Question

11. What are the goals or target A1C & blood glucose levels in diabetes and gestational diabetesCheck book and www.nutritioncaremanual.org for answers. Fill out chart. Normal Values(Not Diabetes Diabetes Gestational DM Goals pregnant/Non-Diabetie): (Diagnosis) Goals: (varies) Fasting Blood ADA, NCM 2014: sugar: S105 mg/di (goals vary w source) AIC: n/a Postprandial: 3140 mg/dl (1 hr post meal) 120 mg/dl (2 hr pp) 12. Note that goals for diabetes is different that "normal" levels. Why is that? 13. Urinary ketones should be tested in clients w/DM if pre-prandial blood glucose is >__mg/dl. 14. What is the difference between ketosis and diabetic ketoacidosis? 15. True or false? Ketoacidosis is typically a result of hypoglycemia in type 1 DM. Explain your answer.

Answer 1

12.

The general goals of the treatment of diabetes are to avoid acute decompensation, prevent or delay the appearance of late disease complications, decrease mortality, and maintain a good quality of life. As for chronic complications of the disease, it is clear that good control of glycemia makes it possible to reduce the incidence of microvascular complications (retinopathy, nephropathy, and neuropathy),3,4 whereas good control of glycemia per se does not seem to be as determinant in the prevention of macrovascular complications (ischemic heart disease, cerebrovascular disease, peripheral arteriopathy).4 In this sense, the treatment of hyperglycemia should be contemplated as part of an integral approach to the combined risk factors present in these patients (arterial hypertension [AHT], dyslipidemia, smoking). Thus, a treatment designed to obtain optimal glycemic control that neglects other cardiovascular risk factors is not very rational. In fact, it will surely be more beneficial to the diabetic patient to address cardiovascular risk factors overall, even if goals are not strictly reached for any of them. The therapeutic objectives are listed in Table 1.5-7 Glycosylated hemoglobin (HbA1c) is the best index of the control of diabetes, since it provides information about the degree of glycemic control in the last two to three months and should remain below 7%. Nevertheless, in older patient or persons with a very limited life expectancy, it is not necessary to reach this therapeutic target since it entails a high risk of causing severe hypoglycemia. As for the target values for the lipid profile and blood pressure, it should be remembered that ischemic heart disease is the main cause of mortality in diabetic patients1,2 and that the cardiovascular risk of diabetic patients is similar to that of nondiabetic patients who already have ischemic heart disease.8 Therefore, the target values required in the diabetic population should be strict and similar to those demanded in patients with established coronary artery disease.

13.140 mg/dl

14.Ketosis and ketoacidosis both involve the production of ketones in the body. However, while ketosis is generally safe, ketoacidosis can be life-threatening.

Nutritional ketosis occurs when the body starts burning fat instead of glucose. Inducing ketosis is the aim of a ketogenic diet, or "keto" diet, which is a high-fat, very-low-carb diet that can help people lose weight.

Ketoacidosis occurs when the body produces dangerously high levels of ketones, and it is often a complication of type 1 diabetes.

In this article, we discuss the differences between ketosis and ketoacidosis, including their symptoms. We also explain when to see a doctor and how to treat and prevent ketoacidosis.

Ketosis vs. ketoacidosis

A doctor may recommend blood or urine tests to determine if someone is experiencing ketosis or ketoacidosis.

Nutritional ketosis occurs when the body uses fat instead of glucose as fuel. The liver breaks down this fat into chemicals called ketones and releases them into the bloodstream. The body is then able to use the ketones as an energy source.

The ketogenic diet aims to induce nutritional ketosis. People do this by eating foods that are high in fat but very low in carbohydrates. Adopting this diet has become a popular way to burn fat and lose weight.

Doctors originally developed the ketogenic diet to treat children with epilepsy. The "classic" ketogenic diet involves eating 3–4 grams (g) of fat for every 1 g of carbohydrate and protein. According to the Epilepsy Foundation, studies show that more than 50 percent of children who try the diet have half the number of seizures or fewer, while 10–15 percent become seizure-free.

