Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes.  If you have diabetes, you are at risk of developing DKA.  If you or a family member has diabetes, you should know how to recognize this potentially life-threatening complication.  Let's talk more about this condition, including how to recognize the warning signs and when you should seek emergency care.

What is diabetic ketoacidosis (DKA)?

DKA develops when your body doesn't have enough insulin.  Insulin helps sugar to enter the cells of your body.  Your cells then use sugar as their main source of energy.  If you do not have enough insulin, your body cannot adequately use sugar for energy.  

This lack of energy production from sugar triggers release of hormones within the body that start breaking down fat to use as energy.  The chemical reaction that breaks down fats produces acids called ketones.  

When excess ketones are produced too quickly, they can build up in the blood, causing your blood and body fluids to become acidic.  As your blood becomes more and more acidic, some of the body's systems can stop functioning properly or even stop functioning altogether.  DKA is a condition that can make you very seriously ill and can kill you.  

Does DKA only happen in diabetics who take insulin?

No.  DKA is more common in people with type 1 diabetes (previously called insulin-dependent diabetes), but people with type 2 diabetes can also develop DKA.  For more information about the differences between type 1 and type 2 diabetes, use this link:  https://www.edocamerica.com/health-tips/difference-type-1-type-2-diabetes/ 

What causes DKA?

The two primary causes of DKA are:

• An illness - Infections, such as pneumonia or urinary tract infections, or other illnesses can cause your body to produce higher levels of certain hormones that can counter the effect of insulin.  Sometimes patients who take insulin may skip doses when they are sick because they are not eating as much, which can also be a trigger.
• Problems with insulin therapy - Missing insulin shots, a malfunctioning insulin pump, or taking the wrong insulin dose, all can leave you with too little insulin in your system.

Other possible triggers for DKA include:

• Heart attack or stroke
• Pancreatitis
• Alcohol or other drug abuse, particularly cocaine
• Physical or emotional trauma
• Pregnancy
• Certain medications, such as diuretics and some types of steroid medications.

What are the symptoms of DKA?

DKA signs and symptoms can develop quickly, often over less than 24 hours.  Sometimes DKA is the first sign that a person has diabetes, particularly type 1 diabetes.  Here are the symptoms to watch for:

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Feeling weak or excessively tired
• Shortness of breath
• Confusion
• Fruity scented breath - (Similar to the smell of Juicy Fruit gum)

Signs that you can see on home blood or urine tests include:

• High blood sugar levels
• High ketone levels in the urine

We will talk more about DKA next week, including prevention, diagnosis, and treatment.  

In the meantime, if you have diabetes and feel ill or stressed, or have had a recent illness or injury, you should check your blood sugar often.  If your blood sugar is above 240 mg/dl, you should use an over-the-counter urine ketone test kit every 4-6 hours.

You should call your doctor, go to the emergency room, or call 911 immediately if:

• Your ketones are moderate to high
• Your blood sugar stays at 300 mg/dl or higher despite home treatment
• Your breath smells fruity
• You are vomiting and can't keep food or drinks down
• You have significant signs and symptoms of DKA that I outlined above

If you have any questions about Diabetic Ketoacidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Multiple Sclerosis

Multiple Sclerosis is an autoimmune disease that affects the central nervous system.  MS can cause a variety of symptoms.  It often begins with subtle symptoms that come and go.  Let's talk more about it and how you can recognize it.

What is multiple sclerosis (MS)?

MS is a disease in which the body's immune system attacks the protective covering of nerve fibers.  This causes a sort of short-circuit of the nerve fibers, making it difficult for the nerve fibers to accurately carry signals from the brain to the rest of your body.  

What are the different types of MS?

Most people with MS have what is called relapsing-remitting MS (RRMS).  This type causes periods of new symptoms or worsening symptoms called relapses, which are followed by periods of improvement.  The improvement or remissions may be complete return to normal or just partial improvement.  Periods of remission can last for months to years.  Over time, about half of patients with RRMS will develop longer and more severe relapses with fewer and shorter remissions, eventually leading to steady progression of worsening symptoms.

About 10-15% of people with MS have primary-progressive MS (PPMS), which causes a gradual onset and steady progression of symptoms without any relapses from the very beginning of the disease.

What are the symptoms of MS?

Although MS symptoms can vary greatly from one person to the next as well as over the course of the disease, here are some of the typical symptoms:

• Numbness or weakness in one or more extremities that often occurs on one side of the body at a time or affects the trunk and legs
• Electric shock-like sensations that can occur with certain movements, especially movement of the neck
• Tremor, poor coordination, or unsteady gait
• Vision symptoms, such as partial or complete loss of vision (usually one eye at a time), pain with eye movements, double vision, blurry vision.
• Fatigue
• Tingling or nerve pain in parts of the body
• Slurred speech
• Dizziness
• Problems with bowel or bladder function, or problems with sexual function

What are the risk factors that may increase your risk of developing MS?

