Respiratory System and Diabetes – Ketoacidosis & Kussmaul Breathing

The respiratory system is the system of organs that allow the body to take in oxygen and expel carbon dioxide, this process is known as gaseous exchange.

We generally breathe between 12 and 20 times a minute. There are a number of complications of diabetes that can negatively affect our breathing.

Parts of the respiratory system

The following parts of the body make up the respiratory system:

• Mouth and nose
• Trachea (windpipe)
• Lungs
• Diaphragm

How the respiratory system works

Breathing is usually initiated by contraction of the diaphragm, a muscle which separates the chest cavity from the abdomen.

As the diaphragm contracts, more space is made available in the chest cavity and this has the effect of creating suction as the lungs expand to fill the space.

The lungs draw in air through the nose and/or mouth which then travels down the trachea (windpipe) before reaching the lungs.

Within the lungs are tiny air sacs called alveoli which allow oxygen from the air we breathe to be absorbed into the many tiny blood vessels contained with the alveoli.

As this happens, the alveoli take in carbon dioxide from the blood vessels and this completes gaseous exchange.

With gaseous exchange complete, the diaphragm relaxes and the carbon dioxide rich air in the lungs is expelled via the trachea out of the mouth and/or nose.

The lungs

As noted above, it is within the lungs that the gaseous exchange of oxygen and carbon dioxide takes place. The lungs are filled with a branched structure of airways called bronchi and smaller airways called bronchioles. Located at the end of the bronchioles are the alveoli in which the exchange of gases takes place.

The average capacity of human lungs is between 4 and 6 litres of air. The capacity of lungs may be reduced if the lungs become diseased or damaged. A common risk of lung damage is smoking

How diabetes can affect the respiratory system

Diabetes can adversely affect our breathing in a number of different ways. Breathing difficulties don’t affect everyone with diabetes and the risk of having difficulty breathing can be reduced by maintaining good diabetes control and a healthy body weight

Ketoacidosis and Kussmaul breathing

Rapid or laboured breathing, known as Kussmaul breathing, can be a symptom of diabetic ketoacidosis (DKA). Ketoacidosis is a short term complication of diabetes caused by very high blood glucose levels accompanied by a high level of ketones in the blood. Ketoacidosis will only usually affect people with diabetes if they haven’t taken sufficient insulin.

Ketoacidosis is a very dangerous condition and should be treated as an emergency.

• Read more about diabetic ketoacidosis

Kidney failure and shortness of breath

Becoming very short of breath, say whilst climbing the stairs, can be a result of kidney failure. Chronic kidney disease can lead to anemia which leaves the blood short of red blood cells with which to carry oxygen. If we have anemia and need to be more active, this can lead to our body struggling to get enough oxygen for our muscles and can leave us out of breath.

Kidney disease is one of the more common complications of diabetes, affecting about 40% of people with diabetes.

• Read more about diabetic kidney disease

Obstructive sleep apnea (OSA)

Obstructive sleep apnea (OSA) is a condition that results in difficulty breathing whilst sleeping. This can happen if the muscles in the throat collapse inwards and block your airway. This may happen partially or completely and can therefore disturb sleep.

Being overweight is the main risk factor of sleep apnea and the NHS notes that people with diabetes have a 3 times higher risk of developing sleep apnea.

• Read more about obstructive sleep apnea

Diabetes Can Affect Your Heart

Diabetes and Your Heart

Diabetes and heart disease often go hand-in-hand. In fact, adults with diabetes are twice as likely to have a heart attack or stroke than those without it. . 

Be Aware, Take Control 

Those affected by all types of diabetes are still at risk of developing heart disease, even if blood glucose (blood sugar) levels are managed. 

The most common form of heart disease is coronary artery disease, which develops over time as the arteries that supply blood to the heart fill with plaque. Plaque, which is made up of cholesterol and other substances, causes the arteries to harden. The medical term for this is atherosclerosis. When plaque continues to build, the arteries narrow, therefore reducing the flow of oxygen-rich blood to the heart. This causes the heart muscle to weaken, increasing the risk of heart disease, heart attacks, strokes, and even heart failure. 

To hear more about the risks of heart disease, and questions from people just like you, visit: Ask the Experts: Medication Management for a Happy Heart.

Three Ways to Decrease Your Risk for Heart Disease 

1. Work with your health care team. Together you’ll  manage your diabetes and risk of cardiovascular disease.
2. Know your numbers. Keep track of your blood glucose (blood sugar) and blood pressure levels along with your weight. Let your health care team know if you see changes or trends of higher or lower results.
3. Live a healthy lifestyle. Exercise regularly and make healthy food choices. Diabetes Food Hub^® is an excellent resource for healthy recipes and tools to create shopping lists with items you can purchase through the site.

