I almost died from dka 18 years ago. I was a newly diagnosed type 1 and was still learning how to manage my diabetes. I went to work and forgot my insulin and tester, I figured I could get through the day without it. At the end of my shift I started to feel nauseated and like I was getting the flu. I had a 1.5 hour commute home and during that time I was pulling over to vomit all the way home and felt like death. I finally made it home and immediately crawled into bed because I felt so awful. I didn't check sugars because I was so out of it. I passed out and went into a comatose state. Thank God my girlfriend came over a few hours later and found me. I don't remember anything but she told me I was basically dead, barely breathing and ghostly white. Thanks to great doctors and nurses about one week later I was well enough to go home from the hospital, with no lasting damage.
Great lecture. In case anyone is curious, the reason why the Acetyl COA (ACA) made from B-oxidation doesn't go through the Krebs cycle here is because in diabetes there is also a lack of Oxaloacetate (OAA). OAA gets depleted for gluconeogenesis to provide glucose for the brain. (In Krebs Cycle, the first step is combination of ACA and OAA to make citrate.)
*My daughter drinks lots of water and urinates with the same rate, there are no other symptoms to show if those have anything to do with diabetes. This is a good information that I have gone through **Diabets.Care** She is 2 years 9 months, hale and healthy, have not done any blood test. But I am not certain if one can get diabetes at such a tender age. Please I will like to know more on that*
MEDCRAM, aka Dr. S, I have listened to almost all your lectures as I was preparing for my nclex-rn exam and I was able to understand the concepts so much better having listened to your explanations and then re-reading the books again. I only wish I had done this sooner so that I could've taken this exam a lot sooner instead of rescheduling it every time I had a panic attack. To whoever out there that is listening to Dr. S's videos, if you are hoping to learn from him, then you are at the right place. Do your readings, then listen to him explain it, then go back and review your notes again and again. That's what I did as I was studying. The biggest hurdle is to not panic when you're studying, just keep studying and reviewing, and review these concepts over and over again if needed, and you'll be prepared when the exam day comes around. Keep the faith. You'll pass. I have just taken my nclex-rn and passed with 75 questions and Dr. S was a big part in helping me achieved this dream. Thank you for making these videos. They are a tremendous help!!
Thank you for a clear explanation. My spouse is currently in the hospital with this issue. Thank you for helping me understand what is happening and why. It made everything that the Dr tried to explain really fast understandable.
nursing student here. I like being explained to me thoroughly instead of just looking at signs and symptoms . it help me understand the topic more if I see the overall picture of whats going on and this helped me so much! well explained! instantly Subscribed! thankyou
I am just preparing for the physiology class that I am signed up for in the fall. I've read several texts but this lecture really goes through it much more clearly. Dr. Seheult tone is right as well, he seems relaxed with the subject and speaking in a conversational tone as if he were tutoring an individual. I've watched several of the MedCram videos over and over. Best way to learn. Thank you.
The way he explains things is perfect. I like the way he pauses after a key word or an explanation of something. It allows the listener to absorb the information rather than a teacher who blurts out the information so fast it becomes white noise. Well done 👍
See the whole series at www.medcram.com along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!
Very good info, and yes.. who gives thumbs DOWN? My 6 yr old Son had tonsils and adenoids removed. Been a challenging few days. These vids help immensely in keeping ketones, which were spiking, down. Choosing the perfect diet, then maintaining a consistent neutral while also making sure to administer a minimum of " 1 unit incilin/carb every 3 hours". Was no walk in the park. Especially when your child's miserable in pain, running a fever and not wanting to eat or drink. Day 5 and looks like we're on our way to a speedy recovery.
Dr. Seheult, it would be great if you could add at the end of your videos a small segment on treatment/therapy that would fall in line with the pathophysiology explained in the majority of the video. That would be really helpful for us medical students. Thanks!
Excellent video! I am an RN but I like to know the how and why of everything in life, sometimes it is just too much information but you have a way of sorting out the tangle and presenting it with the how and why, love that. Thank you!
