Dka

tchristifulli

tchristifulli

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I was reading some information on the Kreb cycle to refresh my memory. I read that fat gives off way more energy when metabolized then glucose. This doesn't make sense to me because when a person is in DKA they are burning fat to create energy and it is very inefficient and leads to a dangerous outcome. Can someone explain?
 
I think the problem is with acidosis, too much ketones. They are also at risk for hyperkalemia because insulin is also suppose to allow potassium into the cell. I don't think a lot of sugar is trouble until like hyperosmolar hyperglycemia non ketonic (HHNK), but increased sugar also draws fluid out of the tissue and into vascular space where the sugar is.
 
tchristifulli said:
I was reading some information on the Kreb cycle to refresh my memory. I read that fat gives off way more energy when metabolized then glucose. This doesn't make sense to me because when a person is in DKA they are burning fat to create energy and it is very inefficient and leads to a dangerous outcome. Can someone explain?
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Fat metabolism has high energy yield but also produces ketones as a byproduct. Ketones are what cause all the problems in DKA.

Do some research on Ketogenic diets. It may help you understand.
 
tchristifulli said:
I was reading some information on the Kreb cycle to refresh my memory. I read that fat gives off way more energy when metabolized then glucose. This doesn't make sense to me because when a person is in DKA they are burning fat to create energy and it is very inefficient and leads to a dangerous outcome. Can someone explain?
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Short answer is that it's easier for our bodies to metabolize glucose than fats. Fats do contain quite a bit more energy though. That's why it's used as energy storage. As Chase says, it's the ketone byproducts of fatty acid metabolism that causes problems. CO2 is easy to get rid of. Ketones, not so much.

As an example:
Muscle cells have lots of ATP available and some glycogen (a form of carb) stored. Make them work hard and they'll burn through stored ATP in about 2 seconds and the stored glycogen in about 8-10 seconds. After that, they have to rely on energy to be delivered to them. They just can't as easily convert fats to ATP as they can convert glucose or glycogen to ATP.
 
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Fat metabolism in DKA is not optimal fat metabolism. Kinda like the difference between a striptease and getting your burning clothes off, the emergency makes things less effective.
 
mycrofft said:
Kinda like the difference between a striptease and getting your burning clothes off, the emergency makes things less effective.
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Do you know this from personal experience? :P
 
On a side note: Insulin drips suck. They are more time consuming than pressors
 
So on the reverse side when someone is hypoglycemic, why does the body not start burning fat for energy? Does it take longer to convert fat into energy!
 
JPINFV said:
Do you know this from personal experience? :P
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Well, sort of. Many years ago, our hostess at her housewarming (no pun intended) spilled scalding oil from a hot oil fondue on herself and we literally tore her clothes off to try to minimize the burning. As it was, second and first degree on her anterior leg from hip to knee, left lower quadrant of her abdomen...and I'll tell you now it wasn't an aesthetic event.
 
tchristifulli said:
So on the reverse side when someone is hypoglycemic, why does the body not start burning fat for energy? Does it take longer to convert fat into energy!
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I think it primarily has to do with the blood brain barrier. In diabetic ketoacidosis, the sugar is still in the blood stream and can cross the blood brain barrier. The energy the body is trying to make from fat is for the rest of the bodu. In hypoglycemia, there is no sugar, or anything, to pass over. I also imagine that it would take longer since it's stored energy.
 
tchristifulli said:
So on the reverse side when someone is hypoglycemic, why does the body not start burning fat for energy? Does it take longer to convert fat into energy!
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One answer for both: It does.

Most people have sufficient glycogen reserves to tide them over so the body has time to optimize the conversion to fatty metabolism. No glycogen stores = Oh $#!& time for the body. Hypoglycemic episodes occur when there's no glucose circulating and insufficient stores of glycogen available for use. Quick & dirty explanation.
 
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mycrofft said:
Well, sort of. Many years ago, our hostess at her housewarming (no pun intended) spilled scalding oil from a hot oil fondue on herself and we literally tore her clothes off to try to minimize the burning. As it was, second and first degree on her anterior leg from hip to knee, left lower quadrant of her abdomen...and I'll tell you now it wasn't an aesthetic event.
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That's hot! :P
 
Akulahawk said:
One answer for both: It does.

Most people have sufficient glycogen reserves to tide them over so the body has time to optimize the conversion to fatty metabolism. No glycogen stores = Oh $#!& time for the body. Hypoglycemic episodes occur when there's no glucose circulating and insufficient stores of glycogen available for use. Quick & dirty explanation.
Click to expand...

Some people burn through the available circulating glucose so fast that their gluconeogenesis can't catch up. Top em off with a LITTLE sugar and/or some starch and they'll catch up.

We had a whole debate about fueling the brain with ketones and the sources say ketone works just fine. Dammit but I just can't get my mental arms around that. BUt it appears t be true. Dunno.
 
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If the body automatically uses the stored glycogen when it starts to become hypoglycemic, why do we carry glucagon? If the body does that anyway.
 
Why? Liberate glucose to serum faster while you follow other measures (get pt to eat, start IV glucose). Hypoglycemia needs treatment ASAP/STAT, it can lead to accidents/falls, fights, syncope, coma, seizure and death in a relatively short time. Also to being mistakenly arrested for drunk.



robin%20williams_0.png

And acting like Robin Williams.
 
I understand hypoglycemia just wonder why we are giving a med that does what the body is gonna do automatically.
 
Because the body isn't doing it fast enough or has otherwise lost the capability.

Sort of like defibbing someone with an implanted pacemaker.

(rookie) "Won't that damage the implanted pacer?"

(medic) "Probably not, but obviously it isn't doing the job. CLEAR!".
 
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