Diabetes mellitus results from either hypo-secretion or hypo-activity of insulin. After a meal, when insulin is either absent or deficient, blood glucose levels remain high because glucose is unable to enter most tissue cells. Insulin is needed for uptake by cells to happen.

Ordinarily, when blood glucose levels rise, hypoglycemic hormones are not released, but when hyperglycemia becomes excessive, you start to feel nauseated. The nausea causes your body to enter the “flight-fright-frolic” response. This is a series of changes brought about by the autonomic nervous system and prolonged by certain members of your endocrine system. The results are inappropriate because they normally occur in the hypoglycemic or fasting state to make glucose available. The nausea triggers glycogenolysis, a breakdown of glycogen, lipolysis, a breakdown of fat and gluconeogenesis when the liver creates glucose. These cause the already high glucose levels to soar even higher and excess glucose begins to leave the body in the urine which is called glucosuria.

When simple sugars, such as glucose, cannot be used as cellular fuel, more fats are mobilized and broken down for fuel. The fats produce a high fatty acid level in the blood, a condition called lipidemia or lipemia. The presence of acids in the blood increases a persons free H+ ion count which results in a lower than normal pH. This is referred to as acidosis. In severe cases of diabetes, blood levels of fatty acids and their metabolites (acetoacetic acid, acetone and others) rise dramatically. The metabolites, collectively called ketones or ketone bodies, are organic acids. They work to push down your pH even more. Your acidosis becomes more severe. Since this is due to ketones the acidosis is renamed ketoacidosis. Excess ketones spill over into the urine from the kidneys. This is called ketonuria.

Severe ketoacidosis is life threatening. One of the very good reasons to see a Diabetologist if you suspect you are starting to lose control of your condition. The severe swings in the pH of the body is a disruption of your normal homeostasis.

The severe ketoacidosis causes the nervous system to initiate rapid deep breathing (hyperpnea) to blow off carbon dioxide from the blood with the net result of temporarily increasing your pH (buffers the blood). If ketoacidosis continues unchecked it will disrupt heart activity and oxygen transport, severely depress the nervous system which leads to coma and death.

Detection, education and control are the keys to managing diabetes.

J. E. Spencer

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