#795 Defining Diabetes: Kussmaul Respirations

November 23, 2022Scott Benner

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define Kussmaul Respirations.

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Scott Benner 0:00
Hello friends, and welcome to episode 795 of the Juicebox Podcast.

I'm excited to have Jenny back today for another installment of defining diabetes. And today, Jenny and I are going to define qu small respirations. This will be the 45th installment of the defining diabetes series. It's a series that takes the time to define the terms that you use every day with diabetes, from fat and protein rise to brittle diabetes, bolusing and everything in between. Check out the finding diabetes short episodes that let you feel like you know what you're talking about. And bonus, after you listen, you will actually know what you're talking about. There are a number of different series within the podcast. So if you go to juicebox podcast.com, to see a list of them. If you do it on a browser, you'll just see it at the top. And you notice the finding diabetes click on it. If you're on your phone, there's a little menu like the three lines, it's a menu click on that, then it shows you to find diabetes. There you will get a complete list of the episodes, as well as an online player and links to a number of different popular podcast apps and links to the other series like bold beginnings thyroid disease algorithm pumping diabetes variables, ask Scott and Jenny mental health afterdark and the diabetes pro tip episodes. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox.

Jennifer Smith, CDE 1:46
I like when are my kids going to be home making noise? Okay, so

Scott Benner 1:49
I'm recording. Okay. Jenny, we have finished up with our bowl beginning series. So let us move on or back to maybe I should say, a couple of defining diabetes terms which I've had on the list here for a while. And we have not gotten around to

Jennifer Smith, CDE 2:06
are these easy ones or hard one? No, I

Scott Benner 2:09
think they're, I mean, they're easy enough. They're just sort of terms that I don't know what happened. Like they, they didn't pop up the first couple of times and what I said to people like what should we define or even when I at the beginning said, what should be defined. There's also stuff on the list that's come up because you and I have been talking along the way and I've realized, wow, I don't know what that means. So I think if I don't know maybe other people don't know why they're. So let's, let's do some there'll be some short ones today. Awesome. Okay, I'll mispronounce some things. And you've you've you've sent me straight and then we'll start talking. What is a coup small respiration?

Jennifer Smith, CDE 2:51
Ah, that's a very good one. And we've certainly talked about something that would be where you would see this right. And we've talked about DKA. And we've talked about ketones before. Correct. So essentially, it's a really deep, a deep, like, heavy, almost like labored breathing that comes most often with DKA or diabetic ketoacidosis. Right? Because of metabolic acidosis. Essentially,

Scott Benner 3:31
it's interesting. I like watching you pull it out of your head because I'm looking at it written in front of me. And I'm like, okay, so cool that she's just getting this so. Yay. So my experience with it. Is that on the evening, wow. On the evening in 2006 when we realized Arden had diabetes, where we realized we thought she did. It was the end of a number of days where she was just listless. I don't even know how to say it like she was beyond like a zombie. You'd move her from one place to another and she just plopped down you know, she was so young, like two years old just just turned two years old. And that day, we were on a beach vacation. So Kelly took hold of the beach. And I stayed home but in the in the beach house with Arden. And I thought no, no, I'm going to try to get her. I'm going to try to take her to the beach. She'll see the beach in the ocean. She'll get really excited. I got her already. I took her the ocean and we kind of stepped I sat her down and she just I put her in the sand. And she just didn't move out there. Yeah. So we I took her back to the house thinking okay, well, she's still sick obviously. And late late that night, the whole family sitting up playing board games or card game or something was like a big family thing. It wasn't just the four of us. My wife's extended family was there. And I remember like looking across the room, trying to figure out what was wrong with the Arden And she was panting Yeah, even in our sleep like she was sleeping and she was just, like really quickly in out in out panting, panting, panting and I realized now that's what this is, right? This is. And so I have here a small respirations are fast, deep breath that occur in response to metabolic acidosis. Small respirations happen when the body tries to remove carbon dioxide and acid from the body by quickly breathing it out. Diabetic Ketoacidosis is the most common cause of small respirations.

