Indigestion (dyspepsia) can be caused by diseases or conditions that involve the gastrointestinal (GI) tract, and also by some diseases and conditions that do not involve the GI tract. Indigestion can be a chronic condition in which the symptoms fluctuate infrequency and intensity. Signs and symptoms that accompany indigestion include pain in the chest, upper abdominal pain, belching, nausea, bloating, abdominal distention, feeling full after eating only a small portion of food, and rarely, vomiting.
Doctors may recommend one or more types of medications to help control diabetes. While taking medications, it's important for people with diabetes to regularly test their blood glucose levels at home. There are many different blood glucose meters available on the market. Speak to a doctor or pharmacist about these meters to help you select the best meter for your needs.
It isn't always easy to start an exercise regimen, but once you get into a groove, you may be surprised at how much you enjoy it. Find a way to fit activity into your daily routine. Even a few minutes a day goes a long way. The American Diabetes Association recommends that adults with diabetes should perform at least 150 minutes of moderate-intensity aerobic physical activity per week (spread over at least three days with no more than two consecutive days without exercise). You don't have to start with this right away, though. Start with five to 10 minutes per day and go from there. To stay motivated, find a buddy, get a fitness tracker, or use another measurement tool that can help you see your progress.
Janis McWilliams, RN, MSN, CDE, BC-ADM, responds: Yes, in type 1 diabetes in particular, the onset of symptoms like frequent urination and extreme thirst can be very sudden. In type 2 diabetes, the symptoms tend to come about more gradually, and sometimes there are no signs at all. People who have symptoms should contact their health care provider immediately for an accurate diagnosis. Keep in mind that these symptoms could signal other problems, too.
Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes
Onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular exercise.[60][61] Intensive lifestyle measures may reduce the risk by over half.[24][62] The benefit of exercise occurs regardless of the person's initial weight or subsequent weight loss.[63] High levels of physical activity reduce the risk of diabetes by about 28%.[64] Evidence for the benefit of dietary changes alone, however, is limited,[65] with some evidence for a diet high in green leafy vegetables[66] and some for limiting the intake of sugary drinks.[32] In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may decrease the risk of developing diabetes.[24][67] Lifestyle interventions are more effective than metformin.[24] A 2017 review found that, long term, lifestyle changes decreased the risk by 28%, while medication does not reduce risk after withdrawal.[68] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.[69]

Infections. Poorly controlled diabetes can lead to a variety of tissue infections. The most commonly encountered is a yeast infection (Candida) and the presence of dry mouth further increases one’s risk (see PATIENT INFORMATION SHEET – Oral Yeast Infections). Typically, affected areas appear redder than the surrounding tissue and commonly affected sites include the tongue, palate, cheeks, gums, or corners of the mouth (see Right). There is conflicting data regarding cavity risk in the diabetic patient, but those who have dry mouth are clearly at increased risk for developing cavities.
Louis B. Malinow, MD is an MDVIP-affiliated physician that's been practicing in Baltimore for more than 20 years. He's board certified in Internal Medicine, a certified Hypertension Specialist and a Diplomate of the American Board of Clinical Lipidology. Dr. Malinow graduated from the University of Maryland School of Medicine and completed his residency at Stanford University Hospital in Stanford, CA. Dr. Malinow is one of the only physicians in Maryland that specializes in both high blood pressure and high cholesterol management. He is also a member of the prestigious Alpha Omega Alpha medical honor society and is recognized by Best Doctors and Top Doctor by U.S. News & World Report and Baltimore Magazine. Dr. Malinow has appeared on numerous news programs advocating for preventive care and wellness.
The prognosis of diabetes is related to the extent to which the condition is kept under control to prevent the development of the complications described in the preceding sections. Some of the more serious complications of diabetes such as kidney failure and cardiovascular disease, can be life-threatening. Acute complications such as diabetic ketoacidosis can also be life-threatening. As mentioned above, aggressive control of blood sugar levels can prevent or delay the onset of complications, and many people with diabetes lead long and full lives.
