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Science and Research

Shachi says

People with diabetes are more adversely affected when they get an infection than someone without the disease, because theyhave weakened immune defenses in diabetes. Some types of infection occur more frequently in patients with diabetes. This increased risk is largely attributable to an altered immune response due to chronic hyperglycaemia, but increased susceptibility to infection may also result from diabetic complications such as diabetic neuropathy and vascular insufficiency. Risk of most common infections is only modestly increased (e.g. 1.2 fold), but a number of rare but potentially fatal infections occur primarily or even almost exclusively in patients with diabetes. These include mucormycosis, emphysematous urinary tract infections, emphysematous cholecystitis, necrotizing fasciitis and malignant otitis externa. When you have diabetes, you are especially prone to foot infections, yeast infections, urinary tract infections and surgical site infections.Your insulin injection site can be a possible infection source. Injections provide a potential gateway for certain immune-suppressing agents to enter the blood. Immediate antimicrobial and/or surgical treatment is needed to prevent serious complications from these infections. In general, antimicrobial treatment of infections in patients with diabetes is not different than in patients without diabetes. Glucose lowering therapy often needs to be increased to counter the loss of control associated with infection. Vaccinations against influenza and pneumococcal infections are recommended for patients with diabetes. People with diabetes are reported to experience 21% more infections than the general population. Even so, it seems clear that the risk of many common infections increases in proportion to hyperglycemia. Special problems may also arise in relations to diabetic nephropathy, which may undermine host defences against infection, and peripheral vascular disease which may impair tissue nutrition, oxygen supply and the ability to mount an effective immune response. Peripheral neuropathy also increases the risk for diabetic foot infections. Hyperglycemia may compromise the immune system. Ex-vivo experiments, in which human cells are analysed in a laboratory environment outside of the body, show that innate cellular immunity may be compromised in hyperglycemic conditions. In a hyperglycemic or acidic environment neutrophils and macrophages malfunction, and restoring normoglycemia and a normal pH reverses these abnormalities.The adaptive cellular immune system may also be compromised, but evidence is sparse. T-cell function may be compromised, especially in hyperglycemic conditions. There is no evidence that the humoral adaptive immune system functions differently in patients with diabetes: this is illustrated by the fact that the antibody response to vaccinations seems to be as effective as in healthy controls.
People with diabetes are more adversely affected when they get an infection than someone without the disease, because theyhave weakened immune defenses in diabetes. Some types of infection occur more frequently in patients with diabetes. This increased risk is largely attributable to an altered immune response due to chronic hyperglycaemia, but increased susceptibility to infection may also... (Read More)
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What is Diabetic Ketoacidosis?

