophy includes lipohypertrophy (thickening of adipose tissue) and lipoatrophy (thinning of adipose tissue), and may affect insulin absorption. Its extremely important to rotate insulin injection or infusion sites within the same region to reduce the risk of lipodystrophy.
Honestly, when it comes to dealing with type 1 diabetes, eating disorders is not the first thing that comes to mind. As a type 1 diabetic, I was shocked when I first heard about the eating disorder (diabulimia) and its association with type 1 diabetics.
Most people are familiar with the more widely known eating disorders anorexia nervosa, bulimia nervosa and even binge eating disorder, but few recognize the link between type 1 and type 2 diabetes and eating disorders (and yes, I was one of those people).
Curious about what this eating disorder was all about, and thanks to Amy (a frequent visitor of the website) and her sharing her empowering story about her personal battle with diabulimia, I decided to do a little research, so lets take a closer look!
Although not yet officially recognized as a medical condition, diabulimia is nevertheless a serious and emerging problem. Experts predict that as many as one-third of young female diabetics could be suffering as a result of this condition. Diabulimia is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need for the purpose of weight loss. When insulin is omitted, calories are purged through the loss of glucose in the urine. Individuals with diabulimia manipulate insulin as an inappropriate behavior to prevent weight gain.
How Does Diabulimia Effect The Body:
The side effects of manipulating and omitting insulin from the body can be serious and dangerous.
Blood sugar levels can surge and reach an unhealthy level, leading to fatigue, dehydration and eventually wearing of the muscle tissue. Over a long-term, the symptoms are the same as badly managed diabetes. Although diabulimia is not a new condition, medical and mental health professionals are becoming more aware of the symptoms of diabulimia. The following are a few of the warning signs that an individual with diabetes may also be developing an eating disorder:
- Changes in eating habits (e.g., eating more but still losing weight)
Rapid weight loss or weight gain
- Poor metabolic control despite the appearance of compliance
- Low self-esteem or preoccupation with body image, weight or food intake
- Frequent urination, excessive thirst or high blood sugar levels
- Low energy, fatigue, shakiness, irritability, confusion, anxiety or fainting
- Purging behaviors (e.g., excessive exercise or the use of laxatives)
- Discomfort with eating or taking insulin in front of other people
- Hoarding food
- Unwillingness to follow through with medical appointments
- Recurrent diabetic ketoacidosis
Ok, so what’s up with this term that people keep throwing around called the dawn phenomenon? As type 1 diabetics we’ve all been there, up at 1:30 in the morning testing our blood sugars and come back with a perfect reading of 100 mg/dl only to wake up a couple of hours later with a glucose level of 400 mg/dl! Why is this?
What’s happening to our bodies during that 2 1/2 hour period that sends sends our blood sugars into the stratosphere! Welcome to what is called, the dawn phenomenon. Lets take a closer look at what this is all about and what we can do to try and stabilize our blood sugars.
What Causes The Dawn Phenomenon:
The body prepares for waking up by secreting several different hormones. First, between 4:00 and 6:30 a.m. it secretes cortisol, epinephrine, and norepinephrin. You may recognize these as they are the hormones involved in the “fight or flight response.” In this case, their job is more benign, to give you the energy to get up and moving.
Besides giving you a burst of energy, these hormones raise blood sugar. You aren’t going to be able to make any kind of energetic response if you don’t have fuel, and after a long night’s sleep, the fuel your body turns to in order to get you going is the glucose stored in the liver.
So once these hormones are secreted, typically around 5:30 am, plasma glucose and insulin can start to rise.
Though a non diabetic will automatically get a rise in insulin to help cells use this morning glucose, as type 1’s, we know that’s not always the case and instead of giving our cells a dose of morning energy, all we get is a rise in our blood sugars.
I fielded a question the other day on my Facebook page asking if I’ve ever head about a condition called HHNS or hyperosmolar hyperglycemic nonketotic syndrome.
HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly. What is HHNS though, and is it really similar to DKA or is it just your typical run of the mill high blood sugar? Lets take a closer look!
What Is HHNS?
