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diabetic ketoacidosis

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https://www.readbyqxmd.com/read/29784696/why-are-we-failing-to-address-the-issue-of-access-to-insulin-a-national-and-global-perspective
#1
David Beran, Irl B Hirsch, John S Yudkin
Insulin was discovered in 1921 and soon became widely available in high-income countries. However, many people currently in need of this life-saving medicine are unable to access it. This is a global phenomenon, impacting not only populations of low- and middle-income countries but low-income populations in the U.S. In the U.S., the rate of diabetic ketoacidosis remains high in certain subpopulations, the cost of insulin being the main precipitating factor. On a global level the main cause of mortality for a child with type 1 diabetes is a lack of access to insulin, and in sub-Saharan Africa the life expectancy of a child with type 1 diabetes can be as low as 1 year...
June 2018: Diabetes Care
https://www.readbyqxmd.com/read/29782357/reversible-microvascular-hyporeactivity-to-acetylcholine-during-diabetic-ketoacidosis
#2
Jérémie Joffre, Simon Bourcier, Geoffroy Hariri, Arnaud-Felix Miailhe, Naike Bigé, Guillaume Dumas, Vincent Dubée, Pierre-Yves Boelle, Idriss Abdallah, Jean-Luc Baudel, Bertrand Guidet, Eric Maury, Hafid Ait-Oufella
OBJECTIVES: Metabolic acidosis is commonly observed in critically ill patients. Experimental studies suggested that acidosis by itself could impair vascular function, but this has been poorly investigated in human. DESIGN: Prospective observational study. SETTING: Medical ICU in a tertiary teaching hospital. PATIENTS: To assess the relationship between metabolic acidosis severity and microvascular reactivity, we included adult diabetic patients admitted in ICU for ketoacidosis...
May 18, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29781681/the-management-of-diabetic-ketoacidosis-at-a-rural-regional-hospital-in-kwazulu-natal
#3
Nontobeko F M Ndebele, Mergan Naidoo
BACKGROUND:  Diabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal. METHODS:  A retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period...
March 22, 2018: African Journal of Primary Health Care & Family Medicine
https://www.readbyqxmd.com/read/29774417/first-report-on-the-nationwide-incidence-of-type-1-diabetes-and-ketoacidosis-at-onset-in-children-in-serbia-a-multicenter-study
#4
Rade Vukovic, Maja D Jesic, Ivana Vorgucin, Sandra Stankovic, Nevena Folic, Tatjana Milenkovic, Silvija Sajic, Dragan Katanic, Sasa Zivic, Slavica Markovic, Ivan Soldatovic
Data regarding incidence of type 1 diabetes (T1DM), as well as data on frequency and severity of diabetic ketoacidosis (DKA) at the time of T1DM diagnosis is of paramount importance for national and regional healthcare planning. The aim of present multicenter study was to provide the first report regarding nationwide annual incidence rates for T1DM in youth in Serbia, as well as prevalence of DKA at the time of diagnosis. Data on all pediatric patients with newly diagnosed T1DM was retrospectively collected from all 15 regional centers for pediatric diabetes in Serbia during the period 2007-2017...
May 17, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29773640/health-care-utilization-and-burden-of-diabetic-ketoacidosis-in-the-u-s-over-the-past-decade-a-nationwide-analysis
#5
Dimpi Desai, Dhruv Mehta, Priyanka Mathias, Gopal Menon, Ulrich K Schubart
OBJECTIVE: Diabetes is one of the most common chronic diseases and a leading cause of morbidity and mortality in the U.S. Although our ability to treat diabetes and its associated complications has significantly improved, presentation with uncontrolled diabetes leading to ketoacidosis remains a significant problem. RESEARCH DESIGN AND METHODS: We aimed to determine the incidence and costs of hospital admissions associated with diabetic ketoacidosis (DKA). We reviewed the National Inpatient Sample Database for all hospitalizations in which DKA (ICD-9 codes 250...
May 17, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29770221/risperidone-induced-type-2-diabetes-presenting-with-diabetic-ketoacidosis
#6
Clarissa Ern Hui Fang, Mohammed Faraz Rafey, Aine Cunningham, Sean F Dinneen, Francis M Finucane
A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2 ). Dipstick urinalysis showed ketonuria and glycosuria...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29768296/pediatric-diabetic-ketoacidosis-with-hypotensive-shock-and-rash-an-unusual-presentation
#7
Yehonatan Pasternak, Omer Niv, Yehezkel Hezi Waisman
We describe a previously healthy adolescent boy who presented with respiratory distress, hypotensive shock, and a diffuse erythematous rash. The final diagnosis was diabetic ketoacidosis. Caregivers should be alert to this unusual combination of symptoms in the emergency department setting in order to improve the recognition and management of children with new-onset diabetes.