Doctors do not know why the ketogenic diet reduces some symptoms of epilepsy. Research suggests that this diet may also help with some other neurological disorders, such as Parkinson's disease and Alzheimer's disease.

In contrast, ketoacidosis occurs when the body thinks that it is starving and starts breaking down fats and proteins too quickly. It is a potential complication of type 1 diabetes.

If a person does not have enough insulin, the body cannot move glucose from the blood into cells, where it is necessary for energy. As a result, dangerous levels of both glucose and ketones can accumulate in the blood. Doctors refer to this condition as diabetic ketoacidosis.

Doctors can use blood and urine tests to determine whether a person is in ketosis or ketoacidosis.

During nutritional ketosis, it is normal to have blood ketone levels of 0.5–3.0 millimoles per liter (mmol/L). According to the American Diabetes Association, a person should check their ketone levels if their blood glucose levels are higher than 240 milligrams per deciliter (mg/dl).

People with diabetes whose blood ketone levels are high have a more significant risk of diabetic ketoacidosis.

Symptoms of ketoacidosis

Diabetic ketoacidosis is a potential complication of type 1 diabetes, and it can occur if a person does not administer enough insulin at the right times. Not eating enough food can also sometimes trigger diabetic ketoacidosis.

The symptoms of diabetic ketoacidosis include:

• high blood glucose levels
• rising levels of ketones in the urine
• thirst and frequent urination
• exhaustion
• dry or flushed skin

As ketoacidosis progresses, symptoms can include:

• nausea and vomiting
• stomach pain
• trouble breathing
• a fruity odor in the breath
• confusion and difficulty paying attention
• loss of consciousness

• Symptoms of ketosis

  Symptoms of ketosis may include fatigue, feeling cold, and general weakness.

  For most people, ketosis is a short-lived metabolic state that happens when the body temporarily switches from burning glucose to burning fat. During this time, the level of ketones in the blood rises.

  People on ketogenic diets aim to spend more extended periods in ketosis. Some people also enter a state of ketosis through fasting.

  Ketosis can lead to bad breath and weight loss. It may also cause headaches, thirst, and stomach complaints in some people.

  Although inducing ketosis is generally safe, it can lead to nutritional imbalances in some people or result in them not getting enough calories. Malnutrition can cause:

• fatigue
• weakness
• poor concentration or memory problems
• changes in mood
• anemia
• feeling cold
• getting ill more frequently
• 15.

• Diabetic Ketoacidosis (DKA)

  Insulin lets glucose get into the body's cells. Without enough insulin, the body can't use glucose for energy and starts to use fat for fuel. This can happen, for example, when someone skips doses of insulin or when the need for insulin suddenly increases (for example, due to stress or illness) and the doses are not adjusted.

  When the body uses fat for energy, chemicals called ketones are released into the blood, causing diabetic ketoacidosis (DKA). Some of the ketones, like extra glucose, exit the body through urine.

  But high levels of ketones in the blood can be a problem because they cause the blood to become acidic. Too much acid in the blood throws off the body's chemical balance.

  Diabetic ketoacidosis is a very serious — but completely preventable — condition that can lead to coma or death if it's not treated quickly. It happens more often in people with type 1 diabetes, but can sometimes happen in people with type 2 diabetes.

  Signs & Symptoms of Diabetic Ketoacidosis

  Symptoms of diabetic ketoacidosis usually don't start all at once — they usually come on slowly over several hours. Signs and symptoms include:

• fatigue (extreme tiredness)
• excessive thirst/urination
• dry mouth and dehydration

• These symptoms are caused by the sustained hyperglycemia (usually lasting several hours) that typically happens before someone develops diabetic ketoacidosis.

  If the person isn't treated, these symptoms can happen:

• abdominal pain
• nausea and/or vomiting
• fruity (acetone) breath odor
• rapid, deep breathing
• confusion
• unconsciousness ("diabetic coma")