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Prologue
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Articles
By Adam Brochert, M.D.
Understanding
the Basics of Diabetes Mellitus:
Diabetes
is a condition characterized by abnormal glucose
(sugar) levels in the blood. In the United States,
more than 10 million people are affected. Diabetes can
begin at almost any age, from childhood to late adulthood,
and its consequences can be devastating...More
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New
Developments in the war on Diabetes:
Diabetes
mellitus is a disease that affects 10 million people
in the United States. Researchers and drug manufacturers
have been working around the clock to help unravel the
mystery of diabetes and devise new and more effective
treatments. Their efforts have already given us new
weapons in the war on diabetes, and more are on the
way...More
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Diabetic
ketoacidosis ("DKA"
for short) is a serious complication of type I diabetes. Type I
is the less common form of diabetes (only 10% of cases) that almost
always begins before the age of thirty and often begins during the
adolescent years. People with type I diabetes require insulin to
live, and without it, they will often die because of DKA.
The
term ketoacidosis refers to the fact that an excess of molecules
called ketones is produced in the liver. These ketones are
acidic and cause the pH (a measure of whether something is an acid
or a base) in the blood to fall. This is important because the pH
in our blood is kept in a very narrow range. In DKA, the pH falls
far below normal, which can be very dangerous to the body.
The
reason ketoacidosis occurs in type I diabetes is because the
pancreas
cannot produce insulin. When there is no insulin, other hormones
in the body dominate, and because the balance between insulin and
other hormones is lost, ketones get produced in overly large amounts.
This causes the pH in the blood to fall (the blood becomes acidic).
Unlike
type II diabetics, who produce enough insulin to avoid DKA, type
I diabetics produce almost no insulin and thus, cannot avoid DKA
unless they take insulin. In fact, most people with type I diabetes
get DKA as the very first manifestation of their diabetes. Because
DKA can fatal up to 10% of the time, it is important to recognize
the symptoms.
The
symptoms are numerous and include nausea, vomiting, decreased appetite,
increased urination, increased thirst, deep and rapid breathing,
and a fruity smell of the breath (which is caused by the excess
ketones in the blood). There may also be altered consciousness (sleepy,
confused, and even comatose), abdominal pain, and fever/infection.
If
a patient has never been diagnosed with diabetes before, it is difficult
to know that diabetes is the cause of these symptoms. It usually
requires a doctor’s visit to determine the nature of the illness.
However, once someone carries a diagnosis of diabetes, they may
recognize when they are going into DKA or at least know when they
are at risk.
This is extremely dangerous! Often, especially in the younger
age group, people want to ignore their diabetes and are upset that
they are not "normal." They may stop taking their insulin
as a form of denial or a way to rebel against their disease.
In
later years, people may get sick or may be eating less than normal,
so they stop taking their insulin because they are afraid their
sugar will get too low. Lastly, sometimes people run out of insulin
and for some reason cannot get to the pharmacy in a timely fashion.
These
are all improper ways of dealing with diabetes. Generally, people
should take their regular dose of insulin as prescribed. If there
is any question about what amount of insulin to take, a doctor should
be consulted. Sometimes, the dose of insulin is decreased if someone
is not eating at all, but almost never is there a situation when
insulin should be stopped completely!
The
most common cause of DKA, if someone is taking his or her insulin,
is another (or secondary) illness. Most commonly, that illness is
an infection. When the body is under stress, as from illness,
more insulin than normal is required. Any diabetic who gets sick
needs to monitor their blood sugar closely and make a visit to their
doctor as soon as possible to help prevent DKA.
The
treatment of DKA is fairly straightforward and is done in a hospital
setting. Patients require large amounts of insulin and fluids
through an IV to correct the low pH of the blood and the high sugar
levels. They also often require antibiotics for infection as
well as salt replacement. Again, it is important to remember that
death can occur in up to 10% of cases, usually due to severe infection.
The immune system of diabetics is compromised because of their condition
and infections can become very serious in a short amount of time.
Ketoacidosis
is a feared complication of type I diabetes. DKA can often be avoided
by taking insulin as prescribed and taking extra precautions whenever
an illness occurs. Knowing what to look for can mean the difference
between life and death.
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Nerve Damage (Neuropathy)
Diabetic
neuropathy is a complication of diabetes that affects the
nerves. The most common type of diabetic neuropathy affects
the peripheral...More
Ketoacidosis
Diabetic
ketoacidosis, a serious complication of high blood sugar,
is a life-threatening condition. It must be treated immediately...More
Infections
How do infections occur as a complication of
diabetes? Diabetes that is poorly controlled seems to decrease
the ability of white blood cells to fight infection...More
Foot
Ulcers and Infections
Foot ulcers (sores) and infections are a problem that can
be caused by diabetes. The severity of the problem can range
from...More
Eye
Problems (Retinopathy)
Diabetic retinopathy is an eye problem caused
by diabetes. It affects the retina. The retina is the membrane
that lines the inside of ...More
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