Glad to hear your lecture again on youtube! Glad to see you are still doing these lectures. I'm recommending them to all my internal med colleagues here in WA.
As a type1, I Had three episodes of DKA over a 20 year period. Hospital saline drip helped me out on one occasion, the other occasions I drank small quantities of water frequently, and administered more insulin up and above the requirements as per the recommendations, Urine Test strips are effective. It’s the worst Flu type symptoms, and a step closer to oblivion if not managed correctly.
I just found your channel, and I LOVE your videos. You are seriously helping so many people - for example I'm a home care nurse and the most I do is actually teaching to my patients, but I was never taught well in school and have to self study. So glad you have HF here!! it seems like everyone has HF and DM!
Watched several times to understand the process correctly (engineer not a medic!). Added a quite a few new words to my vocabulary too! I would be very interested to see a presentation explaining the flip side of this topic; hypoglycaemia.
Thank you, this answered so many of my questions! I have a fourteen year-old child who has had type 1 for nine years, and he had a DKA episode this year. His first, and hopefully last.
I learn from these videos but I think they could be improved, the lapses where you have to watch him spell or draw out something is a time waste. But I agree, great info here.
Thank you for this video. I had terrible symptoms, being extremely thirsty, unsteady on my feet, a weird smell. My doctor, said I had diabetes and put me on Kombliglyze XR.
I love this videos. Should the phosphate level be high prior to giving insulin for a patient with DKA? Phosphate is needed for glycolysis and there's a lack of insulin or inability of the cell to respond to insulin in DKA, therefore, phosphate can't go in the cell to help metabolize the glucose.
I'm type 1 diabetic and a Highschool AP biology student. I came here with the question why if both hyper and hypoglycemia prevent glucose from entering the cells why are they diffrent. I knew that your body turns fat into energy in situations with high bloodsugar, but I didn't realize that insulin keeps the fatty acids from entering the mitochondria. So that's why! To much insulin = lack of both glucose and ketosis.
I went to the ER 2 weeks ago. I had oral thrush, heart palpitations, was peeing 8-10x an hour, and could barely hold myself up in a chair. Found out my blood sugar was 590 and A1C was 19.4%. I had glucose tests done 5 years ago and no family history.
In HHNS insulin is still being produced, & receptors still function on some small level. As long as insulin is available it can prevent β-oxidation & allow some glycolysis to occur. No β-oxidation = No Ketone bodies = No acidosis. In HHNS a hyperosmolar state leads to diuresis, which causes significant Hypotension and loss of consciousness.
I'm not sure I understand the potassium part, if someone could explain it to me please. He said protons leave the cell and increase in the serum in exchange for potassium. But if protons leave the cell why is potassium leaving as well? It could be that I misunderstood him. Love this lecture on DKA!
I thought this was good. A little over my head but still got the just of it. Totally complicated issue. One thing I have been trying to find is a video detailing the importance of B12 (why +B6) and the pathway for iron absorption. Want to do one on that subject?? Until then I will work on it.
So, how do you account for the energy produced from ketones to fuel endurance athletes who have a low carb lifestyle. there insulin levels are almost static, ketone levels around 1.5 - 2.0 (not ketoacidosis) and have a wonderful endurance ability, mental clarity and improved blood lipids. Prof Volek has countless studies on the effectiveness and benefits of a LCHF lifestyle for endurance athletes or those who are insulin resistant or T2D. Are your confusing being in a state of ketosis rather than ketoacidosis - two completely different states.
