Biochemistry - Ketoacidosis in Insulin-Dependent Diabetes Mellitus
Introduction To Type 1 Diabetes + Involvement of Ketones
Type 1 Diabetes or Insulin-Dependent Diabetes Mellitus is a chronic disease affecting as many as three million Americans. Type 1 Diabetes causes the destruction of pancreatic beta cells that produce the hormone known as insulin - a hormone that pushes sugar from your blood, into your bloodstream. One of the more deadly aspects of having Type 1 Diabetes is known as diabetic ketoacidosis - a condition that occurs when ketones (an organic compound) build up inside your bloodstream. A Type 1 Diabetic, (one whose pancreas no longer produces insulin) requires treatment of insulin through injections to keep blood-sugar levels stable. Since Type 1 diabetics' body do not produce insulin, if a T1D does not have onboard insulin (insulin in their system) the glucose in their blood cannot move into their cells - resulting in a lack of energy in their body. This causes their bodies to break down fat for energy, resulting in the compound known as ketone bodies, commonly referred to as "ketones." Ketone production is a typical process for the majority of people, though those without diabetes naturally produce hormones such as insulin and glucagon which prevent ketones from building in their systems.
Image of Composition of a Ketone Body
T1D Diagnoses and Symptoms of Ketone Production
Symptoms at the start of heavy ketone buildup include:
- dry mouth
- hyperglycemia
- extreme thirst
- frequent urination
- confusion
- extreme fatigue
- flushed skin
- fruity breath
- vomiting
- stomach pain
- trouble breathing
These symptoms are the start of how Type 1 Diabetes is recognized, though the unfortunate reality is that the majority of Type 1 Diabetics are diagnosed off of the more extreme symptoms:
- swelling in the brain
- loss of consciousness
- diabetic coma
- death
The Chemistry Behind Ketones
The way the state of ketoacidosis is diagnosed is the detection of hyperketonemia and metabolic acidosis, measured through an "anion gap." This anion gap is the difference between the concentration of cations that aren't sodium and the concentration of anions other than chloride and bicarbonate. The calculation of the anion gap involves sodium and bicarbonate measurements, the equation being [Na^+ – (Cl^- + HCO3^-)] To keep it short, if the anion gap isn't between 8mEq/L and 12mEq/L it is telling of ketoacidosis and requires rapid and aggressive treatment (which if not given results in cerebral edema.) The hyperketonemia element of diabetic ketoacidosis is due to insulin deficiency, and the oxidation of fatty cells (from fat to acetylCoA.)
Who uses research over ketoacidosis and why is it important? (+ basic research)
Any research completed over ketoacidosis would definitely be incredibly important to any person afflicted with Type 1 Diabetes, and would genuinely be important enough to save lives. Due to the fact that insulin really isn't a cure, it just works over time to keep people with T1D alive, research over ketoacidosis that could resolve symptoms rapidly would potentially save lives.
Applied Research
Due to the method of reducing the buildup of ketones being releasing ketones through urine & insulin, the only applied research being done over resolving issues with ketones is the more effective use of insulin. This insulin is then sold to hospitals and pharmacies for the purpose of supplying insulin to Type 1 (or 2) diabetics who require it.
If anyone actually sees this blog post and has any questions about T1 please comment because it is something (obviously :P) I'm a bit passionate about and would love to inform others over.
Sources: If anyone actually sees this blog post and has any questions about T1 please comment because it is something (obviously :P) I'm a bit passionate about and would love to inform others over.
http://www.healthline.com/health/type-2-diabetes/facts-ketones?m=2#overview1
https://themedi /> b calbiochemistrypage.org/diabetic-ketoacidosis.php
My endocrinologist (Dr. Hseah)
http://www.healthline.com/health/diabetes/facts-statistics-infographic#4
http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/
My endocrinologist (Dr. Hseah)
http://www.healthline.com/health/diabetes/facts-statistics-infographic#4
http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/
Wow, this is really informative Thomas. I learned a lot about Type 1 diabetes and insulin and ketoacidosis, which before reading your blog post were terms I had heard of but never understood. It's cool that something we've just learned about, ketones, apply to diabetes, which is a very real-life application (which makes sense because ketones are from Organic Chemistry). I always like when I can see something concrete and real-life to hold onto which connects to something that I am learning about in the classroom. It really is a great reminder that what we are learning in the classroom is not in a vacuum; instead, it has very real-life applications. And of course for you, it does not get any more real-life. Well Thomas, you've given me a great appreciation for the wonderful piece of engineering that is the human body, and a wonder at the oh so complex processes it performs on a daily basis... all to keep you alive.
ReplyDeleteVery impressive Thomas, I thought I already knew a lot about how ketones affect the body since you have explained it roughly to me before, but didn't know all of the symptoms and the chemistry behind it. I also appreciated how you took it upon yourself to inform the rest of us further about the effects that Type-1 Diabetes has on your body from a chemical stand point. You provide very interesting information, more so in the symptoms and explanation, but all of it can be used to understand you illness. The only thing I would change would probably be a deeper explanation of how ketones form.
ReplyDeleteHey, Thomas. While you do a great job of describing why a ketone buildup would happen in a diabetic body and identifying all of the adverse effects of a ketone buildup, I am still unsure of how, exactly, a ketone buildup causes all of the problems that you have listed. Would yo mind elaborating?
ReplyDeleteThe primary reason a buildup of ketone bodies kills type 1 diabetics is due to the inability to a. Manage & Reduce the buildup of Ketone bodies and b. Because ketones directly impact the pH of your blood (where they are primarily carried) The "acidosis" part of DKA is referring to the fact that the pH of a IDDM's bloodstream becoming acidic due to the buildup of ketone. Hence me in the past referring to my blood literally becoming acid. :P
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