Shachi says

DIABETIC KETOACIDOSIS (DKA) Diabetic ketoacidosis is an acute, life threatening metabolic acidosis which mostly complicates type 1 diabetes. Occasionally a patient with type 2 diabetes may develop DKA, especially if they have intercurrent illness or long duration of diabetes with complete depletion of insulin stores. When cells don't get the glucose they need for energy, body begins to burn fat which produces ketones. Ketones are acids that build up in the blood and appear in the urine when body doesn't have enough insulin. They are a warning sign that diabetes is out of control.High levels of ketones can poison the body and when the levels get too high, a person can develop diabetic ketoacidosis, or DKA. CAUSES: Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassiumand other salts in the excessive urination is also common. PRESENTING FEATURES: The symptoms of DKA are due to metabolic acidosis and dehydration. The patient will also have symptoms of severe hyperglycemia SYMPTOMS • Polyuria, nocturia • Thirst • Weight loss • Malaise, lethargy • Visual disturbance • Abdominal pain • Anorexia • Nausea, vomiting • Breathlessness SIGNS • Dehydration, loss of skin turgor • Hypotension • Tachycardia • Hypothermia • Acetone odor in breath • Hyperventilation (Kussmaul’s breathing) • Drowsiness • Hyperreflexia, hypotonia • Acute abdomen/gastric dilation TESTS AND DIAGNOSIS: If doctor suspects diabetic ketoacidosis,he will do a physical exam and various blood tests. In some cases, additional tests may be needed to help the doctor determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: • Blood sugar level: If there isn't enough insulin in body to allow sugar to enter cells, blood sugar level will rise (hyperglycemia). As body breaks down fat and protein for energy, blood sugar level will continue to rise. • Ketone level. When body breaks down fat and protein for energy, toxic acids known as ketones enter bloodstream. • Blood acidity. If have excess ketones in blood, blood will become acidic (acidosis). This can damage organs throughout body. Additional tests doctor also may order tests to identify underlying health problems that may have contributed to diabetic ketoacidosis and check for complications. Tests may include: • Blood electrolyte tests • Urinalysis • Chest X-ray DIABETIC KETOACIDOSIS MANAGEMENT Self-Care at Home Home care is generally directed toward preventing diabetic ketoacidosis and treating moderately to elevated high levels of blood sugar. If have type 1 diabetes, should monitor blood sugars as instructed by health care practitioner. Check these levels more often if feel ill, if you are fighting an infection, or if you have had a recent illness or injury. Be alert for signs of infection and keep yourself well hydrated by drinking sugar free fluids throughout the day. The goals of treatment: Improving Circulating Volume and Tissue perfusion Decreasing serum glucose and osmolarity Clearing blood and urine ketones Correcting electrolyte imbalances Identifying and treating the underlying cause FLUID AND ELECTROLYTES As it takes about 48-72 hours for DKA to develop, full replacement of the previous losses and correction of acid-base disturbances should be done with the same speed. Initially the fluid of choice is normal saline. 1 litre should be infused in the first 1 hour; The next 1 litre in the next 2 hours; 2 litres in the next 4 hours; 2 litres in the next 8 hours. i.e. about of saline should be monitored by BP, CVP, pulse an skin turgor. If the sodium levels are >150 mEg/I, half normal saline can be used. When the blood sugar levels reach around 250 mg/ld, the fluid should be changed to 5% dextrose saline drip (along with administration of insulin) to prevent hypoglycemia. Care should be taken not to infuse large amount of fluid too rapidly in elderly patients and especially those with pre-existing heart disease, congestive cardiac failure or renal failure. Insulin It is now well-accepted that a slow, steady infusion of insulin is ideal- often in adults after a bolus of 0.1-0.2units/kg body weight. If this is not possible an hourly small injection of short or rapid acting insulin is equally effective. The recommended insulin infusion dose is 0.1unit/kg/hour Potassium Potassium levels should be monitored regularly. Initially it may be low, normal or high. If it is low, start a potassium drip immediately with 40 meg of KCI per litre of fluid to begin with making sure that the urine output is adequate (>50 ml/hr). If the response is not adequate, adjust the dose of the KCI drip accordingly. If patient is taking oral feeds, oral potassium can be formula. Next Steps Follow-up In cases of mild dehydration with borderline diabetic ketoacidosis, may be treated and released from the emergency department providing that you are reliable and will promptly follow-up with your health care practitioner. Whether you are released to go home or monitored in the hospital, it is important that close monitoring of blood sugar and urinary ketone levels be continued. Elevated blood sugars should be controlled with extra insulin doses and drinking plenty of sugar-free fluids. Long-term care should include periodic follow-up with health care practitioner to achieve good control of blood sugars. Care includes screening for and treating the complications of diabetes by periodic blood tests of hemoglobin A1C, kidney function, and cholesterol, as well as an annual eye examination and regular inspection of the feet (for evidence of wounds or damage to nerves). PREVENTION • Educate patient about sick day rules • Advise not to omit insulin • Advise patients to do frequent blood sugar monitoring and tell them the targets • Advise patients to test urine for ketones during sick days • Advise patient to seed prompt treatment for fever or any other infection • Increase fluid intake during fever • Keep a vial of regular insulin at home • Advise patients to report to hospital or physician as early as possible if unable to eat or drowsy.
DIABETIC KETOACIDOSIS (DKA) Diabetic ketoacidosis is an acute, life threatening metabolic acidosis which mostly complicates type 1 diabetes. Occasionally a patient with type 2 diabetes may develop DKA, especially if they have intercurrent illness or long duration of diabetes with complete depletion of insulin stores. When cells don't get the glucose they need for energy, body begins to burn fat... (Read More)
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Shachi says