FIGURE 19-1 ■. This figure shows the hyperbolic relationship of insulin resistance and beta cell function. On the y-axis is beta cell function as reflected in the first-phase insulin response during intravenous (IV) glucose infusion; on the x-axis is insulin sensitivity and its mirror image resistance. In a subject with normal glucose tolerance (NGT) and beta-cell reserve, an increase in insulin resistance results in increased insulin release and normal glucose tolerance. In an individual for whom the capacity to increase insulin release is compromised, increasing insulin resistance with partial or no beta-cell compensation results in progression from normal glucose tolerance, to impaired glucose tolerance (IGT), and finally to diabetes (T2D). Differences between these categories are small at high insulin sensitivity, which may be maintained by weight reduction, exercise, and certain drugs. At a critical degree of insulin resistance, due to obesity or other listed factors, only a further small increment in resistance requires a large increase in insulin output. Those that can increase insulin secretion to this extent retain normal glucose tolerance; those who cannot achieve this degree of insulin secretion (e.g., due to a mild defect in genes regulating insulin synthesis, insulin secretion, insulin action, or an ongoing immune destruction of beta cells) now unmask varying degrees of carbohydrate intolerance. The product of insulin sensitivity (the reciprocal of insulin resistance) and acute insulin response (a measurement beta-cell function) has been called the “disposition index.” This index remains constant in an individual with normal beta cell compensation in response to changes in insulin resistance. IGT, impaired glucose tolerance; NGT, normal glucose tolerance; T2D, type 2 diabetes.
Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type 2 diabetic.[10] If one identical twin has diabetes, the chance of the other developing diabetes within his lifetime is greater than 90%, while the rate for nonidentical siblings is 25–50%.[13] As of 2011, more than 36 genes had been found that contribute to the risk of type 2 diabetes.[37] All of these genes together still only account for 10% of the total heritable component of the disease.[37] The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5 times and is the greatest risk of the common genetic variants.[13] Most of the genes linked to diabetes are involved in beta cell functions.[13]
The beta cells may be another place where gene-environment interactions come into play, as suggested by the previously mentioned studies that link beta cell genes with type 2. "Only a fraction of people with insulin resistance go on to develop type 2 diabetes," says Shulman. If beta cells can produce enough insulin to overcome insulin resistance, a factor that may be genetically predetermined, then a person can stay free of diabetes. But if the beta cells don't have good genes propping them up, then diabetes is the more likely outcome in a person with substantial insulin resistance.
From a dental perspective, pregnancy leads to hormonal changes that increase the mother’s risk of developing gingivitis and gingival lesions called pregnancy tumors (see Right). Not surprisingly, poor glycemic control further adds to this risk. Therefore, it is imperative that if you become pregnant, you should promptly see your dentist. He or she will work with you to ensure that your dental self-care regimen is maximized to prevent or control your dental disease. Additional Resources on Diabetes and Oral Health National Institute of Dental and Craniofacial Research www.nidcr.nih.gov American Diabetes Association www.diabetes.org American Dental Association www.dental.org American Academy of Periodontology www.perio.org The Diabetes Monitor www.diabetesmonitor.com David Mendosa www.mendosa.com Diatribe www.diatribe.us The information contained in this monograph is for educational purposes only. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.
The development of type 2 diabetes is caused by a combination of lifestyle and genetic factors.[24][26] While some of these factors are under personal control, such as diet and obesity, other factors are not, such as increasing age, female gender, and genetics.[10] A lack of sleep has been linked to type 2 diabetes.[27] This is believed to act through its effect on metabolism.[27] The nutritional status of a mother during fetal development may also play a role, with one proposed mechanism being that of DNA methylation.[28] The intestinal bacteria Prevotella copri and Bacteroides vulgatus have been connected with type 2 diabetes.[29]
When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine, dragging along fluids from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more.
Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3]
Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team (including your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian nutritionist, diabetes educator, and pharmacist), family, and other important people in your life. Managing diabetes can be challenging, but everything you do to improve your health is worth it!

