Diabetic Keetoacidosis (DKA)

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,

Further complicating the diagnosis and treatment can be a mixed picture of both HHS and DKA. This occurs in both type 1 diabetes and Type 2 diabetes. In this case treatment is balanced between correcting the metabolic acidosis and lowering the osmolality of the blood. (Kearney T. & Dang, C., 2007)

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

Type two diabetes mellitus or non-insulin dependent diabetes mellitus is a disease state characterized by hyperglycemia or high levels of blood glucose. This can cause a variety of symptoms such as excessive urination or excessive thirst as the kidneys try to get rid of the excess sugar.. What distinguishes type two diabetes from type one diabetes is that a person with type two diabetes is not insulin dependent. Often times, there are decreased to normal levels of insulin detected in the bloodstream of humans with type two diabetes. The reason diabetes is developed is due to insulin insensitivity or a decrease in insulin production by the beta cells in the pancreas. Usually, patients with type two diabetes exhibit both insulin insensitivity and decreased insulin production. When the body does not react to insulin or when insulin levels are too low, sugar in the blood cannot be used effectively to create anabolic products such as glycogen, and it cannot be used as fuel because the glycolysis pathway is not activated. The high glucose levels that are then left in the bloodstream can cause blood to become very viscous and lead to many vascular diseases. If diabetes type 2 is not treated, then a number of problems arise such as numbing of the extremities, poor wound healing and decreased neurological function. Renal failure may also result as the kidney overworks itself to get rid of the excess sugar. Diabetes patients are also at risk of dehydration as they constantly

Chronic elevated glucose in blood (hyperglycemia) with disturbances metabolism of protein, fat and carbohydrate resulting from disorder in insulin secretion, insulin action, or both. (1) Expected to increase diabetic patients by 2025 to approximately 300 million people in the worldwide (2) In ancient times it was difficult to identify diabetes as the ability of patients to heal weak, the researchers think the diabetes resulting from defect in the bladder and kidneys are the cause of diabetes. (6)

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 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.

Dehydration that can be a result not just of poor fluid intake but also of badly managed Type 2 Diabetes Mellitus. Blood

Ketoacidosis in diabetics also referred to as Diabetic Ketoacidosis (DKA) is a serious medical condition caused by abnormal increase in quantities of ketones in the body, as result of some unregulated biochemical circumstances. It is the combination factor of an excess of glucose in the bloodstream and abnormally high concentration of ketone bodies in the blood. Insulin is the main hormone in relation to ketoacidosis in diabetics.

Additionally, Room 40 is at risk for hyperglycemia due to DM1. A hyperosmolar hyperglycemic state (HHS) is known by a blood glucose level of greater than 600 mg/dL, hyperosmolarity (plasma osmolarity greater than 320 mOsm/L), dehydration, the lack of ketoacidosis, and depression of the sensorium. If Room 40’s insulin level appears to be higher than 600 mg600mg/dL, then he may be presenting signs of HHS. HHS causes severe dehydration which then causes the plasma volume to decrease. If the plasma volume decreases, blood glucose levels increase as well as the severity of the hyperosmolar state. Renal insufficiency can develop which causes abnormal renal

One of the diseases is diabetes mellitus which is a major cause of renal failure. This disease can be defined as an increase of fasting blood glucose that is affected by a deficiency in insulin hormone. The normal range for glucose (fasting) in the blood is 2.8-6.0 mmol/L. It is classified into two groups, type 1 (insulin-dependent diabetes mellitus) and type 2 (non insulin-dependent diabetes mellitus). Stein (2008, p.6) points out that kidney failure happens most often when patients have suffered from diabetes mellitus for more than 10 years. According to United States Renal Data System (USRDS) report in 2007, approximately 44% of primary causes of renal failure is diabetes mellitus in the United States in 2005. Also, Stein (2008) indicates that 15% of dialysis patients are influenced by diabetes mellitus in the United Kingdom. Diabetes mellitus has negative affects throughout the kidneys where the increase of the range of blood sugar causes the damages to the cells in the kidneys. This leads to the presence of the glucose in the urine which is known as glycosuric.

The most common symptoms of diabetes mellitus are chronic elevated blood glucose level. Glycosuria is a condition in which the kidneys excrete increased glucose as they are unable to reabsorb the excess amount. This leads to fluid and electrolyte excretion which leads to electrolyte imbalance and dehydration. Loss of glucose leads to increase in the use of fats and protein for the energy, which leads to accumulation of ketone bodies in the blood which leads to ketoacidosis (could be fatal).