George, Diabetic Ketoacidosis [SNR111US] |
Oxford Medical Simulation - VR training for
optimal patient care|2025 Update with
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How does the body get energy when the cells cannot absorb glucose, and
glycogen stores are exhausted?
Ketogenesis (the production of ketones) occurs when there is insufficient
glucose supply, and glycogen stores are exhausted, such as in prolonged
fasting.
How are ketones produced?
The liver takes fatty acids and converts them to ketones.
Ketones are water-soluble fatty acids that can be used as fuel.
Can the brain use ketones?
Yes, they can cross the blood-brain barrier
Is ketone production normal?
Producing ketones is normal and not harmful in healthy patients under fasting
conditions or on very low carbohydrate, high-fat diets.
How can you tell if someone is in ketosis?
Ketone levels can be measured in the urine with a dipstick test and in the
blood using a ketone meter.
People in ketosis have a characteristic acetone smell to their breath.
Why do elevated ketones not affect healthy people?
, The kidneys buffer ketone acids (ketones) in healthy people so the blood does
not become acidotic.
Without insulin, the body's cells cannot recognise glucose, even when there is
plenty in the blood, so the liver starts producing ketones for fuel. The blood
glucose and ketone levels keep rising. Initially, the kidneys produce
bicarbonate to counteract the ketone acids in the blood and maintain a normal
pH. Over time, the ketone acids use up the bicarbonate, and the blood
becomes acidic.
What is diabetic ketoacidosis?
When type 1 diabetes causes extreme hyperglycaemic ketosis, the result is life-
threatening metabolic acidosis.
What are some reasons that a patient may present with DKA?
- Initial presentation of T1DM
- Existing patient with T1DM who is unwell for another reason (infection)
- Existing T1DM patient who is not adhering to insulin regime
The most common precipitating factors of DKA are infection, missed insulin
doses and myocardial infarction.
Can someone with T2DM get a DKA?
Rarely, under conditions of extreme stress, patients with type 2 diabetes
mellitus may also develop DKA.
What are the key features of DKA? (bloods)
- Hyperglycaemia
- Ketoacidosis (metabolic acidosis, raised ketones, low bicarbonate)
- Dehydration
- Potassium imbalance
What are some presenting features of DKA?
- Polyuria, polydipsia, dehydration
- Kussmaul respiration
Oxford Medical Simulation - VR training for
optimal patient care|2025 Update with
complete solution.
How does the body get energy when the cells cannot absorb glucose, and
glycogen stores are exhausted?
Ketogenesis (the production of ketones) occurs when there is insufficient
glucose supply, and glycogen stores are exhausted, such as in prolonged
fasting.
How are ketones produced?
The liver takes fatty acids and converts them to ketones.
Ketones are water-soluble fatty acids that can be used as fuel.
Can the brain use ketones?
Yes, they can cross the blood-brain barrier
Is ketone production normal?
Producing ketones is normal and not harmful in healthy patients under fasting
conditions or on very low carbohydrate, high-fat diets.
How can you tell if someone is in ketosis?
Ketone levels can be measured in the urine with a dipstick test and in the
blood using a ketone meter.
People in ketosis have a characteristic acetone smell to their breath.
Why do elevated ketones not affect healthy people?
, The kidneys buffer ketone acids (ketones) in healthy people so the blood does
not become acidotic.
Without insulin, the body's cells cannot recognise glucose, even when there is
plenty in the blood, so the liver starts producing ketones for fuel. The blood
glucose and ketone levels keep rising. Initially, the kidneys produce
bicarbonate to counteract the ketone acids in the blood and maintain a normal
pH. Over time, the ketone acids use up the bicarbonate, and the blood
becomes acidic.
What is diabetic ketoacidosis?
When type 1 diabetes causes extreme hyperglycaemic ketosis, the result is life-
threatening metabolic acidosis.
What are some reasons that a patient may present with DKA?
- Initial presentation of T1DM
- Existing patient with T1DM who is unwell for another reason (infection)
- Existing T1DM patient who is not adhering to insulin regime
The most common precipitating factors of DKA are infection, missed insulin
doses and myocardial infarction.
Can someone with T2DM get a DKA?
Rarely, under conditions of extreme stress, patients with type 2 diabetes
mellitus may also develop DKA.
What are the key features of DKA? (bloods)
- Hyperglycaemia
- Ketoacidosis (metabolic acidosis, raised ketones, low bicarbonate)
- Dehydration
- Potassium imbalance
What are some presenting features of DKA?
- Polyuria, polydipsia, dehydration
- Kussmaul respiration