• Age - The onset of MS is usually between ages 20-40 but can occur at any age.
• Sex - Women are more than 2-3 times more likely as men to have RRMS.
• Family history - You are at increased risk if a parent or sibling has had MS.
• Race - White people (especially Northern European descent) are at highest risk of MS.
• Infections - A number of viruses have been linked to MS, but no definitive cause has been identified.
• Climate - MS is more common in temperate climates.
• Vitamin D - Low levels of vitamin D and low sunlight exposure are associated with greater risk.
• Autoimmune disease - Having another autoimmune disease slightly increases risk.
• Smoking - Increases risk.

If you are having any of the symptoms of MS listed above for unknown reasons, you should see your family doctor.

If you have any questions about Multiple Sclerosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Poison Prevention

March is Poison Prevention Awareness Month.  It is a time when people should take the time to make themselves aware of the potential hazards of poisoning, as well as understanding the potentially hazardous materials that are in your environment.  Everyone should have the Poison Help Line number easily accessible: 1-800-222-1222.

What is the most common place for poisonings to occur?

More than 90% of poisonings happen in people's homes.  The majority of these happen in the kitchen, bathroom, and bedroom.  

What are common poisons that could be in and around your home?

• Medicines - Many medications can be toxic if taken in higher than recommended amounts or taken in combination with certain other medications or with alcohol.  This includes over-the-counter (OTC) medications such as Tylenol, as well as prescription medications.
• Carbon Monoxide - Common sources include gas stoves and cooktops, blocked chimneys, furnaces, water heaters, grills and barbecues, motor vehicles parked in a garage, portable generators, gas powered tools, gas clothes dryers.
• Household products - such as cleaners, disinfectants, bleach
• Chemicals - such as fertilizers, insecticides, antifreeze
• Animals and insects  
• Plants, mushrooms, and berries

What can you do to help prevent poisoning?

First of all, teach your family to never touch or put anything in their mouth unless they know what it is.

Here are some other prevention tips:

• Keep all medicines and potentially poisonous substances in locked cabinets or out of the reach of children.
• Keep medications, household cleaning products, and all chemicals in their original containers, properly labeled, and stored appropriately.  Never store them in milk jugs, cups, or bottles.
• Never share prescription medicines.  Tell your doctor about all medications you are taking, including OTC medications or herbal supplements and ask about possible drug interactions before taking a new medication.
• Have a working carbon monoxide detector in your home.  You can use this link to see more about preventing carbon monoxide poisoning.  The Silent Killer That Could Be In Your Home - eDocAmerica
• Never mix household or chemical products together, as dangerous gases can be created.
• Bleach is especially toxic and should NEVER be mixed with anything but water.  If mixed with any cleaning product containing ammonia, it produces a deadly chlorine gas.  
• Wash fruits and vegetables with running water.  Never use commercial cleaning products or bleach on foods.
• Wash your hands and work surfaces before, during, and after preparing food.
• Store food at the proper temperature.
• Know what poisonous snakes live in your area and how to identify them.
• Check the labels before using insect repellent.  Most of them contain DEET, which can be poisonous in large quantities.
• Learn about common poisonous plants in your area.  Make sure that you and your family can identify poisonous plants and mushrooms.  Research houseplants for possible toxic effects before purchasing, especially if you have children or pets.

Next week we will talk about what you should do if you suspect that you or someone you know has been poisoned.

If you have any questions about poison prevention, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Strategies to Prevent Cardiovascular Disease

Last week we talked about cardiovascular disease in women.  This week, we will talk about strategies that you can use to help prevent cardiovascular disease.  This advice applies to both men and women.

Don't Smoke or Use Tobacco

This is one of the best things that you can do to protect your heart and cardiovascular system.  If you are a smoker, you should stop.  If you are not a smoker, you should avoid secondhand smoke.

Here's how tobacco increases your risk of cardiovascular disease:

• The chemicals in tobacco and its smoke can damage the heart and blood vessels.
• Cigarette smoke reduces the oxygen in the blood, which leads to an increase in blood pressure and heart rate because the heart has to work harder to get enough oxygen to your brain and body.

No matter how long or how much you have smoked, it's never too late to quit.  The risk of cardiovascular disease starts to drop as soon as the day after you quit!  Within a year of your quit date, the risk of heart disease drops to around half that of a smoker.

Move More!  Aim for 30-60 minutes of activity each day.

Regular physical activity can significantly lower your risk of cardiovascular disease in many ways.

• Your heart muscle becomes stronger with exercise, just like any other muscle in your body.
• Physical activity reduces your chances of developing other conditions that can affect your heart and blood vessels, such as type 2 diabetes, high blood pressure, and high cholesterol.
• It also helps control your weight.

