Diabetic Ketoacidosis

Question 1

What are the 2 types of diabetes mellitus?

Answer 1

1. type 1: lack of production of insulin by beta cells
2. type 2: lack of response to insulin / resistance to the effects of insulin

Question 2

How does lack of insulin / lack of response to insulin cause diabetes mellitus?

Answer 2

Insulin is required to facilitate movement of glucose, potassium, and phosphorus into some cells to be used for energy.

Question 3

What is released when your blood sugar is HIGH and what is the effect?

Answer 3

insulin is released
causes glucose uptake from the blood into the tissues/cells to lower the blood glucose.

Question 4

what is release when the blood glucose is LOW and what is the effect of this?

Answer 4

glucagon is released.
This stimulates glycogen breakdown into glucose within the liver to increase the blood glucose.

Question 5

why is hyperglycemia a hallmark of diabetes mellitus?

Answer 5

there is LACK of insulin or response to insulin, so there is LACK of cellular uptake of glucose. The glucose is staying in the blood and therefore the cells are sending out signals that they are “hungry” which initiates glycogenolysis and gluconeogensis.

Question 6

What causes ketosis?

Answer 6

When there is a lack of insulin, fatty acids will be converted into ketone bodies to be used as an energy source.

Question 7

T/F: ketones are acidic and when they build up, they cause ketoacidosis

Answer 7

true

Question 8

What 2 things are required for diagnosis of diabetic ketoacidosis?

Answer 8

1. diabetes mellitus
2. acidemia (caused by excess ketones)

Question 9

what is the treatment for DKA?

Answer 9

Insulin.
This allows the cells to take up some of the glucose within the blood and reduces the “complaining” that the cells are doing to decrease gluconeogenesis and ketone prodction/ utilization.
goal: make them diabetic again.

Question 10

what are 2 reasons patients develop DKA?

Answer 10

1. unmanaged diabetes
2. previously well-managed diabetes but develops a co-morbidity thta leads to the dysregulation of diabetes mellitus. ex. neoplasia, cushings, hyperthyroidism, infections, pancreatitis

Question 11

What is regular insulin?

Answer 11

insulin that is similar to the insulin your pancreas makes
it is short acting and fast acting, so it is typically used in emergent situations or diabetic crises.

Question 12

What is intermediate/long-acting insulin used for?

Answer 12

management of diabetes mellitus in dogs and cats.
but it can also be used to managed DKAs.
It is dosed twice daily.

Question 13

when should you start insulin therapy in a case of DKA?

Answer 13

within 1-4 hours of the presentation. delaying a little is good because want to ensure they have good perfusion first.

Question 14

Why is it not recommended to monitor the blood glucose as a sole means to assess whether you have DKA under control? What would be a good adjunctive monitoring tool?

Answer 14

If you give insulin, we expect the blood glucose to decrease. However, we do not want to STOP giving insulin because the blood glucose is lower. The goal of DKA management is to lower the ketone levels.
Therefore, monitoring blood gas would be helpful to assess the blood pH (affected by ketones).

Question 15

If you are treating a patient with DKA by giving them insulin, but there blood gas shows that the pH is not increasing and their blood glucose is still high, what is your plan?

Answer 15

increase the insulin dose!

Question 16

What other values (besides pH and blood glucose) should you check when managing a DKA patient?

Answer 16

potassium!

this is because insulin facilitates movement of potassium into cells.