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.
Ever wonder why when we are severely dehydrated as diabetics or when we are dealing with an extreme high blood sugar our medical team tells us to make sure we replenish our electrolytes? I mean, what is an electrolyte anyway, what are the symptoms of low electrolytes and how can they help us as diabetics or if your just out mowing the lawn? Diabetic or not, they are extremely important when it comes to our overall health so lets take a closer look!
When dissolved in fluid, salts tend to break apart into their component ions, creating an electrically-conductive solution. For example, table salt (NaCl) dissolved in water dissociates into its component positive ion of sodium (Na+) and negative ion of chloride (Cl-). Any fluid that conducts electricity, such as this new saltwater solution, is known as an electrolyte solution: the salt ions of which it’s composed are then commonly referred to as electrolytes. So that leads us to the next question…
What Are Electrolytes?
There are several common electrolytes found in the body, each serving a specific and important role, but most are in some part responsible for maintaining the balance of fluids between the intracellular (inside the cell) and extracellular (outside the cell) environments. This balance is critically important for things like hydration, nerve impulses, muscle function, and pH levels.
With the correct body water balance, the electrolytes separate into positive and negative ions. When the body loses water or becomes dehydrated an electrolyte imbalance starts to occur. During heavy exercise, sodium and potassium electrolytes in particular are lost through sweating. To ensure constant electrolyte concentrations in the body, fluids must be regularly consumed.
To avoid an electrolyte imbalance which can cause lethargy and muscle twitching, athletes consume electrolyte solution drinks to make sure the electrolyte balance is maintained during and after exercise – this contributes to achieving optimum performance
You should drink frequently during strenuous physical activity. Thirst usually does not kick in until well after you have reached a state of dehydration, so consume plenty of fluid whether you feel like it or not. About 6 to 8 ounces every 15 minutes is sufficient. Help replace electrolytes by consuming a beverage that contains 0.7 milligrams of salt per quart of fluid. Consuming fruit slices, such as bananas, strawberries and oranges can help restore lost potassium, but obviously we still need to be careful here and a small bolus may be needed after exercise due to the sugar content in fruit.
7 Major Electrolytes & Their Function:
Let’s take a look:
- Sodium (Na+)
- Chloride (Cl-)
- Potassium (K+)
- Magnesium (Mg++)
- Calcium (Ca++)
- Phosphate (HPO4–)
- Bicarbonate (HCO3-)
So what do each of these to?
Sodium (NA+) is the major positive ion in fluid outside of cells (extracellular) and when combined with chloride the resulting substance is table salt. Some functions of sodium include the regulation of the total amount of water in the body and the transmission of sodium into and out of individual’s cells, which plays a role in critical body functions. Many processes in the body, especially in the brain, nervous system, and muscles require electrical signals for communication. The movement of sodium is critical in generation of these electrical signals. Too much or too little sodium can cause cells to malfunction and extremes in the blood sodium levels.
Potassium (K+) is the major positive ion found inside of cells. Some of the functions of K+ are the regulation of heartbeat and muscle function. The proper level of potassium is essential for normal cell function. Any seriously abnormal increase or decrease in K+ can profoundly affect the nervous system and increase change of irregular heartbeats.
Calcium (Ca++) is needed to build and maintain bones. It also plays a role in nerve impulse transmission and muscle contraction.
Magnesium (Mg++) is an essential mineral that is involved in more than 300 enzyme reactions in the body. Mg supports heart and nerve function. Mg is essential in the formation of bones and teeth and in converting blood sugar into energy.
Chloride (Cl-) is the major anion (negatively charged ion). CI- is found in the fluid outside of the cells and in the blood. The balance of chloride ion (CI-) is closely regulated by the body. Seawater has almost the same concentration of chloride ion as human body fluids. CI- plays a role in helping the body maintain a normal balance of fluids.
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