If you haven't been very active for a while, you may need to slowly work your way up to your goals.  If you already have cardiovascular disease or other medical conditions, you should check with your doctor before starting an exercise routine.

Here is what your goal should be:

• 150 minutes per week of moderate aerobic exercise, such as walking at a brisk pace, OR 75 minutes per week of vigorous aerobic activity, such as running
• Two or more strength training sessions per week

If you can't exercise this much, don't be discouraged.  Even 5 minutes of moving can help.  And activities like taking the stairs, walking the dog, gardening, doing household chores, all count toward your total activity.  You will see bigger benefits by increasing the frequency, duration, and intensity of your workouts, but you don't have to do strenuous exercise to improve your risk.

Eat a Heart Healthy Diet

A heart healthy diet includes - more of these foods:

• Fruits and vegetables
• Beans and legumes
• Lean meat and fish
• Whole grains
• Low-fat or fat-free dairy products
• Healthy fats, such as olive oil

And less of these:

• Sugar
• Salt
• Processed carbohydrates
• Alcohol
• Saturated fats (found in red meat and full-fat dairy products) and trans fats (found in fried/fast food, chips, and pre-packaged baked goods)

Maintain a Healthy Weight

Being overweight, especially around the middle of the body, increases the risk of cardiovascular disease.  Even small amounts of weight loss can be beneficial.

Get Enough Good Quality Sleep

Make this a priority!  People who don't get enough sleep have a higher risk of cardiovascular disease and many other medical problems.  You should aim for 7-8 hours of sleep a night.

Get Regular Health Screenings

Talk with your doctor about screening blood pressure, cholesterol levels, and blood sugar levels.  Otherwise, you won't know you have them until they have already done damage.

If you already know you have one of these conditions, follow your doctor's advice and follow up regularly to help lower your risk of damage to your heart and blood vessels.

If you have any questions about preventing cardiovascular disease, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Cardiovascular Disease in Women

February is American Heart Month.  Since 1964, this is an annual event designated to encourage Americans to focus on their heart health.  Cardiovascular disease, including heart disease and stroke, remains the leading cause of death globally.  Many people incorrectly think that heart and vascular disease is something that only affects men.  Women are often unaware that they too are at risk for heart disease.

How common is cardiovascular disease in women?

• Cardiovascular disease is the number 1 killer of women.
• It causes more deaths in women than all forms of cancer combined!
• One of every 3 deaths in women each year is caused by cardiovascular disease.

Important facts about cardiovascular disease in women:

• Only 44% of women recognize that cardiovascular disease is their biggest health risk.
• Cardiovascular disease is the number 1 killer of new mothers and accounts for over one third of maternal deaths.
• Black women have some of the highest maternal mortality rates related to cardiovascular disease.
• Most cardiovascular events, like heart attacks and strokes, can be prevented through education and lifestyle changes, like moving more, healthier eating, and managing blood pressure and diabetes.
• Going through menopause does not cause cardiovascular disease, but menopause does mark a point in life when women’s cardiovascular risk can accelerate.  This makes increased focus during this stage of life very important to women.
• Almost 60% of deaths from high blood pressure are in women.  Out of all women, over 57% of black women have high blood pressure, more than any other race or ethnicity.
• Nearly 60% of total stroke deaths are in women.
• Women are often less likely to receive CPR from bystanders.  This may be because rescuers are less likely to believe a woman has had a heart attack, or because they fear accusations of inappropriate contact or sexual assault, or a combination of both.

Is cardiovascular disease in women linked to dementia?

Recent research indicates that women who have cardiovascular disease also have a significantly higher incidence of thinking and memory problems than those without cardiovascular disease.

Regardless of whether women had heart disease, those women with high blood pressure and diabetes also had a higher risk of decline in brain function.

What are the signs and symptoms of a heart attack in women?

Just like men, the most common heart attack symptom in women is chest pain or discomfort.  If you have any of these signs, call 911 and get to a hospital right away.  Here are the signs and symptoms to watch for:

• Uncomfortable pressure, squeezing, fullness, or pain in the center of your chest, lasting more than a few minutes, or coming and going over a period of time
• Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
• Shortness of breath, which may happen with or without chest pain
• Breaking out in a cold sweat, nausea, or lightheadedness
• Women are somewhat more likely than men to have symptoms of shortness of breath, back or jaw pain, and nausea/vomiting.

What are the signs and symptoms of stroke?

• Sudden numbness or weakness of the face, arm, or leg, particularly on one side of the body
• Sudden confusion, trouble speaking or understanding what it being said to you
• Sudden trouble with vision, like blurry vision or even blindness in one or both eyes
• Sudden trouble walking, dizziness, or loss of balance or coordination
• Sudden severe headache with no known cause

Next week we will talk more about what you can do to lower your risk of cardiovascular disease.

If you have any questions about cardiovascular disease, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor