What Is the Relationship Between Ketosis and Urine?

When lipolysis is accelerated and ketone bodies are generated more than the tissue can use, the accumulation of ketone bodies in the body causes blood ketones to exceed 2 mg%, that is, ketosis occurs. When excess ketone bodies are excreted in the urine, a positive urine ketone test is called ketonuria.

When insulin therapy is interrupted or the dosage is insufficient, and non-insulin-dependent diabetes suffers from various stresses, diabetes metabolic disorders worsen, fat breakdown accelerates, and ketone body production exceeds accumulation and accumulation of ketone bodies in blood It is called ketemia, and its clinical manifestation is called ketosis.

Overview of ketosis

When lipolysis is accelerated and ketone bodies are generated more than the tissue can use, the accumulation of ketone bodies in the body causes blood ketones to exceed 2 mg%, that is, ketosis occurs. When excess ketone bodies are excreted in the urine, a positive urine ketone test is called ketonuria.

Insulin deficiency produces ketosis

When ketones accumulate and metabolic acidosis occurs, it is called diabetic ketoacidosis. In addition to the increase in blood glucose and strong positive ketone body, the blood pH value decreased, and the blood carbon dioxide binding capacity was less than 13.5 mmol / L. A coma may occur if the condition is severe, which is called diabetic ketoacidosis.

Diabetic ketoacidosis is a serious complication of diabetes and was the leading cause of death before insulin application. After the advent of insulin, its fatality rate has been greatly reduced, and it currently accounts for only 1% of the fatality rate of diabetic patients.

Clinical manifestations of diabetic ketoacidosis:

First, the symptoms of diabetes aggravated irritability, increased urine output, fatigue, etc., but there was no obvious overeating.

Second, the symptoms of digestive system loss of appetite, nausea, vomiting, vomiting can also occur after drinking water.

3. Symptoms of Respiratory System Breathing is deep and fast when acidosis occurs, showing Kussmonl breathing. When the pH of arterial blood is lower than 7.0, breathing becomes shallower and slower due to respiratory central paralysis and muscle weakness. The exhaled breath may have an acetone smell (rotten apple smell).

Fourth, when the amount of dehydration exceeds 5% of body weight, the amount of urine decreases, the skin and mucous membranes dry, and the eyeballs sink. If the amount of dehydration reaches more than 15% of body weight, due to reduced blood volume, circulatory failure, rapid heart rate, decreased blood pressure, cold limbs, and no significant increase in body temperature even with concurrent infection.

Fifth, there are obvious individual differences in mental state, dizziness, headache, and apathy in the early stage. Gradual drowsiness, irritability, dullness, tendon reflexes disappear, and to a coma, pathological reflexes often occur.

6. Other extensive severe abdominal pain, abdominal muscle tension, occasional rebound pain, often misdiagnosed as acute abdomen. Refractive errors can occur due to dehydration.

Ketosis

Long-term hunger caused severe energy insufficiency, and the body mobilized fat and protein to provide energy for the body to increase the amount of acetone in the metabolites and related syndromes similar to diabetic ketosis.

The manifestation of starvation ketosis is that patients cannot eat and cause hunger, and it is easy to gradually reduce the glycogen in the liver and cause exhaustion. On the one hand, there is a lack of food carbohydrate supplements, and on the other hand, the glucose stored in the liver is depleted, and the energy required by the body must be opened up by another "path", which is replaced by fat stored in the body. However, when fat catabolism is enhanced, it is often accompanied by insufficiency of oxidation, and it is easy to produce too many intermediate products, such as acetone, acetoacetic acid B-hydroxybutyric acid, etc., collectively referred to as ketone bodies. Under normal circumstances, the ketone body in the blood is very small, if due to long-term starvation, the blood ketone body is too high, and ketone body in the urine will occur, hunger ketosis. To put it simply: dieting leads to an increase in ketone bodies produced in the body, which exceeds the body's metabolic capacity, and develops step by step, which will cause metabolic acidosis of blood acidification. The patients with mild hunger ketosis only have elevated ketones in blood and ketones in urine, which may be clinically asymptomatic. Starvation ketosis is a related syndrome similar to diabetic ketosis. Compared with diabetic ketoacidosis, although both are ketosis, starvation ketosis is characterized by normal or low blood sugar, and ketosis. Most of the acidosis is not serious. One hour after a meal, ketone bodies in urine disappeared. Starvation ketosis and diabetic ketoacidosis have many similarities in the clinical manifestations of moderate to severe patients. The patients with mild hunger ketosis only have elevated ketones in blood and ketones in urine, which may be clinically asymptomatic. In moderate to severe patients, metabolic acidosis occurs due to excessive accumulation of ketones in the blood, and early symptoms such as limb weakness, fatigue, thirst, polyuria, loss of appetite, and increased nausea and vomiting. With the development of the disease, the patient developed headache, deep breathing, exhaled smell of rotten apple, and gradually fell into drowsiness, blurred consciousness and coma.