Recognize the Symptoms of Heart Disease

If you have prediabetes or type 1 or type 2 diabetes, you should be aware of the symptoms of heart disease, including: 

• Chest pain, also known as angina, including feelings of chest tightness or pressure
   
• Shortness of breath
   
• Fainting or near fainting
   
• Fluttering in your chest
   
• Fast heartbeat, not due to a temporary increase in physical activity
   
• Slow heartbeat 
   
• Dizziness or lightheadedness 
   
• Pain in one or both arms
   
• Numbness or weakness in your legs
   
• Neck, jaw, throat, back, or upper abdomen pain
   
• Extreme fatigue
   
• Nausea and vomiting

*If you or someone you’re caring for has chest pain, shortness of breath, or is fainting, seek emergency medical care by calling 911 immediately.

Talk With Your Health Care Team 

Describe all your symptoms as accurately as possible and be honest about your lifestyle. Keep a log of your activities and eating habits.

When you visit your primary care physician, cardiologist, diabetes educator, or endocrinologist, come prepared with questions such as:

• How does my diabetes increase my risk of heart disease? Find the 4 Questions to ask your doctor on the Know Diabetes by Heart™ Website. 
   
• What should I monitor in addition to my A1C, blood pressure, and cholesterol levels?
   
• What tests do you recommend?
   
• How often should my heart health be checked?
   
• What lifestyle changes would you advise?
   
• Do I need to lose weight? Should I change my eating plan?
   
• If you’re taking medication: What side effects should I be aware of?

Testing for Cardiovascular Disease

Based on your symptoms, your doctor may request any of these outpatient tests to evaluate your risk of heart disease:

Electrocardiograms (EKG) monitor your heart’s electrical signals to check if your heart rate and rhythms are average. The test may reveal if you have heart enlargement due to high blood pressure or if you’ve had a heart attack in the past.

Like electrocardiograms, Holter monitoring checks for heart irregularities through a chest monitor over a 24-hour period. 

Echocardiograms produce images of your heart beating and pumping blood. Your doctor will be able to evaluate your heart valves and chambers to make sure they’re functioning normally.

Stress tests monitor how your heart rate, blood pressure, and breathing respond when you in-crease your activity levels. 

Cardiac computerized tomography (CT) scans use x-rays to compile a three-dimensional, high-quality picture of your heart and blood vessels. Your doctor will look for any signs of decreased blood flow and oxygen (ischemia) due to plaque buildup or blockages in your coronary arteries.

Cardiac magnetic resonance imaging (MRI) is another way to produce detailed images of your heart and its vessels without the use of radiation. It allows your doctor to evaluate the anatomy and function of your heart and its vessels to detect any blockages.

Take medications prescribed by your doctor to reduce the risk of heart disease.

If needed, you and your doctor will create a medication plan based on your individualized assessment, metabolic goals, and test results to reduce heart disease risk. 

New Food and Drug Administration (FDA)-approved drugs not only lower blood sugar, but reduce the risk of heart disease as well. 

“Two medications have come out within the last five years. Recent trials show that these are much more beneficial for people with atherosclerotic coronary vascular disease (the buildup of fats, cholesterol, and other substances in and on the artery walls), heart disease, or heart failure. There are two classifications of medications: SGLT2 Inhibitors and GLP1 agonists.” —Seth Kluzwicz, SP, MD

Want to know more? Listen to Medication Management for a Happy Heart.

Stay in the Know 

Join the Know Diabetes by Heart initiative and receive a monthly newsletter filled with useful facts about the connection between diabetes and heart disease, in addition to resourceful, science-backed tips and tools for people living with type 2 diabetes. 
 

Diabetes mellitus and ARVI — News — Demidov Central District Hospital

12.11.2018

Diabetes mellitus and ARVI

In the cold season, an epidemic of ARVI and influenza inevitably comes to us. These diseases cause an additional stress load on the body of any person. In patients with diabetes, the risk of hospitalization and complications is 3 times higher than in patients without impaired carbohydrate metabolism.

In order not to get sick, you must follow the recommendations of doctors for prevention. Preventive measures include: 1) avoiding crowded places during an epidemic; 2) wash your hands and face more often; 3) for the prevention of influenza, annual vaccination is recommended, the greatest effectiveness of which is achieved if it is carried out a month or more before the expected start of the epidemic.

But if the disease still could not be avoided, then people with diabetes should know that infectious diseases are doubly dangerous for them. First of all, the fact that the level of sugar in the blood rises noticeably. This is due to the fact that during illness, the body produces hormones aimed at suppressing inflammation. They have a counter-insulin effect, that is, they reduce the effectiveness of insulin in the body.

So if you get sick:

1) Measure your blood sugar more often than usual – every 3-4 hours. Keep a diary of self-control, where you write down not only the dose of insulin, blood glucose level and the XE eaten, but also the medications taken, body temperature, the presence of acetone in the urine

2) Be sure to buy urine ketone strips and measure their levels, especially if blood sugar exceeds 13 mmol/l

3) For every degree increase in body temperature above 37 ^{o diabetes mellitus type 1) with an increase in blood sugar, it is necessary to increase the dosage of short insulin by 15-20%. In this case, the dosage of basal insulin does not change. If additional insulin injections are required: the next injection of short-acting insulin can be given at least 4 hours later, and of ultra-short-acting insulin 2 hours after the last injection}

4) Sometimes in the case of a severe course of a viral disease, patients taking oral hypoglycemic drugs can also use insulin for a short time, followed by its withdrawal

5) despite a decrease in appetite during illness, do not experiment with the diet so as not to cause significant fluctuations blood sugar

6) drink as much unsweetened liquid as possible

cannot correct, the presence of ketones in the urine and the smell of acetone from the mouth – consult a doctor or call an ambulance team.