+Silvio Fontana ...and the runners don't have type 1diabetes...so that is ketosis, not ketoacidosis....that's what this video is about; Ketoacidosis, which occurs when there is an insulin deficiency (i.e. no insulin.). The runners would go into Ketoacidosis if there wasn't enough insulin. So no, his video is right. You are thinking about a healthy body. As he said, they can make energy, but ketoacidosis occurs when there is a huge, unrestrained amount of fatty acids pouring into the mitochondria. That's when they go into Ketoacidosis. Oh, and T2D, that's a lot different than T1D. T2D people can still make insulin (most of the time), but T1D victims' pancreases are NOT working. At all. So no insulin.
za ah, I think he forgets to mention that in addition to transcellular shifting of potassium out of cells, there is obligate excretion of cations in the kidneys, due to ketnouria (earlier in the lecture he mentions BHB and ACA are negatively charged...). So the K goes out of cells into plasma, and then out through kidneys. I think you tend to see hyperkalemia if there is concurrent decrease in GFR, or renal failure.
Internal med resident here (well will be one in about 3 months) interested in pulm/crit care... DKA is super important I see it almost everyday in tr ICU to varying degrees of severity.. Sometimes it's subtle and a few times I ve seen people die from DKA or come out brain damaged
Acetone can be smelt when you are on KETOSIS also. And you should make this clear. Intracellular potassium is depleted. The funny thing is there is no test for that 😃
![🎤 ไปกันต่อออ! จับฉลากร้องเพลง x P’ #XXSIVK [EP.2] (1/2) เพลงของใครจึ้งสุดน้าา 💓🎤 #MXFRUIT](http://i.ytimg.com/vi/mLI_K0sAS4o/mqdefault.jpg)
I almost died from dka 18 years ago. I was a newly diagnosed type 1 and was still learning how to manage my diabetes. I went to work and forgot my insulin and tester, I figured I could get through the day without it. At the end of my shift I started to feel nauseated and like I was getting the flu. I had a 1.5 hour commute home and during that time I was pulling over to vomit all the way home and felt like death. I finally made it home and immediately crawled into bed because I felt so awful. I didn't check sugars because I was so out of it. I passed out and went into a comatose state. Thank God my girlfriend came over a few hours later and found me. I don't remember anything but she told me I was basically dead, barely breathing and ghostly white. Thanks to great doctors and nurses about one week later I was well enough to go home from the hospital, with no lasting damage.
Great lecture. In case anyone is curious, the reason why the Acetyl COA (ACA) made from B-oxidation doesn't go through the Krebs cycle here is because in diabetes there is also a lack of Oxaloacetate (OAA). OAA gets depleted for gluconeogenesis to provide glucose for the brain. (In Krebs Cycle, the first step is combination of ACA and OAA to make citrate.)
*My daughter drinks lots of water and urinates with the same rate, there are no other symptoms to show if those have anything to do with diabetes. This is a good information that I have gone through **Diabets.Care** She is 2 years 9 months, hale and healthy, have not done any blood test. But I am not certain if one can get diabetes at such a tender age. Please I will like to know more on that*
MEDCRAM, aka Dr. S, I have listened to almost all your lectures as I was preparing for my nclex-rn exam and I was able to understand the concepts so much better having listened to your explanations and then re-reading the books again. I only wish I had done this sooner so that I could've taken this exam a lot sooner instead of rescheduling it every time I had a panic attack. To whoever out there that is listening to Dr. S's videos, if you are hoping to learn from him, then you are at the right place. Do your readings, then listen to him explain it, then go back and review your notes again and again. That's what I did as I was studying. The biggest hurdle is to not panic when you're studying, just keep studying and reviewing, and review these concepts over and over again if needed, and you'll be prepared when the exam day comes around. Keep the faith. You'll pass. I have just taken my nclex-rn and passed with 75 questions and Dr. S was a big part in helping me achieved this dream. Thank you for making these videos. They are a tremendous help!!
As an individual with type 1 Diabetes for 9 years. This has helped me see what DKA is more than any doctor I've had could explain. Thank you.
Thank you for a clear explanation. My spouse is currently in the hospital with this issue. Thank you for helping me understand what is happening and why. It made everything that the Dr tried to explain really fast understandable.
nursing student here. I like being explained to me thoroughly instead of just looking at signs and symptoms . it help me understand the topic more if I see the overall picture of whats going on and this helped me so much! well explained! instantly Subscribed! thankyou
Another nursing student here who found this very helpful. Thank you.
