Monday, March 23, 2009


Questions in order

1. What is "metabolic syndrome" or "syndrome X"?
2. What is "prediabetes"?
3. How is prediabetes treated?
4. What is "hypoglycemia"?
5. What is "diabetic ketoacidosis"?
6. What are the risk factors for diabetic ketoacidosis?
7. What are the symptoms of diabetic ketoacidosis?
8. What happens when a diabetic doesn't get enough hydration?

Diabetes: Complications And Conditions
What is "metabolic syndrome" or "syndrome X"?

Metabolic syndrome, which has also been called syndrome X or the insulin resistance syndrome, is a syndrome in people which gives them a high risk for heart disease and a risk for going on to get diabetes. It's kind of inseparable from type 2 diabetes, in a way, or prediabetes. But basically, it is people who are at risk for type 2 diabetes who gain weight in their center. Gaining weight in your center leads to a higher blood pressure level, to abnormal lipid or cholesterol levels, and to an increase in insulin resistance, which means increases in insulin levels and eventually, potentially, to diabetes. So, if you have the metabolic syndrome, first and foremost, it means you need to be assessed for your risk for cardiovascular disease, for heart attack or stroke. Then you also need to be assessed for your risk for going on to develop diabetes.
What is "prediabetes"?

Prediabetes means an elevation in blood sugar levels above the normal level, but an elevation that's not really considered to be diabetes yet. So the definition is if the blood sugar level fasting, without eating overnight, is between 100 and 125, then that's considered "prediabetes." The point of this is that it's not that one day you wake up with the disease that is prediabetes, it means that you slowly started and gradually have gotten your blood sugar levels higher, higher, and higher. What you want to do is not only be aware of what your fasting blood sugar levels are, but to track the change over time. So, if you start out with a blood sugar level of 95 when you're 38, and when you're 45 it's 105, and 2 years later it's 110, you're really getting worse.
How is prediabetes treated?

The first thing you need to do in that setting is worry about your risk for heart disease because most people in that setting have the metabolic syndrome that is a risk for heart attack, stroke, caused by central fat. But, they're also having an increase in blood sugar levels and the way to reduce increasing blood sugar levels is weight loss and exercise. Seems simple, but it isn't and people need to lose about seven percent of their body weight. So it's somewhere between ten and twenty pounds and then you need to keep it off. You need to exercise and exercise five days a week, thirty minutes at a time. Then if that doesn't work, there are some medications that can be taken to prevent progression to diabetes. So, prediabetes, like everything else, can be managed. It can't entirely go away, because even if you go back to completely normal, as you get older, you get more resistant to insulin so it can actually come back. So it's one of those things that you need to be aware of to follow to work with lifestyle changes and then potentially medication to treat and hopefully prevent ever from getting heart disease or diabetes.
What is "hypoglycemia"?

Hypoglycaemia means a blood sugar level that's fallen below normal, and for most people, that means below a blood sugar of 7. And as your blood sugar falls from 7 to 5 in a case of hypoglycaemia, most people will feel it; they'll feel weak, shaky, hungry. And as your blood sugar level falls much below 5 in a case of hypoglycaemia, you stop being able to think normally: you become fuzzy, you can't do math in your head if you could do it before, and you just get sort of out of it, until you might fall into a hypoglycaemic coma. But hypoglycaemia simply means that the blood sugar is falling and the brain is not getting the glucose it needs to function normally. And your brain must have glucose to function.
What is "diabetic ketoacidosis"?

Diabetic ketoacidosis is a very serious complication that happens only in people with type one diabetes. What diabetic ketoacidosis means is that the body has so little insulin in it that it starts to break down fat. It turns out we need insulin to keep fat in our cells as well as glucose in our cells and when the fat breaks down, it causes a build-up of acid, and that build-up of acid can very quickly cause people to become comatose, they become really hypotensive and their blood pressure falls. It's very serious but also very easy to treat, you just give somebody fluid and insulin, generally by vein, until they get better. You could die from it if you have underlying heart disease, if you're elderly or if somebody doesn't treat you soon enough, because in a day or two in this state, you would be dead. So it's a very serious problem, but very very rare.
What are the risk factors for diabetic ketoacidosis?

It happens in people for a variety of reasons. One, if you don't know you have diabetes, you can develop diabetic ketoacidosis because you don't know to get insulin because nobody told you. The second reason is because you get an infection. So, let's say you get pneumonia and your body becomes very resistant to insulin as bodies tend to and you don't get enough extra insulin to compensate. Then you can go into ketoacidosis. The third reason -- and one of the reasons I see this in my population in East Los Angeles -- is because they run out of insulin: they don't have a refill; they can't find a doctor. If you don't take your insulin, this can happen. So, people with Type I diabetes must take their insulin and they must have access to insulin. Otherwise, they can get ketoacidosis; and, in the worst case scenario, they would die.
What are the symptoms of diabetic ketoacidosis?

Symptoms of diabetic ketoacidosis generally start with a person feeling just generally sick. They often get a very severe headache. They get a lot of abdominal pain. They start vomiting, nauseated. They pee a lot in the beginning, but as they get dehydrated, they stop peeing a lot. And very quickly, they'll get very dehydrated and can become comatose. But the headache and the abdominal pain and the inability to keep down fluid is very classic, and those people need to immediately go to seek medical attention, because they can quickly get worse. Those are the most common symptoms.The others are more subtle. People get a kind of breathing pattern, a Kussmaul respiration, where they have the deep breathe in and out, in order to try to get the acid out of their body. And I have had some patients call me on the phone, and I can tell they're Kussmaul breathing and I know they have ketoacidosis. But it's not exactly a way that you want to diagnose it. You basically want to take anyone with type 1 diabetes who's vomiting and unable to keep fluids down and get them to an emergency room.
What happens when a diabetic doesn't get enough hydration?

Hyperosmolar nonketotic syndrome is a syndrome that happens in adults generally with diabetes where they don't actually have enough access to water. Unlike diabetic ketoacidosis, which happens in people with type 1 diabetes where they're very suddenly sick, adults that get hyperosmolar nonketotic syndrome get gradually sick; say over a week, and I often see it in people, say for example they're in a nursing home and can't get to enough water. They're sort of out of it, and their blood sugars instead of being the normal 100 go to 200 and then 400 and then 600 and then to 1000. These are very, very, very sick people, and often they've had a heart attack or they have an infection and it often kills them. On the other hand, they're very simple to treat in a way; they really just need gentle hydration, and a little bit of insulin and they'll come back down to normal. I have seen younger people with this; just the other day I saw a 45 year-old with hyperosmolar nonketotic syndrome who was admitted to a hospital. He hadn't really taken care of or noticed his symptoms over a week and got very sick, came to my clinic after being discharged from the hospital and is now doing fine. So, hyperosmolar nonketotic syndrome is really a state of the body just becoming extremely dehydrated due to high blood sugar levels, but because it happens in elderly people who are also sick for other reasons it can be very serious.


Diabetes: What is "metabolic syndrome" or "syndrome X"?


Diabetes: What is "prediabetes"?


Diabetes: How is prediabetes treated?


Diabetes: What is "hypoglycemia"?


Diabetes: What is "diabetic ketoacidosis"?


Diabetes: What are the risk factors for diabetic ketoacidosis?


Diabetes: What are the symptoms of diabetic ketoacidosis?


Diabetes: What happens when a diabetic doesn't get enough hydration?

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