Oral glucose tolerance test (OGTT): With this test you will be required to fast for at least 8 hours and then are given a drink with 75 g of carbohydrate. Your blood glucose is checked at fasting and then 2 hours after drinking the solution. If your blood glucose is 11.1 mmol/L or higher, your doctor may diagnose diabetes. If your blood glucose 2 hours after drinking the solution is between 7.8 to 11.1 mmol/L, your doctor may diagnose prediabetes. This is the preferred method to test for gestational diabetes.
Research continues on diabetes prevention and improved detection of those at risk for developing diabetes. While the onset of Type I diabetes is unpredictable, the risk of developing Type II diabetes can be reduced by maintaining ideal weight and exercising regularly. The physical and emotional stress of surgery, illness, pregnancy, and alcoholism can increase the risks of diabetes, so maintaining a healthy lifestyle is critical to preventing the onset of Type II diabetes and preventing further complications of the disease.
The brain depends on glucose as a fuel. As glucose levels drop below 65 mg/dL (3.2 mmol/L) counterregulatory hormones (eg, glucagon, cortisol, epinephrine) are released, and symptoms of hypoglycemia develop. These symptoms include sweatiness, shaking, confusion, behavioral changes, and, eventually, coma when blood glucose levels fall below 30-40 mg/dL.

If you find that you are a little rusty and could use a refresher course in nutrition or anything else related to diabetes, consider signing up for a diabetes conversation map class. These classes are a good way to re-learn key components of diabetes in a group setting. If you have adequate knowledge and are instead looking for ways to make your life easier, check out some apps, nutrition resources, or fitness trackers that can help you stay moving and cook healthy meals. Keeping up the good work is worth it, as it can help prevent complications.


Acute Coronary Syndrome Moderate Risk Acute Coronary Syndrome Management Low Risk Acute Coronary Syndrome Management Myocardial Infarction Stabilization Post Myocardial Infarction Medications Cardiac Rehabilitation Angina Pectoris Heart Failure Causes NYHA Heart Failure Classification Diastolic Heart Failure Systolic Dysfunction Atrial Fibrillation Acute Management Atrial Fibrillation Anticoagulation Coronary Artery Disease Prevention in Diabetes Hypertension in Diabetes Mellitus CHAD Score Hypertension in the Elderly Isolated Systolic Hypertension Hypertension Criteria Hypertension Evaluation History Hypertension Management Hypertension Risk Stratification Resistant Hypertension Hypertension Management for Specific Comorbid Diseases Hypertension Management for Specific Emergencies Bacterial Endocarditis HDL Cholesterol LDL Cholesterol Triglyceride VLDL Cholesterol Hypercholesterolemia Hypertriglyceridemia AntiHyperlipidemic Hypertensive Disorders of Pregnancy Preeclampsia Prevention Congenital Heart Disease Hypertension in Children Medication Causes of Hypertension ACE Inhibitor Angiotensin 2 Receptor Blocking Agent Dihydropyridine Calcium Channel Blocker Nifedipine Selective Aldosterone Receptor Antagonist Niacin HMG-CoA Reductase Inhibitor Cardiac Risk Cardiac Risk Management Exercise Stress Test Stress Myocardial Perfusion Imaging Preoperative Cardiovascular Evaluation Eagle's Cardiac Risk Assessment Revised Cardiac Risk Index ACC-AHA Preoperative Cardiac Risk Assessment ACP Preoperative Cardiac Risk Assessment Syncope Subclavian Steal Syndrome Periodontitis Oral Health Cellulitis Necrotizing Soft Tissue Infection Group A Streptococcal Cellulitis Vibrio Cellulitis Gram-Negative Toe Web Infection Impetigo Skin Infections in Diabetes Mellitus Erythralgia Blister Skin Ulcer Cutaneous Candidiasis Onychomycosis Alopecia Areata Skin Abscess Skin Infection Intertrigo Nail Discoloration Terry's Nail