I am just preparing for the physiology class that I am signed up for in the fall. I've read several texts but this lecture really goes through it much more clearly. Dr. Seheult tone is right as well, he seems relaxed with the subject and speaking in a conversational tone as if he were tutoring an individual. I've watched several of the MedCram videos over and over. Best way to learn. Thank you.
Nice
I'm a 4th year med student studying for Step 2 CK and this helped a lot! I like the organic chem structures too....gave me tons of nostalgia!!
Sim Simma Good to hear- thank you for the feedback
The way he explains things is perfect. I like the way he pauses after a key word or an explanation of something. It allows the listener to absorb the information rather than a teacher who blurts out the information so fast it becomes white noise. Well done 👍
Not even in medical school yet but I still enjoy all this stuff! Thanks for helping me satisfy my knowledge cravings!
Wilson Lei you’ll do well!
See the whole series at www.medcram.com along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!
Very good info, and yes.. who gives thumbs DOWN? My 6 yr old Son had tonsils and adenoids removed. Been a challenging few days. These vids help immensely in keeping ketones, which were spiking, down. Choosing the perfect diet, then maintaining a consistent neutral while also making sure to administer a minimum of " 1 unit incilin/carb every 3 hours". Was no walk in the park. Especially when your child's miserable in pain, running a fever and not wanting to eat or drink. Day 5 and looks like we're on our way to a speedy recovery.
wow made no sense to me in class but you made it so simple love it.
+ORACIO CALVILLO Thanks for the comment, glad the video cleared some things up
Mate, awesome vid, I like how intricately you explain DKA yet still make it relatively easy to comprehend, love it!
Dr. Seheult, it would be great if you could add at the end of your videos a small segment on treatment/therapy that would fall in line with the pathophysiology explained in the majority of the video. That would be really helpful for us medical students. Thanks!
Excellent video! I am an RN but I like to know the how and why of everything in life, sometimes it is just too much information but you have a way of sorting out the tangle and presenting it with the how and why, love that. Thank you!
Lisa Towe Likewise. I also like to know the “why” behind everything in life!
Every time I ask “why” in my head, you answer lol I love it thanks 😁
Glad to hear your lecture again on youtube! Glad to see you are still doing these lectures. I'm recommending them to all my internal med colleagues here in WA.
As a type1, I Had three episodes of DKA over a 20 year period.
Hospital saline drip helped me out on one occasion, the other occasions I drank small quantities of water frequently, and administered more insulin
up and above the requirements as per the recommendations, Urine Test strips are effective.
It’s the worst Flu type symptoms, and a step closer to oblivion if not managed correctly.
Nursing student here-this was very helpful-thanks!
I wish you were my lecturer, I would ace all my exams, Thank you for this great video and all your other content!!!
Andile Kheswa thank you for the feedback
I just found your channel, and I LOVE your videos. You are seriously helping so many people - for example I'm a home care nurse and the most I do is actually teaching to my patients, but I was never taught well in school and have to self study. So glad you have HF here!! it seems like everyone has HF and DM!
hammypie Glad the videos have been helpful for your home care nursing work- thanks so much for the feedback
Watched several times to understand the process correctly (engineer not a medic!). Added a quite a few new words to my vocabulary too! I would be very interested to see a presentation explaining the flip side of this topic; hypoglycaemia.
Thank you, this answered so many of my questions! I have a fourteen year-old child who has had type 1 for nine years, and he had a DKA episode this year. His first, and hopefully last.
Definitely a med student video. A bit advanced for me, but I love learning new things.
who would dislike this video? this is for med students. if this is too advanced for you, then move along
Ahaha get over yourself
Shut up your fucking nerd
I learn from these videos but I think they could be improved, the lapses where you have to watch him spell or draw out something is a time waste. But I agree, great info here.
he's going so slow
This is so well done. I really really appreciate it, thank you.