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29766636/empagliflozin-as-add-on-to-linagliptin-in-a-fixed-dose-combination-in-japanese-patients-with-type-2-diabetes-glycemic-efficacy-and-safety-profile-in-a-52-week-randomized-placebo-controlled-trial
#8
Ryuzo Kawamori, Masakazu Haneda, Keiko Suzaki, Gang Cheng, Kosuke Shiki, Yuki Miyamoto, Fernando Solimando, Christopher Lee, Jisoo Lee, Jyothis George
AIMS: This double-blind, randomized, placebo-controlled trial evaluated the efficacy and safety of empagliflozin (Empa) 10 or 25 mg as add-on to linagliptin (Lina) 5 mg (fixed-dose combination, Empa/Lina 10/5 or 25/5) in insufficiently controlled Japanese type 2 diabetes patients. METHODS: The trial (40 sites; May 2015-March 2017) screened 433 adults (≥20 years) who were treatment-naive or on one oral antidiabetic drug for ≥12 weeks (discontinued at enrolment)...
May 15, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29766633/empagliflozin-as-adjunct-to-insulin-in-japanese-participants-with-type-1-diabetes-results-of-a-4-week-double-blind-randomized-placebo-controlled-phase-2-trial
#9
Akira Shimada, Toshiaki Hanafusa, Atsutaka Yasui, Ganghyuck Lee, Yusuke Taneda, Akiko Sarashina, Kosuke Shiki, Jyothis George, Nima Soleymanlou, Jan Marquard
AIMS: This phase 2, double-blind, randomized, placebo-controlled trial (4 sites in Japan) investigated the pharmacodynamics (PD), pharmacokinetics (PK), and safety profile of empagliflozin in Japanese participants with type 1 diabetes mellitus (T1DM) as adjunctive therapy to insulin. MATERIALS AND METHODS: Participants on multiple daily injections of insulin for ≥12 months with an HbA1c of 7.5%-10.0%, entered a 2-week, open-label, placebo run-in period followed by a 4-week, double-blind period where participants were randomized 1:1:1:1 to receive empagliflozin 2...
May 15, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29763710/diabetes-mellitus-in-friedreich-ataxia-a-case-series-of-19-patients-from-the-german-austrian-diabetes-mellitus-registry
#10
Angeliki Pappa, Martin G Häusler, Andreas Veigel, Konstantina Tzamouranis, Martin W Pfeifer, Andreas Schmidt, Martin Bökamp, Holger Haberland, Siegfried Wagner, Joachim Brückel, Gideon de Sousa, Lukas Hackl, Esther Bollow, Reinhard W Holl
Friedreich ataxia (FRDA) is a multisystem autosomal recessive disease with progressive clinical course involving the neuromuscular and endocrine system. Diabetes mellitus (DM) is one typical non-neurological manifestation, caused by beta cell failure and insulin resistance. Because of its rarity, knowledge on DM in FRDA is limited. Based on data from 200 301 patients with DM of the German-Austrian diabetes registry (DPV) and two exemplary patient reports, characteristics of patients with DM and FRDA are compared with classical type 1 or type 2 diabetes...
May 12, 2018: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29760789/higher-cardiometabolic-risk-in-idiopathic-versus-autoimmune-type-1-diabetes-a-retrospective-analysis
#11
Valentina Guarnotta, Enrica Vigneri, Giuseppe Pillitteri, Alessandro Ciresi, Giuseppe Pizzolanti, Carla Giordano
Background: Idiopathic type 1 diabetes mellitus (IDM) is characterized by an onset with insulinopenia and ketoacidosis with negative β-cell autoimmunity markers and lack of association with HLA. The aim of the study is to compare the clinical and metabolic parameters, the macro and microvascular complications, the adipose tissue dysfunction and the insulin secretion and sensitivity indexes in patients with IDM and autoimmune type 1 diabetes mellitus (ADM) at clinical onset. Methods: Thirty patients with IDM and 30 with ADM, matched for age and gender, were retrospectively analyzed...
2018: Diabetology & Metabolic Syndrome
https://www.readbyqxmd.com/read/29756707/impact-of-the-hyperchloremic-component-of-metabolic-acidosis-on-the-patient-s-hydration-status-and-the-treatment-of-diabetic-ketoacidosis
#12
Ismael Toledo, Raquel Wainsztein, Carla Mannucci, Mabel Ferraro, Juan Ferreira, Alejandro Balestracci
INTRODUCTION: Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only...
June 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29755797/a-rare-and-lethal-complication-cerebral-edema-in-the-adult-patient-with-diabetic-ketoacidosis
#13
Christopher W Meaden, Beth J Kushner, Stacey Barnes
Commonly seen in the emergency department, diabetic ketoacidosis is a potentially lethal sequela of uncontrolled diabetes mellitus. In the adult population, a rare complication of diabetic ketoacidosis is cerebral edema. This case report discusses a 26-year-old male with new onset diabetes mellitus who developed cerebral edema leading to death.