People over the age of 65 with type 2 diabetes are at greater risk of hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Even though it is possible, it is very rare in people with type 1 diabetes can develop HHNS. HHNS is a medical emergency caused by a very high blood sugar, typically over 600 mg/dL due to poor control. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. This makes you urinate more and you lose too much body fluid, causing dehydration.
As you lose fluids, your blood becomes thicker and your blood sugar level gets too high for the kidneys to be able to fix. With the high blood sugar and dehydration there is also an imbalance of minerals, especially sodium and potassium in the blood. The imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death.
Signs & Symptoms Of HHNS?
As mentioned earlier, HHS can happen to anyone, but is more common in older individuals who have type 2 diabetes. Symptoms may begin gradually and worsen over a few days or weeks. A high blood sugar level is a warning sign of HHS. I also found it very interesting that the symptoms are very similar to diabetic ketoacidosis (DKA) so its extremely important to be aware and if you suspect anything out of the ordinary, its imperative that you call 911 or get yourself into your doctors office.
- excessive thirst
- high urine output
- dry mouth
- warm skin that doesn’t perspire
- nausea, vomiting
- weight loss
- leg cramps
- vision loss
- speech impairment
- loss of muscle function
While I’ve heard this several times, is it the insulin that is causing the weight gain, or could it be something else? Perhaps a hormone that as type 1 diabetics we also stop producing since our beta cells have died off.
Have you ever heard of Amylin? Could the lack of this hormone be the reason why she is seeing an increase in her weight? What is amylin anyway, and is it something we should be concerned with if we are no longer producing it?
These are all great questions and honestly this was news to me as well as I’ve never heard of it. So lets take a closer look at what this little hormone does and if it has a direct impact on our overall health as type 1 diabetics!
Function Of Amylin?
So what is amylin? Or as its also called, pramlintide, and how can it help us? Amylin is a peptide hormone (insulin’s partner in crime) which is released by the beta cells in response to ingesting food. This hormone, is also released at the same time as insulin, but in different quantities and its primary function is to help aid in the digestive process by helping to control the rate of digestion.
The complete range of functions of amylin is still not fully known, but its main function has been determined to be to help to slow the speed at which food is digested and glucose is released into the bloodstream after a meal. Essentially, amylin keeps too much glucose from appearing in the blood in the first place.
Amylin accomplishes this in a number of ways. It decreases appetite by promoting a feeling of fullness, hence reducing food intake. It slows gastric emptying and inhibits the secretion of digestive enzymes, all of which slow the appearance of glucose in the blood after a meal and it also slows the secretion of glucagon, which otherwise causes additional glucose release by the liver at mealtimes.
In short, the release of amylin minimizes glucose spikes that often occur after meals. I know, frustrating right! I mean this disease is already hard enough, now this. Fortunately for us, we do have another option to replace this important hormone that has also died off with our beta cells so go ahead and keep on reading.
Its a fantastic question and was a test that was run on me to confirm my type 1 diagnosis. A c-peptide! What is it? What is the purpose and why do they use this particular test in order to confirm a type 1 diabetes diagnosis? Lets take a closer look!
What Is C-Peptide?
C-peptide, similar to the hormone insulin is produced in the pancreas. Both are released simultaneously from the pancreas where a compound called pro-insulin is split into two pieces.
As we are aware by now, Insulin is responsible for regulating the body’s glucose levels. Glucose, the body’s main source of energy, is a sugar that comes from foods. After a meal, our bodies break down the foods we eat into glucose and other nutrients, which are then absorbed into the bloodstream to give us the energy we need in order to fuel our bodies. Glucose levels in the blood rise after a meal and trigger the pancreas to make insulin and release it into the blood, and when insulin is released, so is C-peptide.
Although both are released into the blood stream simultaneous, C-peptide has zero effect on our blood sugar levels. That being said, it is extremely useful as its used as a marker of insulin production, since the pancreas typically releases C-peptide and insulin in about equal amounts.
In a nut shell, high C-peptide levels are associated with increased insulin production, while low C-peptide levels indicate decreased insulin production.