Beautifully explained in very simple way.Thank you very much.
DR.JAGAT CHAUDHARY Thank you for the feedback
absolutley fabulous lecture it made analysing acid base peorlems easy
Terrific short lecture. Thanks.
I really enjoy your lectures. I've never felt so aware. Thank you so much! I'm a paramedic intern btw.
Please do HHNK next! :)
not really relevant for a paramedic to understand this lvl of detail is it?
Lection is very interesting and easy for understanding!
i nailed this dka ...thanks a lot..now i will play with this topic..
This helps a ton! Its been a while since I've had this in school. Thanks for the refresher!
Great to hear, thanks!
Saw a pt today that I had to explain this to today and felt a little rusty. This filled in the gaps of knowledge. Thank you!
even for a nursing student (furthermore a mature one) it has been an insightful visual aid :) thank you and I have definitely subscribed.
thank you for that wonderful explanation on DKA
Thank you for this video.
I had terrible symptoms, being extremely thirsty, unsteady on my feet, a weird smell.
My doctor, said I had diabetes and put me on Kombliglyze XR.
Thank you for a simple and understandable explanation of DKA
budskirlee thanks for the comment
really clear and concise explanation! great review for PICU
Great video, very clearly explained. Thanks!
Awesome video! thank you very explaining the treatment because many people fail to recognize correct reasons we treat with insulin.
This video was exactly what I was looking for. Fantastic.
I was just diagnosed in March and I got this like a week later, my sugar was 1094....
Thank you for great, simple explanations.
This is one of the best videos l have sown never!!!
Thank you for watching!
This was a great video. I would like to request if you can cover hypothyroidism vs hyperthyroidism
Very helpful in my studies. Thanks
I am a nursing student and found this lecture to be very helpful! Thank you for your series!
Thanks alot it's very clear n good presentation ❤️
I love this videos. Should the phosphate level be high prior to giving insulin for a patient with DKA? Phosphate is needed for glycolysis and there's a lack of insulin or inability of the cell to respond to insulin in DKA, therefore, phosphate can't go in the cell to help metabolize the glucose.
another fantastic and brilliant lecture....its to perfection
I'm type 1 diabetic and a Highschool AP biology student. I came here with the question why if both hyper and hypoglycemia prevent glucose from entering the cells why are they diffrent. I knew that your body turns fat into energy in situations with high bloodsugar, but I didn't realize that insulin keeps the fatty acids from entering the mitochondria. So that's why! To much insulin = lack of both glucose and ketosis.
Dr roger ,do you ha ve any videos explaining diabetes 1 and 2?
Thank you for magnificent enlightenment always...
Last time i study biologi is like 5 years ago. And i still think that biologi is my favorite course.
Nice lecture, very illustrative!!
Thanks... this Nursing student appreciates the info :)
Your explanation is really good 💜
Nice video overall. At .56, you draw a cell and mention cell wall. I am pretty sure you misspoke and meant cell membrane :)
where is the part 2 of this lecture?
Solid.... really cleared things up...
-2nd yr med student
eXELLENT EXPRESION. CONGRATULATIONS
One suggestion, please use different colours whenever possible, thanks for this video!
+mr black Thank you for the suggestion
Congrats on your education. I did IM then Pul/CC as well. You'll never be bored.
I went to the ER 2 weeks ago. I had oral thrush, heart palpitations, was peeing 8-10x an hour, and could barely hold myself up in a chair. Found out my blood sugar was 590 and A1C was 19.4%. I had glucose tests done 5 years ago and no family history.
I would love to see this in contrast to HHNS and why there is more glucose but not acidosis
In HHNS insulin is still being produced, & receptors still function on some small level. As long as insulin is available it can prevent β-oxidation & allow some glycolysis to occur. No β-oxidation = No Ketone bodies = No acidosis. In HHNS a hyperosmolar state leads to diuresis, which causes significant Hypotension and loss of consciousness.
