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Diabetes ketoacidosis

Colin J Crilly, Amy J Allen, Teresa M Amato, Allison Tiberio, Rifka C Schulman, Robert A Silverman
OBJECTIVE: To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded...
February 27, 2018: American Journal of Emergency Medicine
Muhammad Ali Karamat, Shujah Dar, Srikanth Bellary, Abd A Tahrani
INTRODUCTION: To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. METHODS: Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness...
March 16, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Joseph Jonathan Lee, Matthew James Thompson, Juliet Alexandra Usher-Smith, Constantinos Koshiaris, Ann Van den Bruel
BACKGROUND: The epidemiology of type 1 diabetes mellitus (T1DM) suggests diagnostic delays may contribute to children developing diabetic ketoacidosis at diagnosis. We sought to quantify opportunities for earlier diagnosis of T1DM in primary care. METHODS: A matched case-control study of children (0-16 years) presenting to UK primary care, examining routinely collected primary care consultation types and National Institute for Health and Care Excellence (NICE) warning signs in the 13 weeks before diagnosis...
March 13, 2018: Primary Care Diabetes
Bryan Padraig Finn, Brian Fraser, Susan M O'Connell
Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new-onset type 1 diabetes (T1D). Supraventricular tachycardia (SVT), however, is a very rare complication of DKA. We present the case of a patient with new-onset T1D who presented with DKA. He received intravenous fluid resuscitation, insulin and potassium supplementation and subsequently developed SVT, confirmed on a 12-lead electrocardiograph despite a structurally normal heart. Vagal manoeuvres and adenosine failed to restore sinus rhythm, but flecainide was successful...
March 15, 2018: BMJ Case Reports
Christina Schumann, Michael Faust
BACKGROUND:  Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in diabetic ketoacidosis equivalent to a torturous death. Today, mortality from diabetic ketoacidosis is low at approximately 2 %. But each death from these two acute metabolic complications of diabetes is potentially avoidable by improved patient and healthcare professional education...
March 2018: Deutsche Medizinische Wochenschrift
Purva Sharma, Yash Jobanputra, Karen Lewin, Stuart Bagatell, Daniel Lichtstein
BACKGROUND: Diabetic ketoacidosis (DKA) is a serious complication of diabetes seen commonly in autoimmune Type 1 diabetes mellitus (DM), however patients with Type 2 diabetes are also at risk. Diabetic ketoacidosis may be precipitated by the catabolic stress of acute illness such as trauma, surgery, or infections. Recent studies have suggested that sodium glucose cotransporter-2 (SGLT-2) inhibitors precipitate DKA in Type 2 diabetes. We present a case series of four patients on SGLT-2 inhibitors who presented with DKA...
March 13, 2018: Reviews on Recent Clinical Trials
Laura Van den Mooter, Simon Caerels, Chantal Mathieu
There is a clear unmet clinical need in people with Type 1 diabetes (T1DM) considering present day insulin therapy. New insulin analogues and novel technologies allowing more tailored insulin administration have improved the quality of life of people with T1DM, but issues like hypoglycemia, weight gain and variability in glucose profiles remain problematic. Areas covered: In this review, the clinical efficacy, safety and tolerability of dapagliflozin, a sodium-glucose cotransporter type 2 inhibitor, in type 1 diabetes (T1DM) is described based on a review of phase 2 and 3 studies to date...
March 14, 2018: Expert Opinion on Pharmacotherapy
Ahmed Hassan Al-Ghamdi, Abdelhameed Ahmed Fureeh
BACKGROUND: The objectives were to describe the frequency of clinical presentation at the onset of type 1 diabetes mellitus (T1DM) and to estimate the prevalence of T1DM among children and adolescents in the AL-Baha region, Saudi Arabia, aiming for early diagnosis of T1DM. METHODS: The clinical and laboratory data of 471 children and adolescents who presented with T1DM and received medical care at an AL-Baha diabetic center during the period from 2007 to 2016 were retrospectively analyzed based on the records...