Alcoholic ketosis

Alcoholic ketoacidosisKetoacidosis is accompanied by mild hyperglycemia, without an increase in blood alcohol content.

This symptom occurs in patients with potential damage to insulin secretion. Stop drinking and starvation are used in combination with endogenous insulin secretion, and stimulate increased free fatty acid (FFA) release and enhanced ketogenic effect. Some chronic drinkers may have recurrent severe vomiting And the tendency for abdominal pain.

The characteristic medical history is that heavy drinking caused vomiting, and he could not eat or drink for more than 24 hours. During hunger, he went to the doctor for repeated vomiting and severe abdominal pain. The degree of blood glucose elevation (such as blood glucose <150mg / dl, that is <8.33mmol / L) is obviously Meets ketoacidosis (DKA) criteria. Most patients have pancreatitis, and many patients show impaired glucose tolerance or mild type 2 diabetes after recovery from an acute attack. Begin treatment with a 5% glucose saline solution intravenously, plus vitamin B1 And other water-soluble vitamins, supplement potassium if necessary. Ketoacidosis and gastrointestinal symptoms usually improve quickly (for patients with atypical DKA, insulin is appropriate).

1 What to eat in ketosis type 1 diabetes

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There are already millions of people with type 1 diabetes, and ketosis is the most common problem. Recently, Dr. Nie Wentao answered the patients' concerns about how to eat after the occurrence of ketosis in type 1 diabetes.

What is the risk of ketosis?

Nie Wentao explained that some children with type 1 diabetes were discovered after severe ketosis. Once type 1 diabetes is discovered, the treatment of ketosis becomes the most basic common sense. Therefore, the risk of ketosis rarely recurs after the diagnosis of type 1 diabetes. However, ketosis often causes great harm to patients. Once symptoms such as limb weakness and mental weakness occur, ketosis should be monitored in a timely manner. If ketosis is found first, and then the limbs feel weak and debilitated, insulin consumption should be increased in time. Of course, reasonable dietary interventions can help eliminate ketosis.

Patient example: Has ketosis occurred during the patient's recovery? Nie Wentao said: The mother of Pang Liwen (a 10-year-old child with type 1 diabetes treated by Nie Wentao) recalled that the use of combination intervention techniques such as mulberry seed had a significant reduction in ketosis. With 10 years of insulin use, ketosis cannot be avoided. Every time Pang Liwen experienced ketosis during recovery, targeted diet intervention played a key role. At the time, I told her to carry bread with her when she went to school. This is not the kind of sugarless bread, but the most common fermented bread. At present, grain protection has become a common concept around the world, and healthy staple food education is also being carried out.

3. What should patients with ketosis eat?

Nie Wentao pointed out that cereals should be the main source and try to avoid high-fat foods. Ketosis is a product of lipolysis. Eating cereals does not cause ketosis. The grain protection curve for blood sugar shows that the long-term effects of grains are beneficial for blood sugar stabilization. For special food combination interventions, we must fully consider the physiological movements of the human body when processing food, including the movement of digestive glands, gastrointestinal motility, blood circulation, material synthesis, and material excretion. Therefore, in addition to eating cereals, food combination technology interventions should be targeted.

What is the difference between type 1 diabetes and type 2 diabetes?

Nie Wentao explained: The human body eats enough sugar to inhibit gluconeogenesis. Therefore, cereals can reduce the incidence and damage of ketosis, which is the same for type 1 and type 2 diabetes. If there is a difference, it is insufficient insulin secretion in type 1 diabetes, which may further increase blood sugar after eating, but the double high state of glucagon and insulin will not occur. People with type 2 diabetes who eat when they are hungry can have both high levels of glucagon and insulin, which can be called double-high syndrome. We know that when blood glucose does not exceed 33mmol / L, patients will not develop hypertonic coma. Therefore, for patients with low blood sugar but accompanied by ketosis, timely supplementation of cereals is correct, even if there is some increase in blood sugar. 5. How to monitor ketosis?

Nie Wentao specifically explained that ketosis was monitored as much as possible after 3, 4, 5, and 6 hours after a meal. Try to capture the period of time when the patient's ketosis worsens. Then, advance dietary intervention. For example, an increase in ketosis occurs at 23:00 in the evening, then you should eat cereals, or eat some foods such as wolfberry and jujube at 22:00. This approach may lead to a slight increase in blood sugar, but it is beneficial to suppress ketosis, so it is a benign increase in blood sugar. Generally, if a patient's body is in a state of high breakdown (high consumption stress), ketosis is prone to occur. Supplementing cereals or special polysaccharides in advance can make the body enter a synthetic state and at least to a certain extent inhibit the occurrence of decomposition states.

Of course, if the patient has symptoms such as dementia, limb weakness, etc., the amount of insulin should be increased in time to relieve ketosis.