I'm not sure I understand the potassium part, if someone could explain it to me please. He said protons leave the cell and increase in the serum in exchange for potassium. But if protons leave the cell why is potassium leaving as well? It could be that I misunderstood him. Love this lecture on DKA!
Very well EXPLAINED!!!!!! Finally......
I thought this was good. A little over my head but still got the just of it. Totally complicated issue.
One thing I have been trying to find is a video detailing the importance of B12 (why +B6) and the pathway for iron absorption. Want to do one on that subject?? Until then I will work on it.
Nice & concise explanation
Your videos help me a lot ! My instructor introduced them to us and since then I've been hooked lol
+Diana Ayon Good to hear- thanks
So, how do you account for the energy produced from ketones to fuel endurance athletes who have a low carb lifestyle.
there insulin levels are almost static, ketone levels around 1.5 - 2.0 (not ketoacidosis) and have a wonderful endurance ability, mental clarity and improved blood lipids. Prof Volek has countless studies on the effectiveness and benefits of a LCHF lifestyle for endurance athletes or those who are insulin resistant or T2D. Are your confusing being in a state of ketosis rather than ketoacidosis - two completely different states.
+Silvio Fontana ...and the runners don't have type 1diabetes...so that is ketosis, not ketoacidosis....that's what this video is about; Ketoacidosis, which occurs when there is an insulin deficiency (i.e. no insulin.). The runners would go into Ketoacidosis if there wasn't enough insulin. So no, his video is right. You are thinking about a healthy body. As he said, they can make energy, but ketoacidosis occurs when there is a huge, unrestrained amount of fatty acids pouring into the mitochondria. That's when they go into Ketoacidosis. Oh, and T2D, that's a lot different than T1D. T2D people can still make insulin (most of the time), but T1D victims' pancreases are NOT working. At all. So no insulin.
Thank you! just had a pt in the ED present this way. You explaination was very helpful!
Excellent 👍
Thank you!! I never understood DKA until now!
+Anna Fontz Glad the video helped in your understanding- thanks for the comment
MedCram - Medical Lectures Explained CLEARLY diabetes
thank you for the excellent and concise explanation!
za ah, I think he forgets to mention that in addition to transcellular shifting of potassium out of cells, there is obligate excretion of cations in the kidneys, due to ketnouria (earlier in the lecture he mentions BHB and ACA are negatively charged...). So the K goes out of cells into plasma, and then out through kidneys. I think you tend to see hyperkalemia if there is concurrent decrease in GFR, or renal failure.
thanks
Great video!
Superb sir
Excellent, concise, relevant.
It's due to the Na+/K+ exchanger in the renal tubules.
This is wonderful! Thanks for sharing this!! :)
Sarah Lemire Thanks for your feedback- glad the video was helpful
Thank you very much Sir🙏
My bf is currently in the hospital for dka , so I’m trying to educate myself on what’s happening
Great lecture :) thanks a lot MED CRAM
The ONLY time I had DKA was when I was first diganosed and my blood sugar was the highest it was 1130
ManTexDal wow that’s high
sir would u pls xplain how osmotic diuresis leads to k depletion...
that pt i cant understand..
thk u!.
Thank you so much! Very helpful :)
Mind blowing video.Thanks
Internal med resident here (well will be one in about 3 months) interested in pulm/crit care... DKA is super important I see it almost everyday in tr ICU to varying degrees of severity.. Sometimes it's subtle and a few times I ve seen people die from DKA or come out brain damaged
amazing job!!! thank you so much. we need more of your work!!
This video is great for nursing students too ^_^
Acetone can be smelt when you are on KETOSIS also. And you should make this clear.
Intracellular potassium is depleted. The funny thing is there is no test for that 😃
this is a fantastic explanation, thank you
you... are amazing
Thank you! I was wondering the same thing.
Very helpful. It would be great if you could cover the pathophysiology of diabetes mellitus , type 1 & 2. Cheers