Hyperglycemic crisis and insulin pump failure -
Kitabchi AE, Murphy MB, Spencer J, Matteri R, Karas J. Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis?. Umpierrez GE, Cuervo R, Karabell A, Latif K, Freire AX, Kitabchi AE.
Treatment of diabetic ketoacidosis with subcutaneous insulin aspart. Viallon A, Zeni F, Lafond P, et al. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis?. Crit Care Med. Green SM, Rothrock SG, Ho JD, et al.
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Sick day management using blood 3-hydroxybutyrate 3-OHB compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial. Diabet Med. Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education.
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search close. PREV Mar 1, NEXT. C 19 Serum ketone level should be used in the diagnosis and management of DKA. C 22 Subcutaneous insulin can be used for treatment of uncomplicated DKA. C 29 , 32 Bicarbonate therapy has not been shown to improve outcomes in persons with DKA, but is recommended by consensus guidelines for persons with a pH less than 6.
Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Copyright American Diabetes Association. Additional information from reference Hyperglycemic crisis in diabetes. PHOSPHATE AND MAGNESIUM.
eTable A. Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F. Effectiveness of a prevention program for diabetic ketoacidosis in children. org Sick day management A7 Early contact with clinician Insulin reduction rather than elimination Measurement of urine or serum ketone level Backup insulin protocol in case of insulin pump failure Psychological counseling for those who eliminate insulin for body image concerns, and those who have major depression or other psychological illnesses that interfere with proper management Disparities in care Assess reasons for discontinuation of insulin e.
DYANNE P. At the time this article was written, she was chief of Family and Community Medicine at Cooper University Hospital, and vice chair of Family Medicine and Community Health at Robert Wood Johnson Medical School in Camden.
Westerberg, DO, FAAFP, Cooper University Hospital, Haddon Ave. Trachtenbarg DE. Am Fam Physician. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved.
Venous pH may be measured as an alternative to arterial pH in persons with DKA who are hemodynamically stable and withoutrespiratory failure. Serum ketone level should be used in the diagnosis and management of DKA.
Bicarbonate therapy has not been shown to improve outcomes in persons with DKA, but is recommended by consensus guidelines for persons with a pH less than 6. Open access. Get Citation Alerts. Download PDF. Check for updates. Learning points: Euglycemic diabetic ketoacidosis is rare.
Consider ketosis in patients with DKA even if their serum glucose levels are normal. Background Diabetic ketoacidosis DKA is defined as a clinical triad comprising metabolic acidosis, hyperglycemia and increased ketone bodies in the blood and urine.
Case presentation 1 A year-old female with T1DM diagnosed five years back and on an insulin pump for the last two years was admitted with complaints of weakness and inability to eat for the past one day.
Table 1 Laboratory investigations of patient 1. Treatment She was treated with 4L bolus of IV normal saline and an insulin drip as per the protocol based on her glucose levels. Outcome and follow-up Patient was discharged to home on long-acting and short-acting insulin and was advised to get her insulin pump fixed on her next appointment with her endocrinologist.
Case presentation 2 year-old female diagnosed with T1DM 10 years back, on regular treatment with insulin glargine at bedtime and insulin aspart at sliding scale as needed before meals, came with complaints of burning while urinating and high-grade intermittent fever of up to F associated with chills and rigors.
Investigation A working diagnosis of urinary tract infection was made, and a routine blood work-up was done, the results of which are given in Table 2. Table 2 Laboratory investigations of patient 2. Treatment She was treated with 5L of bolus IV normal saline to reverse the dehydration and was started on insulin drip according to the protocol for her blood glucose levels.
Outcome and follow-up Patient was started back on her regular insulin regimen with insulin glargine and insulin aspart and was discharged home. Declaration of interest The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Patient consent Written informed consent has been obtained from the patients for publication of this article. Author contribution statement Study design, drafting by P R, critical revisions and final approval by P R, A R V, S S B and J P R.
CO; PubMed Laffel L Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. CO; false. cr PubMed Prater J Chaiban J Euglycemic diabetic ketoacidosis with acute pancreatitis in a patient not known to have diabetes.
cr false. Diabetes mellitus type 1. Diabetic ketoacidosis. Country of Treatment. United States. Signs and Symptoms. Metabolic acidosis. Renal insufficiency. Vaginal dryness. Anion gap. Creatinine serum.
Glucose blood. Glucose urine. Ketones urine. Leukocyte esterase urine. Urea and electrolytes. White blood cell count. Fluid repletion. Insulin glargine. General practice. Case Report Type. More information is on the Reasons to publish page. Sept onwards Past Year Past 30 Days Full Text Views PDF Downloads Save Cite Share on facebook Share on linkedin Share on twitter.
Related Articles. Summary Learning points: Background Case presentation 1 Investigation Treatment Outcome and follow-up Case presentation 2 Investigation Treatment Outcome and follow-up Discussion Declaration of interest Funding Patient consent Author contribution statement.
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Remember If you are sick and not eating, you may need extra insulin. Check for Urine Ketones: Negative-small ketones Take a correction dose with the pump.
If your glucose decreases, continue your activities as usual. If your blood glucose does not decrease or is higher: Re-check for urine ketones — if ketones are not improving or higher, take a correction via pen or vial and syringe injection Change your pump infusion site If your blood sugar does not decrease or is higher hours after the injection Call your diabetes team!
Remember - If your glucose does not improve after two additional insulin doses, call your diabetes team! When your glucose is high for a long period, it will take some patience, time, and sugar free decaffeinated fluids to lower your blood glucose.
Abbas E. Kitabchi anf, Cooking with fresh herbs and spices E. Umpierrez Hyperflycemic, Mary Beth MurphyHyperglycemic crisis and insulin pump failure A. Kreisberg; Hyperglycemic Crises in Adult Patients With Diabetes : A consensus statement from the American Diabetes Association. Diabetes Care 1 December ; 29 12 : — Diabetic ketoacidosis DKA and hyperosmolar hyperglycemic state HHS are the two most serious acute metabolic complications of diabetes. Hyperglyceic diabetic coma is a life-threatening disorder that causes unconsciousness. If you have insulih, dangerously high blood sugar hyperglycemia or dangerously criis blood Training adaptations hypoglycemia can lead to Supplements for athletes with food intolerances diabetic Hyperglycemic crisis and insulin pump failure. If you go into a diabetic coma, you're alive — but you can't wake up or respond purposefully to sights, sounds or other types of stimulation. If it's not treated, a diabetic coma can result in death. The idea of a diabetic coma can be scary, but you can take steps to help prevent it. One of the most important is to follow your diabetes treatment plan.
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