March 28, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
K Farrell, R Fernandez, Y Salamonson, R Griffiths, D J Holmes-Walker
AIMS: To identify a) determinants of glycated haemoglobin (HbA1c) at 18 and 30 months following transition in young people with Type 1 diabetes mellitus (T1DM) to a youth-specific diabetes service; and to b) evaluate the impact of the service on acute admissions with diabetic ketoacidosis (DKA) over a 14-year period. METHODS: An audit of records of youth with T1DM referred from paediatric services to the multidisciplinary transition service at Westmead Hospital, from 2001-2012, and followed-up to 2014...
March 10, 2018: Diabetes Research and Clinical Practice
Neda Mostofizadeh, Serajaddin Arefnia, Mahin Hashemipour, Elham Hashemi Dehkordi
Thrombotic thrombocytopenic purpura (TTP) secondary to diabetic ketoacidosis has been rarely reported and is considered as a rare complication. If left untreated, this condition could be life threatening with considerable morbidity and mortality. Herein, we report a 6-year-old girl with reduced consciousness and respiratory distress with a history of polydipsia and polyuria in the 2 weeks before hospitalization. The patient was initially diagnosed as diabetic ketoacidosis based on clinical and laboratory findings and treated accordingly...
2018: Advanced Biomedical Research
Jagannath M Sherigar, Joline De Castro, Yong Mei Yin, Debra Guss, Smruti R Mohanty
Glycogenic hepatopathy (GH) is a rare complication of the poorly controlled diabetes mellitus characterized by the transient liver dysfunction with elevated liver enzymes and associated hepatomegaly caused by the reversible accumulation of excess glycogen in the hepatocytes. It is predominantly seen in patients with longstanding type 1 diabetes mellitus and rarely reported in association with type 2 diabetes mellitus. Although it was first observed in the pediatric population, since then, it has been reported in adolescents and adults with or without ketoacidosis...
February 27, 2018: World Journal of Hepatology
Ryohei Ono, Koji Uehara, Izumi Kitagawa
Emphysematous osteomyelitis is a rare but potentially fatal infection. It is caused by gas-forming organismsand is characterized by the presence of intraosseous gas. A 75-year-old woman with untreated diabetes mellitus presented with difficulty in moving and anorexia. Laboratory studies revealed inflammation, a urinary infection, and diabetic ketoacidosis. Klebsiella pneumoniae was detected in both urine and blood cultures. Computed tomography and magnetic resonance imaging revealed emphysematous lesions in the paravertebral soft tissue, spinal canal, and iliopsoas muscle, with intraosseous gas at L1 and L2...
March 9, 2018: Internal Medicine
Yang Huang Grace Ng, Tat Xin Ee, Devendra Kanagalingam, Hak Koon Tan
Diabetic ketoacidosis (DKA) during pregnancy is a serious metabolic complication of diabetes with high mortality and morbidity if not detected and treated immediately. We report a case of a woman with type 1 diabetes mellitus who had poorly controlled diabetes in the first half of pregnancy and developed DKA at 29 weeks gestation. At presentation, she had a pathological fetal heart tracing but delivery was delayed for maternal stabilisation and reversal of acidosis. Once hyperglycaemia, acidosis and maternal stabilisation were achieved, fetal compromise resolved and delivery was no longer indicated...
March 9, 2018: BMJ Case Reports
Johann Große, Henriette Hornstein, Ulf Manuwald, Joachim Kugler, Ingmar Glauche, Ulrike Rothe
No abstract text is available yet for this article.
March 2018: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
Johann Große, Henriette Hornstein, Ulf Manuwald, Joachim Kugler, Ingmar Glauche, Ulrike Rothe
Type 1 diabetes mellitus (T1DM) is usually diagnosed by insulin deficiency at a young age. Diabetic ketoacidosis (DKA) represents a severe complication occurring before the first diagnosis of T1DM. Actually, the data situation is still unsettled in assessing the current state of diagnosis. This study summarizes the latest rates of DKA of new-onset T1DM in children and adolescents in different countries available over the last five years. Different T1DM-related, geographical and socioeconomic moderators are suitable to explain the heterogeneity of observed DKA rates...
