Diabetic ketoacidosis

 

Diabetic ketosis –The warning symptoms:  Urine examination  for ketones Vs  efficacy of dry strips    :

It is very important to examine urine for ketones in certain specific situations such as :

1)                  When  patient has excessive  thirst , hunger  and frequent urination.

2)                  Whenever   there is  vomiting  with or without  deterioration  in general condition

3)                  Whenever  a diabetic is drowsy and urine is loaded with   glucose  and blood glucose  is above 250 mg% 

 

In all above mentioned situations presence of ketones in urine indicates diabetic ketosis and the patient should be instructed to seek immediate  medical attention .But how many members know how to estimate acetone in urine? Do all of us know this methodology?? 

Method for examination of ketones in urine  is simple  and essentially same as that for glucose  estimation . Many companies market dry strips for urine ketone examination e.g. Keto diastick , which is designed to simultaneously  examine glucose and   ketones in urine.

 

Tip 16 : Know about DM from these posts  & treat your pt by your own skill & wisdom:-Tr  on diabetes:--:-How to test urine glucose? Does it furnish any new in formations to us?? Limitations of urine glucose estimation

As regards urine glucose  estimation. It should  never be solely relied upon  for diagnosis of diabetes. It can only be used for getting a very rough   idea of control  on a day  to day  basis  provided the patient or  his physician interpreting the results  is thoroughly conversant with limitations and pitfalls.

While doing urine  tests observe the following

a)  Use  the dry  strip method  which is  specific for glucose instead  of Benedict’s  test which  gives many false positive  results.

In order    to reduce the cost by 50%  cut the test strip  vertically  in two equal  halves

b) Ask the patient to  complet4ely empty the bladder 15 minutes before  the time of urine  estimation so that when   the second   sample is collected for estimation  freshly formed urine  is obtained . Such  urine glucose estimation will give a more  realistic idea  about the spot  blood  glucose value.

In many diabetics glucose is invariably  spilled over in urine during the post  prandial period but they can  still have  a normal fasting blood glucose  and absence   of urine  glucose   in fasting state. However    in such  patients  urine voided first  thing in the morning  is actually  a mixture  of urine  formed  over several  hours overnight and hence it can show  glycosuria   even though  urine actually formed  in the morning  does not contain  glucose. Hence  it is  important to always  collect  freshly voided urine  for glucose  estimation .

: Tip 16 : Know about DM from these posts  & treat your pt by your own skill & wisdom:-Tr  on diabetes:--:-How to test urine glucose? Does it furnish any new in formations to us?? Limitations of urine glucose estimation

As regards urine glucose  estimation. It should  never be solely relied upon  for diagnosis of diabetes. It can only be used for getting a very rough   idea of control  on a day  to day  basis  provided the patient or  his physician interpreting the results  is thoroughly conversant with limitations and pitfalls.

While doing urine  tests observe the following

c)  Use  the dry  strip method  which is  specific for glucose instead  of Benedict’s  test which  gives many false positive  results.

In order    to reduce the cost by 50%  cut the test strip  vertically  in two equal  halves

d) Ask the patient to complet4ely empty the bladder 15 minutes before the time of urine  estimation so that when   the second   sample is collected for estimation  freshly formed urine  is obtained . Such  urine glucose estimation will give a more  realistic idea  about the spot  blood  glucose value.

In many diabetics glucose is invariably  spilled over in urine during the post  prandial period but they can  still have  a normal fasting blood glucose  and absence   of urine  glucose   in fasting state. However    in such  patients  urine voided first  thing in the morning  is actually  a mixture  of urine  formed  over several  hours overnight and hence it can show  glycosuria   even though  urine actually formed  in the morning  does not contain  glucose. Hence  it is  important to always  collect  freshly voided urine  for glucose  estimation .

examine glucose and   ketones in urine.

Tip 19 on diabetes –What are the usual investigations in diabetics and suspected diabetics??? : For  the diagnosis  of diabetes one should order Fasting and Post  75 gm glucose   challenge venous  plasma   glucose . GTT is usually not required. One should  order fasting  and post  glucose  challenge  blood  glucose  tests  in the following  situations:

a)   Those having symptoms  of diabetes

b) Those having  tuberculosis peripheral neuropathy hypertension coronary  artery  disease cerebro vascular  disease  peripheral vascular disease  eczema premature  cataract etc

c)  As   a pre operative check up

d) Those above 40 years  as part of a routine  medical  checkup

e)  These  tests should be done  every  six months in those who  have pre diabetes  and every 3 months in those who are known diabetics provided they are  well controlled d In known diabetics instead of post glucose blood  glucose post meal blood glucose should be ordered. In the initial  period  and in those who have  unstable control   blood glucose  tests should be repeated  more frequently  whereas  in emergencies  such  as diabetic  ketoacidosis  hypoglycemic coma etc  blood glucose  should be done several  times  a day.

f)    In a newly  detected diabetic  patient  the following  additional   baseline  investigations should be ordered

a)   Lipid profile

b) Serum  creatinine

c)  Full urine  examination  and test for micro albuminuria if routine  urine exam  . shows absence   of albuminuria

d) Electrocardiogram

Detailed  ophthalmic  check up 

Tip 18 : Urinary ketones in DM::: Know about DM from these posts  & treat your pt by your own skill & wisdom:-Tr  on diabetes:--:- How & when to tets Urine examination  for ketones :

It is  very important to examine urine for ketones in certain  specific situations such as :

4) When  patient has excessive  thirst hunger  and urination

5) Whenever   there is  vomiting  with or without  deterioration  in general condition

6) Whenever  a diabetic is drowsy and urine is loaded with   glucose  and blood glucose  is above 250 mg% 

 

In above mentioned situations presence of ketones in urine indicates diabetic  ketosis  and the patient should be instructed to seek immediate  medical attention .

e)  Method for examination of ketones in urine  is simple  and essentially same as that for glucose  estimation . Many  companies  market  dry strips  for urine ketone  examination  e.g. Keto diastick , which is designed to simultaneously 

Tip 20  on diabetes evolution by markers of damage already dome by long standing  untreated / uncontrolled  DM ??  A) Serum tests :- like Serum  creatinine, Dyslipidaemia, CRP,  ,,ophthalmic  check up and  urine   for micro & quantitative estimation albuminuria  should be repeated every year . Neurological evaluation essential yearly basis .If the patient  develops  proliferate  retinopathy. It should be further  evaluated with Flouroscein  aangiography and treated  with Laser photocoagulation  to prevent  blindness.