Ingrown Toenail Hyperpigmentation Carotenemia Incision and Drainage Cryotherapy Skin Conditions in Diabetes Mellitus Acanthosis Nigricans Diabetic Dermopathy Granuloma Annulare Necrobiosis Lipoidica Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Metabolic Syndrome Diabetes Mellitus Complications Diabetic Ketoacidosis Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Children Hyperosmolar Hyperglycemic State Diabetic Education Diabetes Mellitus Glucose Management Diabetes Mellitus Control in Hospital Diabetes Resources Diabetic Retinopathy Unintentional Weight Loss Unintentional Weight Loss Causes Hypoglycemia Serum Glucose Glucose Challenge Test Glucose Tolerance Test 2 hour Hemoglobin A1C Sex Hormone Binding Globulin Endocrinology Links Diabetic Neuropathy Neonatal Hypoglycemia Obesity Risk Gestational Diabetes Gestational Diabetes Management Gestational Diabetes Perinatal Mortality Diabetes Mellitus Preconception Counseling Obesity in Children Systemic Corticosteroid Medication Causes of Hyperglycemia GlucoWatch 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Presentation Hepatitis in HIV HIV Related Neuropathy Stavudine Emerging Infection Methicillin Resistant Staphylococcus Aureus Fever of Unknown Origin Candidiasis Neutropenic Fever Hepatitis B Vaccine Influenza Vaccine Postherpetic Neuralgia Fluoroquinolone Third Generation Fluoroquinolone Sulfonamide Travel Preparation Travel Immunization Influenza Dengue Legionella Acute Exacerbation of Chronic Bronchitis Pneumonia in the Elderly Pneumonia Churg-Strauss Syndrome Tuberculin Skin Test Cystic Fibrosis Isoniazid Lung Transplantation in Cystic Fibrosis Active Tuberculosis Treatment Medical Literature Autonomic Dysfunction Bell's Palsy Facial Nerve Paralysis Causes Dementia Agitation in Dementia Ischemic Stroke Stroke Pathophysiology CVA Management Multiple Sclerosis Down Syndrome Cranial Nerve 3 Coma Exam Hemiplegia Giant Cell Arteritis Spinal Headache CSF Protein Altered Level of Consciousness Causes Guillain Barre Syndrome Restless Leg Syndrome Triptan Prevention of Ischemic Stroke Nerve Conduction Velocity Paresthesia Causes Peripheral Neuropathy Asymmetric Peripheral Neuropathy Peripheral Neuropathy Tremor Neonatal Distress Causes Newborn History Newborn Exam Neonatal Jaundice Causes Respiratory Distress Syndrome in the Newborn Late Pregnancy Loss Preterm Labor First Trimester Bleeding Fetal Macrosomia Hyperemesis Gravidarum Medications in Pregnancy Ritodrine Terbutaline Pregnancy Risk Assessment Probe-to-Bone Test Shoulder History Dupuytren's Disease Septic Bursitis Spinal Infection Osteomyelitis Causes Vertebral Osteomyelitis Patellar Tendinopathy Meralgia Paresthetica Frozen Shoulder Exertional Compartment Syndrome Hip Pain Low Back Pain Red Flag Carpal Tunnel Syndrome Adolescent Health Bullying Ephedrine Ginseng Myoinositol Nonsteroidal Anti-inflammatory Lab Markers of Malnutrition Nutrition Guidelines Glycemic Index Non-nutritive Sweetener Conenzyme Q10 Mortality Statistics Adult Health Maintenance Screening DOT Examination Family History Refugee Health Exam Automobile Safety Substance Abuse Evaluation Alcohol Detoxification in Ambulatory Setting Major Depression Major Depression Differential Diagnosis Anorexia Nervosa Antabuse Selective Serotonin Reuptake Inhibitor Antipsychotic Medication Clozapine Olanzapine Psychosis Insomnia Causes Renal Artery Stenosis Idiopathic Cyclic Edema Acute Kidney Injury Risk Chronic Renal Failure Acute Glomerulonephritis Nephrotic Syndrome Serum Osmolality Hypomagnesemia Drug Dosing in Chronic Kidney Disease Hyperkalemia due to Medications Hyperkalemia Causes Prevention of Kidney Disease Progression Intravenous Contrast Related Acute Renal Failure Osteoporosis Evaluation Antiphospholipid Antibody Syndrome Systemic Lupus Erythematosus Polymyositis Differential Diagnosis Septic Joint Gouty Arthritis Fibromyalgia