To stay healthy throughout the year, follow some simple prevention rules. Move more, every day at least half an hour or an hour breathe fresh air. Take vitamins and include as many vegetables and fruits in your diet as possible. And most importantly, achieve a good compensation for diabetes – immunity will better reflect the attacks of viruses.

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Weekly forecast

Diabetes shortness of breath

Diabetes is a condition in which the body produces too little insulin or develops insulin resistance. Insulin is a hormone the body needs to break down carbohydrates in the food we eat into energy in the form of glucose. Without insulin, the body cannot function effectively. Because the body needs energy, diabetes can affect every system in the body. Over time, especially if diabetes is not treated and controlled, it can lead to other diseases. The body systems that are susceptible to the effects of diabetes are the kidneys and the cardiovascular system. A person with diabetes should report new symptoms or changes in their general health to their doctor. One symptom to watch out for is new or worsening shortness of breath.

Shortness of breath in diabetes – causes

New or worsening shortness of breath in a person with diabetes can be a sign of a potentially serious illness.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) occurs when the body does not produce enough insulin to convert carbohydrates into glucose for energy. The body begins to break down fats for energy. When this happens, a by-product is formed called ketones . Ketones are excreted from the body by the kidneys in the urine. In DKA, ketones accumulate faster than the kidneys can clear them from the body. This leads to the accumulation of ketones, which are toxic. The body may use the lungs to remove excess ketones, which causes shortness of breath. Meanwhile, due to lack of insulin, blood glucose levels rise. In addition to shortness of breath, a person with DKA often has nausea and vomiting, dry mouth, and sometimes fruity breath. People can pass out due to increased levels of ketones in the body, so seek emergency medical attention.

The initial treatment for this condition is fluid through a vein and insulin, either injected under the skin or into a vein. Sometimes people are admitted to the hospital for close monitoring and continued treatment until ketone levels drop and insulin levels stabilize. Careful monitoring is necessary to ensure insulin balance is maintained to prevent DKA.

Heart attack and stroke

In people with diabetes, shortness of breath can be a sign of cardiovascular disease. Cardiovascular disease is the leading cause of death for people with type 1 diabetes: they are twice as likely to have a heart attack or stroke. In people with diabetes, even with careful monitoring, there may be periods when blood glucose levels rise. Over time, these elevated glucose levels can damage the network of blood vessels and nerves throughout the body, especially the delicate blood vessels and nerves around the heart.

Shortness of breath may be one of the first signs of a heart attack or stroke. Other symptoms that people may notice include sweating, upset stomach or nausea, pain or discomfort in the arms, jaw, chest, upper abdomen or back, a drooping eyelid or smiling on one side of the face, or slurred speech. Any of these symptoms should be evaluated urgently.

Because people with diabetes are at high risk of heart attacks and strokes, it is important to see a doctor regularly. The doctor will perform a complete physical examination, including blood pressure measurement, and order laboratory tests to determine cholesterol and blood sugar levels, such as a hemoglobin A1C test. He will also recommend medications to treat diabetes and prevent complications of heart disease such as heart failure.

Diabetic coma

People with diabetes may have high blood glucose, called hyperglycemia, or too low blood glucose, called hypoglycemia. Like ketoacidosis, too much or too little glucose can affect lung function and cause people to become short of breath. Other symptoms may include drowsiness, abdominal pain, dry mouth, extreme thirst, trembling or weakness, and confusion. Extremely high or low blood sugar levels can lead to a life-threatening emergency called diabetic coma, where a person passes out and becomes unresponsive to their environment.

For hypoglycemia, initial treatment is fluid and glucose through a vein. For hyperglycemia, initial treatment is fluid and insulin. For both hypoglycemia and hyperglycemia, patients are observed for a period of time and may be hospitalized for close monitoring and prevention of a recurrent episode of hypoglycemia or hyperglycemia. After initial treatment is completed, patients should consult their physician to develop strategies to prevent hypoglycemia and hyperglycemia.

Kidney failure

People with diabetes are at higher risk of a kidney disease known as diabetic nephropathy. Over time, diabetes can impair the ability of the kidneys to properly filter waste and can cause significant damage to the kidneys. As the kidneys lose their ability to function properly, fluid builds up in the body and can enter the heart and lungs, which can lead to shortness of breath. Other possible symptoms include swelling of the feet, hands, ankles, and eyelids, loss of appetite, nausea and vomiting, confusion and difficulty concentrating, persistent itching, and fatigue. It is important to see a doctor as soon as possible. Most likely, he will order laboratory tests and refer you to a nephrologist, a kidney specialist, to determine the extent of damage to the kidneys.

When to See a Doctor

In people with diabetes, high and low blood glucose levels can cause serious, even life-threatening conditions. New or worsening shortness of breath may be one of the initial symptoms.