March 2018: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
B Chacko, M Whitley, U Beckmann, K Murray, M Rowley
Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated euglycaemic diabetic ketoacidosis (euDKA) is a serious and increasingly recognised complication of treatment with this class of oral hypoglycaemic agents and can present a diagnostic challenge, resulting in delayed recognition, inappropriate treatment and potentially life-threatening acidosis. We present two cases of patients developing SGLT2i-associated euDKA in the early postoperative period. We support ceasing SGLT2i for 72 hours preoperatively and would suggest continuing to withhold the medication until oral intake is restored, and recommend a wider awareness of SGLT2i-associated diabetic ketoacidosis (DKA) amongst patients and their healthcare providers with an emphasis on checking ketone levels irrespective of blood glucose levels in the postoperative setting...
March 2018: Anaesthesia and Intensive Care
AbdulWahab Hritani, M Fuad Jan, Gregory Schleis, Tara Zehrer, Susan Olet, Khawaja Afzal Ammar, Suhail Allaqaband
BACKGROUND: After the introduction of the universal definition of myocardial infarction, the incidence and diagnosis of type 2 myocardial infarction have risen dramatically, yet there are no clear guidelines on clinical management. Diabetic patients are at high risk for developing type 2 myocardial infarction when admitted in a decompensated state and they are also at high risk for future cardiovascular events. METHODS: We performed a retrospective analysis of 1058 patients between 2011 and 2016 admitted with diabetic ketoacidosis or hyperosmolar hyperglycemic state...
March 5, 2018: American Journal of Medicine
Eleonora Malerba, Michela Mazzarino, Francesca Del Baldo, Sara Corradini, Gaia Carotenuto, Massimo Giunti, Federico Fracassi
Objectives The aim of this study was to evaluate the efficacy and safety of lispro insulin for the treatment of feline diabetic ketoacidosis (DKA). Times to resolution of hyperglycaemia, ketosis and acidosis were compared between cats treated with continuous rate infusion (CRI) of lispro insulin and cats treated with CRI of regular insulin. Methods Client-owned cats with naturally occurring DKA, newly diagnosed with diabetes mellitus (DM) or already receiving treatment for DM, were included. Diagnosis of DKA involved the presence of at least two clinical signs consistent with DKA (eg, polyuria/polydipsia, anorexia, severe lethargy, vomiting and dehydration), blood glucose (BG) concentration >13...
March 1, 2018: Journal of Feline Medicine and Surgery
Helen Phelan, Bruce King, Donald Anderson, Patricia Crock, Prudence Lopez, Carmel Smart
BACKGROUND: Young children with type 1 diabetes (T1D) present unique challenges for intensive diabetes management. We describe an intensive diabetes program adapted for young children and compare glycemic control, anthropometry, dietary practices and insulin regimens before and after implementation. METHODS: Cross sectional data from children with T1D aged ≥0.5 to <7.0 years attending the John Hunter Children's Hospital (JHCH), Australia in 2004, 2010 and 2016 were compared...
March 4, 2018: Pediatric Diabetes
Lan Liu, Wenjuan Jia, Ruike Liu, Jie Shen
BACKGROUND: Studies reported that fulminant type 1 diabetes (fT1DM) can occurred during pregnancy or within 2 weeks after delivery, and was defined as pregnancy-associated fulminant type 1 diabetes (PF). In PF patients, plasma glucose (PG) levels have an abrupt rise while glycated hemoglobin (HbA1C ) levels are not markedly elevated, resulting in a sharply increased PG/HbA1C ratio. METHODS: We studied 30 PF patients, 21 non-pregnant fulminant type 1 diabetes (NPF) patients, and 26 female patients of child-bearing age (13-49 years) with diabetic ketoacidosis (DKA), all from China...
March 2, 2018: Endocrine
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