Charcot's Joint Charcot Foot Complex Regional Pain Syndrome Osteoarthritis Methotrexate Joint Injection Rheumatoid Arthritis Fatigue Causes Impairment Evaluation Pre-participation History Exercise 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Paronychia Chronic Paronychia Urinary Retention Decreased Visual Acuity Gastrointestinal Manifestations of Diabetes Mellitus Shoulder Osteoarthritis Vitiligo Cardiomyopathy Heart Transplant Contraceptive Selection in Diabetes Mellitus Periodontal Bleeding Perioperative Antiplatelet Therapy Charlson Comorbidity Index Constipation Causes in the Elderly Chronic Osteomyelitis Abnormal Gait and Balance Causes in the Elderly Calcium Channel Blocker Overdose Diverticular Bleeding Framingham Cardiac Risk Scale Cardiac Risk in Diabetes Score Outpatient Bleeding Risk Index Four Year Prognostic Index Diabetes Screening ABCD2 Score Urine Microalbumin Hearing Loss in Older Adults Preoperative Guidelines for Medications Prior to Surgery Contrast-Induced Nephropathy Risk Score Hyperlipidemia in Diabetes Mellitus Diamond and Forrester Chest Pain Prediction Rule Coronary Risk Stratification of Chest Pain Diabetes Sick Day Management Urinary Tract Infection in Geriatric Patients Insulinlike Growth Factor 1 Avascular Necrosis of the Femoral Head Family Practice Notebook Updates 2014 Emergency Care in ESRD Medication Compliance Slit Lamp Sulfonamide Allergy Health Care of the Homeless CHADS2-VASc Score Tuberculosis Risk Factors for progression from Latent to Active Disease Family Practice Notebook Updates 2015 Wound Infection Asymptomatic Bacteriuria Toxic Shock Syndrome Tetanus ASA Physical Status Classification System Family Practice Notebook Updates 2016 Solid Organ Transplant Calcineurin Inhibitor Cardiac Pacemaker Infection DAPT Score Acute Maculopathy Medication Causes of Delirium in the Elderly Family Practice Notebook Updates 2017 Major Bleeding Risk With Anticoagulants Severe Asymptomatic Hypertension Chronic Wound Family Practice Notebook Updates Stable Coronary Artery Disease Nocturia Polyuria Hyperhidrosis Causes Pneumaturia Anemia in Older Adults Type 2 Diabetes Mellitus in Children
Exercise is very important if you have this health condition. Exercise makes cells more insulin sensitive, pulling glucose out of the blood. This brings down blood sugar, and more importantly, gives you better energy because the glucose is being transferred to the cells. Any type of exercise will do this, but extra benefit is gained when the activity helps build muscle, such as weight training or using resistance bands. The benefits of exercise on blood sugar last about 48-72 hours, so it is important for you to be physically active almost every day.

People with T2D produce insulin, but their bodies don’t use it correctly; this is referred to as being insulin resistant. People with type 2 diabetes may also be unable to produce enough insulin to handle the glucose in their body. In these instances, insulin is needed to allow the glucose to travel from the bloodstream into our cells, where it’s used to create energy.

In type 1 diabetes, other symptoms to watch for include unexplained weight loss, lethargy, drowsiness, and hunger. Symptoms sometimes occur after a viral illness. In some cases, a person may reach the point of diabetic ketoacidosis (DKA) before a type 1 diagnosis is made. DKA occurs when blood glucose is dangerously high and the body can't get nutrients into the cells because of the absence of insulin. The body then breaks down muscle and fat for energy, causing an accumulation of ketones in the blood and urine. Symptoms of DKA include a fruity odor on the breath; heavy, taxed breathing; and vomiting. If left untreated, DKA can result in stupor, unconsciousness, and even death.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
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