There are three main types of carbohydrates in food, namely: • Starches (also known as complex carbohydrates) • Sugars • Fiber You'll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains and whole grains. No wonder how knowing what kind and how much carbohydrate to eat is confusing! A number on the nutrition label under 'total carbohydrate' is what you must pay attention to when counting carbs. It includes all 3 types of carbohydrates. STARCH: Foods high in starch include: • Starchy vegetables like peas, corn, lima beans and potatoes • Dried beans, lentils and peas such as pinto beans, kidney beans, black eyed peas and split peas • Grains like oats, barley and rice. (The majority of grain products are made from wheat flour. These include pasta, bread and crackers but the variety is expanding to include other grains as well.) The grain group can be broken down even further into whole grain or refined grain. A grain contains three parts: • bran- it is the outer hard shell of the grain. It is the part of the grain that provides the most fiber and most of the B vitamins and minerals. • germ- it is the next layer and is packed with nutrients including essential fatty acids and vitamin E • endosperm- it is the soft part in the center of the grain. It contains the starch. Whole grain means that the entire grain kernel is in the food. If you eat a whole grain food, it contains the bran, germ, and endosperm so you get all of the nutrients that whole grains have to offer. If you eat a refined grain food, it contains only the endosperm or the starchy part so you miss out on a lot of vitamins and minerals. Because whole grains contain the entire grain, they are much more nutritious than refined grains. SUGAR: Sugar is another type of carbohydrate. You may also hear sugar referred to as simple or fast-acting carbohydrate. There are two main types of sugar: • naturally occurring sugars such as those in milk or fruit • added sugars such as those added during processing such as fruit canned in heavy syrup or sugar added to make a cookie On the nutrition facts label, the number of sugar grams includes both added and natural sugars. Sugar is given various names like table sugar, brown sugar, molasses, honey, beet sugar, cane sugar, confectioner's sugar, powdered sugar, raw sugar, maple syrup, high-fructose corn syrup, agave nectar and sugar cane syrup. You may also see table sugar listed by its chemical name, sucrose. Fruit sugar is also known as fructose and the sugar in milk is called lactose. You can recognize other sugars on labels because their chemical names also end in "-ose." For example glucose (also called dextrose), fructose (also called levulose), lactose and maltose. FIBER Fiber comes from plant foods so there is no fiber in animal products such as milk, eggs, meat, poultry, and fish.It is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts and legumes. When you consume dietary fiber, most of it passes through the intestines and is not digested. For good health, adults need to try to eat 25 to 30 grams of fiber each day. Most of us do not consume nearly enough fiber in our diet, so while it is wise to aim for this goal, any increase in fiber in your diet can be beneficial. Most of us only get about half of what is recommended. Fiber contributes to digestive health, helps to keep you regular, and helps to make you feel full and satisfied after eating. Some suggest fibres as they help in cholestrol control. Good sources of dietary fiber include: • Beans and legumes. Think black beans, kidney beans, chick peas , white beans, and lentils. • Fruits and vegetables, especially those with edible skin (for example, apples, corn and beans) and those with edible seeds (for example, berries). • Whole grains such as: o Whole wheat pasta o Whole grain cereals (Look for those with three grams of dietary fiber or more per serving, including those made from whole wheat, wheat bran, and oats.) o Whole grain breads (To be a good source of fiber, one slice of bread should have at least three grams of fiber. Another good indication: look for breads where the first ingredient is a whole grain. For example, whole wheat or oats.) Many grain products now have "double fiber" with extra fiber added. • Nuts — try different kinds. Peanuts, walnuts and almonds are a good source of fiber and healthy fat, but watch portion sizes, because they also contain a lot of calories in a small amount. In general, an excellent source of fiber contains five grams or more per serving, while a good source of fiber contains 2.5 - 4.9 grams per serving. It is best to get your fiber from food rather than taking a supplement.The abovementioned foods have many more nutrients than fiber alone! If you sought to increase fiber intake, make sure it's gradual, so as to prevent stomach irritation, and increase your intake of water and other liquids to prevent constipation.
There are three main types of carbohydrates in food, namely: • Starches (also known as complex carbohydrates) • Sugars • Fiber You'll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains and whole grains. No wonder how knowing what kind and... (Read More)
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