hypoinsulinemia hyperglycemia

[RanchoEMT]

I've been having this discussion going back and forth with my medic. Im surprised to hear his answer.
So if you would be so kind, your thoughts please, as to the signs and symptoms of a type 1 diabetic who has eaten, has a BS=210, and has not taken her insulin.

My thoughts, if insulin is not present in the hyperglycemic diabetic type 1 patient wouldn't this patient almost be experiencing signs and symptoms normally associated with hypoglycemia? As glucose is not reaching the cells for cellular respiration. If I am wrong I would love for someone to correct me.
Thank You Pre-Empt.

 

[Dwindlin]

Insulin is not required for glucose transport across the blood-brain-barrier.

 

[RanchoEMT]

Insulin is not required for glucose transport across the blood-brain-barrier.

Are you saying the over all mental status should not be effected? But will the body?

 

[abckidsmom]

I would expect this patient to look completely normal until her sugar had been up for many hours or days.

 

[abckidsmom]

Are you saying the over all mental status should not be effected? But will the body?

No. Not in the situation you describe. It takes time for hyperglycemia to make you sick.

 

[DesertMedic66]

I would expect this patient to look completely normal until her sugar had been up for many hours or days.

Same. I have had a many of patients with type 1 who have their sugars in the 200s-500s looking completely normal and not having any complaints.

 

[RanchoEMT]

No. Not in the situation you describe. It takes time for hyperglycemia to make you sick.

I know what your talking about with regard to a gradual acidosis, but since we are talking about a type 1 diabetic who has not been given insulin to utilize glucose efficiently, the cells arent getting any of the glucose from the lack of insulin right??, are you still taking into account we are talking about a hyperglycemia that is now at present a 'hypoglycemic-esc' situation in which cells are without glucose?? Or are all 'hypoglycemic-like' symptoms not present because

Insulin is not required for glucose transport across the blood-brain-barrier.

 

[usalsfyre]

Cells can do a fairly good job utilizing proteins and fats for their metabolic needs, however the byproduct is ketones, hence DKA. You won't see alteration in LOC for the reason listed above.

 

[Aidey]

From a biochemical standpoint dietary carbohydrate intake is not mandatory for humans. The body has the ability to break down fats and protein into all of the nutrients necessary for life. This is called ketogenesis, and it produces ketones which the body and brain can use for energy.

If a person is healthy, ketogenesis doesn't cause acidosis because the body compensates to keep the pH in range. The production of ketones raises the blood sugar and sine type I diabetics the lack of insulin production it means that their blood sugar just keeps going up. The lack of insulin also impairs the body's ability to regulate pH, and those two things together eventually leads to acidosis. Ketoacidosis can also happen in alcoholics, but the pathophys is different.

This is why type 2 diabetics very very rarely develop DKA and instead develop HHNK. The small amount of insulin present in their body is enough to keep them from developing acidosis.

So, in short she would be exhibiting absolutely zero symptoms. 210 mg/dl isn't that high, and the body has the ability to provide the brain with energy without utilizing glucose. The reason that DKA patients get loopy is more because of the acidosis, not because of the hyperglycemia.

There are actually people who follow a ketogenic diet a purpose. It is common in bodybuilding before competitions and some epileptics show a marked improvement in their seizures on the diet. Some diabetics even follow a ketogenic diet because it allows them to use less insulin and they don't get blood sugar spikes from consuming carbohydrates.

 

[Handsome Robb]

From a biochemical standpoint dietary carbohydrate intake is not mandatory for humans. The body has the ability to break down fats and protein into all of the nutrients necessary for life. This is called ketogenesis, and it produces ketones which the body and brain can use for energy.

If a person is healthy, ketogenesis doesn't cause acidosis because the body compensates to keep the pH in range. The production of ketones raises the blood sugar and sine type I diabetics the lack of insulin production it means that their blood sugar just keeps going up. The lack of insulin also impairs the body's ability to regulate pH, and those two things together eventually leads to acidosis. Ketoacidosis can also happen in alcoholics, but the pathophys is different.

This is why type 2 diabetics very very rarely develop DKA and instead develop HHNK. The small amount of insulin present in their body is enough to keep them from developing acidosis.

So, in short she would be exhibiting absolutely zero symptoms. 210 mg/dl isn't that high, and the body has the ability to provide the brain with energy without utilizing glucose. The reason that DKA patients get loopy is more because of the acidosis, not because of the hyperglycemia.

There are actually people who follow a ketogenic diet a purpose. It is common in bodybuilding before competitions and some epileptics show a marked improvement in their seizures on the diet. Some diabetics even follow a ketogenic diet because it allows them to use less insulin and they don't get blood sugar spikes from consuming carbohydrates.

^^^What she said.^^^

 

[mycrofft]

OP, list the signs and symptoms you are expecting us to comment on and we can consider each one's mechanism.

As a possible lead on that:

Agitation, diaphoresis, tremor, confusion: not necessarily, not to the extent seen in acute frank hypoglycemia.
Feeling weak: maybe. Could have impaired tolerance to energy output.
Hunger: maybe.

The presence and increase of ketones and the imbalances accruing to fluid and electrolytes can cause some s/s a little similar to the above (confusion, weakness).

Note use of "can", "could", not necessarily", and "maybe". A urine dip for ketones could quickly suggest the diagnosis.

 

[abckidsmom]

^^^What she said.^^^

Which is somewhat different from ^^^That's what she said.^^^