Diabetic Ketoacidosis : An Acute Complication Of Uncontrolled Glucose Levels

Ketosis is the metabolic state that most of the body's energy supply comes from ketone bodies in the blood, contrasting to the state of glycolysis in which blood glucose provides most of the energy (Taubes, 2011, 140-141). Ketosis might be better known as acetone breath, a common symptom of progressing diabetes mellitus type. It is characterized by serum concentrations of ketone bodies, with low and stable levels of insulin and blood glucose. It is commonly generalized with hyper-ketonemia, which is an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis as the liver glycogen stores are depleted (Taubes, 2011, p.155). The ketone bodies used for energy are acetoacetate and beta-hydroxybutyrate, with that, the levels of ketone bodies are regulated mainly by glucagon and insulin (p.156). Most cells can then be used by both glucose and ketone bodies for fuel, and during ketosis, free fatty acids and glucose synthesis fuel the rest.

The blood glucose level has very limited range for humans to survive and stay healthy. Generally, people are able to remove excess glucose rapidly from the body but this is not the case when they are diagnosed with diabetes and insulin resistant situations. The lack of insulin resistance can also lead to a decrease in glycogen synthesis and storage as it usually converts glucose to energy for cell’s use (Jensen & et al. 2011). When insulin is produced under insulin resistance, the cells are incapable of using them effectively which then leads to high blood sugar level as ketones and ketoacids are produced as an alternative energy source for the body. The rise of ketoacid causes the blood pH acidic and the patient may also be diagnosed with ketoacidosis (Newton & Raskin 2004). There would also be less intake of lipid and more of stored triglycerides as the lipids are effected by the insulin. As the glucose levels increase, the muscle glucose uptake will decrease while the liver glucose production and blood fatty acid concentration will also increase within the body (Lichtenstein & Schwab 2000). Excess glucose within the blood are converted to fat which can lead to Diabetic Dyslipidaemia and furthermore to obesity, hypertension and

“Diabetes is a silent killer” (Demille 2005, p.5). It is a metabolic disorder that can result in impaired quality of life and serious complications. This study aims to understand the case of Mr. Skyler Hanson who is newly diagnosed with Diabetes Mellitus Type 1 that leads to diabetic ketoacidosis which was confirmed by the presence of moderate to high ketones in the urine and a high blood glucose level. It was noted that he has a history of fatigue, headache, abdominal pain, nausea and frequent urination. Furthermore, it was disclosed that he has difficulty in adjusting to his diagnosis and he occasionally missed administration of insulin dose when socialising. Subsequently, he was admitted in the Critical Care Unit for rehydration,

Diabetes Mellitus is a growing issue for health care providers internationally. The World Health organization estimated in 2013 there were 347 Million diabetics worldwide, predicting that Diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In both type 1 and type 2 diabetes Mellitus, factors such as poor compliance with diet and medication, infection, acute medical or surgical illness or trauma can lead to poor glycaemic control, precipitating a hyperglycaemic emergency such as Diabetic Ketoacidosis (DKA) (Scobie & Samaras, 2009). In Type 2 Diabetes, another equally dangerous

DKA is presented with three major physiological disturbances which are hyperosmolality due to hyperglycemia, metabolic acidosis because of the buildup of ketoacids, and hypovalemia from osmotic diuresis. Diabetic ketoacidosis is caused by a profound deficiency of insulin, its most likely occur in people with type 1 diabetes, inadequate insulin dosage, poor self management, undiagnosed type 1 diabetes, illnesses and infections. In type 1

At Yale New Haven on the medicine floor SLA 4, the nurse manager identified the need of education on both the hyperglycemia and diabetic ketoacidosis protocols. The nurses and doctors were not aware of the steps outlined in the protocol that needed to be followed. There have been several incidents across the hospital of orders not being correctly prescribed by physicians and nurses following through with these incorrect orders, therefore seriously effecting patient outcomes. Specifically on SLA 4 there was a recent incidence of a patient coming off of an

Diabetic ketoacidosis is a dangerous state - nutritional ketosis, on the other hand, is where the body is using ketones as a fuel source safely. For those who don't have diabetes, having insulin to ensure good blood sugar levels keeps ketones at safe levels which is achieved by reducing carbohydrate-intake to below 50

Diabetic ketoacidosis is considered to be one of the most life threatening complications for Type 1 diabetics. Along with it being the most common cause of death in Type 1 diabetics under the age of 40 (Mills & Stamper, 2014). Diabetic ketoacidosis, also known as DKA, is when there are consistently high levels of glucose in the blood and not enough insulin to allow the body to function properly. The body then begins to breakdown body tissue in order to create energy in lieu of glucose. Acidic ketones begin to build up in the body and become toxic (Mills & Stamper, 2014). The amount of patients that are admitted to the hospital for a DKA episode are staggering, approximately 8,400 people were admitted from the span of April 2010 to March 2011.

For the purpose of this report we will consider the clinical scenario of Ava, and comprehensively discuss the conditions she has been diagnosed with in regards to negative feedback loops, the clinical manifestations and pathophysiology of type 1 Diabetes, an understanding of autoimmunity and how Grave’s disease identifies as autoimmune in nature, and how it also presents in Serum laboratory testing.

Diabetic ketoacidosis is an event which occurs when there is not enough insulin in the body to utilize sufficient amount of glucose needed to provide cells with energy; body then starts to use fatty acids as a fuel, which are converted to ketones in the liver. In healthy people who do not have diabetes, ketone bodies are produced in normal quantities and then successfully used by tissues as energy supply. This state is known as dietary ketosis and it is completely normal and may even provide health benefits. But in those who have diabetes, ketones are produced in enormous quantities and aren't used in full by cells, so they start to build up in the blood. Acids 3-hydroxybutyric acid and acetoacetic acid are produced rapidly causing decrease in buffering capacity of the blood and eventually depleting buffering systems (Manninen, 2004).

Classic symptoms of diabetes usually presented with newly diagnosed diabetics are: hyperglycaemia, polyuria, polydipsia, polyphagia, fatigue, blurred vision, headaches, and unexplained weight loss. Ketone bodies are found in the urine, this abnormal finding occurs when fatty acid by-products (acetones) are excreted in the urine. The ketones are present from a lack of the insulin hormone used to metabolize fats and carbohydrates. Diabetic ketoacidosis (DKA) is a life-threatening complication which results from minimal useful insulin hormone in the body, hypoglycaemia, or insufficient food intake (American Diabetes Association, 2008).

Diabetic ketoacidosis (DKA) is an acute life threatening complication of diabetes. Although DKA is most common in patients with type 1 diabetes, it can also occur in those with type 2 as seen in our patient from the case study. DKA develops when there is an absolute or relative deficiency of insulin and an increase in the levels of insulin counter regulation (Huether & McCane, 2104). DKA is characterized hyperglycemia, ketoacidosis, and ketonuria.

Shannon’s history of being a DM1 since she was three years old directly relates to her current medical condition. Illnesses interfere with the management of diabetes because blood glucose levels are not regulated when intake of food and fluids is altered as well as the administration of insulin (Centers for Disease Control and Prevention [CDC], 2014). In addition, being ill usually causes stress on the body which increases the blood glucose levels (Robbins et al., 2010). Lastly, diabetes affects the immune system by disturbing humoral immunity, damaging neutrophil function, and depressing the antioxidant system. As a result the individual will be more susceptible to illness or have a reduced ability to fight microbes. Certain organisms thrive in hyperglycemic environments which make it harder for a diabetic clients immune system to control (Casqueiro, Casqueiro, & Alves, 2012). Since Shannon has not been eating and not taking insulin she has not been managing her diabetes during their illness appropriately. This means her body has not been able to process glucose for energy and has been forced to metabolize fat instead leading to the development of DKA (Robbins et al., 2010).

Diabetic Ketoacidosis (DKA) is a disease state, most often seen in individuals with Type I Diabetes. While it most often results from uncontrolled insulin levels, young children can often present in diabetic ketoacidosis as the initial presentation of undiagnosed type I Diabetes. The major symptoms of Type I Diabetes, polydipsia, polyphagia, and polyuria, are often subtle and can be normal in growing children (Urden, Stacy & Lough, 2014; Wilson, 2012). Unless alert to the symptoms of Diabetes they can often be overlooked until severe enough to warrant immediate medical attention.

Potassium is crucial to heart function, important for normal digestive and muscular function. It is the primary positive ion (cation) found inside body cells that it is essential for normal cell function. The proper function of the body requires 8% electrolytes in the bones,90% in skin intracellular fluid and 2% in extracellular fluid. Buttarro, et. al., (2017) mentioned that the human body average potassium is about 50 mEq/kg and normal blood potassium level is 3.5 - 5.0 milliEquivalents/liter (mEq/L). The decrease in potassium level is known as Hypokalemia; it profoundly affects the nervous system and heart, and when extreme may lead to sever complication or death (Buttarro et. al., 2017). Hypokalemia is a possible life-threatening imbalance that in some cases are acquired through inducing drugs (iatrogenic), genetic, endocrine, vascular and renal disorders (Butarro et. al.,