2018: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29741925/glycemic-control-in-adult-type-1-diabetes-patients-with-insulin-glargine-insulin-detemir-or-continuous-subcutaneous-insulin-infusion-in-daily-practice
#14
Päivi Rautiainen, Hilkka Tirkkonen, Tiina Laatikainen
BACKGROUNDS: This study aims to compare glycemic control of persons with type 1 diabetes using multiple daily injections (MDI) with insulin glargine versus insulin detemir or with continuous subcutaneous insulin infusion (CSII) in daily practice. SUBJECTS AND METHODS: All adult individuals with type 1 diabetes (n = 1053) were identified from the electronic patient database in North Karelia, Finland. The persons' individual data for insulin treatment, diabetic ketoacidosis (DKA), and hemoglobin A1c (HbA1c) measurements during the year 2014 were obtained from medical records...
May 9, 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29735574/management-of-type-1-diabetes-with-a-very-low-carbohydrate-diet
#15
Belinda S Lennerz, Anna Barton, Richard K Bernstein, R David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T Rhodes, Cara B Ebbeling, Eric C Westman, William S Yancy, David S Ludwig
OBJECTIVES: To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS: We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events...
May 7, 2018: Pediatrics
https://www.readbyqxmd.com/read/29732161/rapid-onset-diabetic-ketoacidosis-secondary-to-nivolumab-therapy
#16
Senhong Lee, Aparna Morgan, Sonali Shah, Peter R Ebeling
We report a case of a 67-year-old man with type 2 diabetes presented with diabetic ketoacidosis, two weeks after his first dose of nivolumab therapy for non-small-cell lung carcinoma. He was started on empagliflozin two days prior in the setting of hyperglycaemia after the initiation of nivolumab therapy. Laboratory evaluation revealed an undetectable C-peptide and a positive anti-glutamic acid decarboxylase (GAD) antibody. He was treated with intravenous fluids and insulin infusion and was subsequently transitioned to subcutaneous insulin and discharged home...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29731652/adjunctive-therapy-for-glucose-control-in-patients-with-type-1-diabetes
#17
REVIEW
Kira Harris, Cassie Boland, Lisa Meade, Dawn Battise
Type 1 diabetes mellitus (T1DM) is characterized by relative or absolute insulin deficiency. Despite treatment with insulin therapy, glycemic goals are not always met, and insulin therapy is sometimes limited by adverse effects, including hypoglycemia and weight gain. Several adjunctive therapies have been evaluated in combination with insulin in patients with T1DM to improve glycemic control while minimizing adverse effects. Pramlintide, an amylin analog, can improve glycemic control, primarily through lowering postprandial blood glucose levels...
2018: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
https://www.readbyqxmd.com/read/29731109/plasma-glucose-to-glycated-hemoglobin-ratio-method-of-differentiating-fulminant-type-1-diabetes-from-diabetic-ketoacidosis
#18
Lan Liu, Wenjuan Jia, Yixing Wu, Ruike Liu, Chunping Zeng, Yuanyuan Hu, Jie Shen
OBJECTIVES: In fulminant type 1 diabetes mellitus (fT1DM), plasma glucose (PG) levels are strongly increased, unlike glycated hemoglobin (HbA1C ) levels, resulting in a sharply increased PG/HbA1C ratio. We investigated the PG/HbA1C ratio in fT1DM and tested the accuracy of cutoff points to easily and efficiently differentiate fT1DM from diabetic ketoacidosis (DKA). METHODS: We report 41 cases of fT1DM in which PG/HbA1C ratio was studied as a novel clinical parameter to predict fT1DM...
May 3, 2018: Annales D'endocrinologie
https://www.readbyqxmd.com/read/29721004/anterior-myocardial-pseudoinfarction-in-a-patient-with-diabetic-ketoacidosis
#19
Jose Ruiz-Morales, Catarina Canha, Farah Al-Saffar, Saif Ibrahim
No abstract text is available yet for this article.
March 2018: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29716801/eruptive-xanthoma-in-the-setting-of-hypertriglyceridemia-and-pancreatitis
#20
Matthew Stark, Jonathan Stuart
BACKGROUND: Undifferentiated dermatologic complaints are often encountered in the emergency department. While a patient's exposures, risk factors, and comorbidities may help guide emergency department evaluation, the accurate diagnosis of dermatologic findings is critical to allowing rapid identification and treatment of disease. CASE: In this vignette we discuss a case of eruptive xanthoma in a 33-year-old male with diabetic ketoacidosis and pancreatitis. DISCUSSION: Dermatologic complaints pose a unique challenge to the emergency physician...
April 25, 2018: American Journal of Emergency Medicine
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