Jennifer Smith, CDE 5:33
Correct. So it's also a reason that a lot of times when you bring when you would go to the emergency department, they'll usually do like an electrolyte panel, they'll look at something called bicarbonate levels and those types of things because this acid kind of component of the body that comes and causes that labored breathing is really because of the increase in acid production, and the ketones and everything that your body's like, must get rid of this thumb away. You know,

Scott Benner 6:09
it's so interesting that your body tries, I wonder if it works at all? Like, is it? Is it dissipating it a little bit? Or is it like a panic? You don't you mean?

Jennifer Smith, CDE 6:19
Like? Yeah, that's a good question. I mean, you know, the, the breadth of people who have really elevated blood sugars and are in DKA. Oftentimes smells like acetone, right? Or a real sweet fruity kind of smell. So I would expect some of its being expelled. Much like, you know, the body is also the reason people often come in severely dehydrated in DKA, is because the body is also trying to rid those ketone bodies and everything by pulling, pulling pulling fluid from the other parts of the body, dehydrating the body but creating a loss through urine.

Scott Benner 7:01
Okay, yeah, well, I've seen, like these kinds of historical writings, where they said that the Egyptians used to refer to a disease called the Great drain, is that right? And they thought people urinated themselves to death. But historians believe that might be type one diabetes.

Jennifer Smith, CDE 7:20
In fact, it ages ago, one of the very easy tests was physicians would just taste the urine. Because it was very sweet,

Scott Benner 7:31
right? And then that meant diabetes. It's interesting. When someone asked us to describe the smell from Arden's breath. I described it as metallic, and calm, and Kelly described it as fruity. So it's interesting, good, because it just a little side note here. DKA symptoms may include fruity, scented breath, weakness, vomiting. So Arden was obviously I mean, just based on this conversation, she was in DK at that point. Oh, I would. Absolutely. Yeah. Even though it's funny, because I asked that question of people when I interview them. And oftentimes, they don't know the answer. And now I realized, as I look back, I don't know if anybody ever said that to us or not. And if they did, if I would have even known what that meant. In that moment. You don't I mean, like, or like, now I know to be like, Oh, no. But back then if somebody would have said, Hey, your kids and tk I would have been like, yeah, it's three o'clock in the morning. I don't know what that is. Right. You know,

Jennifer Smith, CDE 8:32
the interesting thing I was curious about your question about whether anything is actually expelled with all of that. So I did a quick look. And it says that the rapid breathing increases the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels and helps to result in some degree of compensation. So there is definitely something coming out that the body is, you know, having this increase in respiration, so so it's helping you not that it's going to definitely help 100% trying to do something

Scott Benner 9:12
else and cracks in the dam and you've got 10 fingers, like, yes, it may be to that level. Well, yes. Hey, listen, if it buys you any kind of time, then thank you, but it really is another it's just really another example because we talked about this sometimes with low blood sugar, right? Like talking about how your body seems to shut down systems in order of importance as your blood sugar gets lower and lower. This is another example that this is your body just like trying to take one more breath. You know what I mean? To stay alive a little longer. super interesting. Okay, so I mean, I don't think anybody who's going to hear this episode is going to hear up before they they know they have diabetes, but if you see this happening, it's it's Dr. Time also there's one other example of why I want to just insert this here since we'll have people's attention. Of course. There's apparently another let's see what two conditions is small breathing associated with disruptions to these compounds can cause small breathing, which is typically associated with conditions that cause metabolic disturbances such as kidney failure, and diabetes. So you could see this in a person and it be kidney failure over diabetes. It's interesting.

Jennifer Smith, CDE 10:27
Again, because the kidneys are very, very much an expeller of many things, right? I mean, there's a filtration system that kind of ends up going on with the kidneys and when your kidneys are not functioning the way that they that they're supposed to. It leaves more of that to sort of float back into your body rather than be removed.

Scott Benner 10:46
Okay, so All right. Well, all right. Well, thank you for doing this with me, I appreciate it. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes. ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Good. Let's see. That's just one I always think. How do we get past? That's

Jennifer Smith, CDE 11:28
one I don't think I have. Honestly, I don't think I have ever used that term in any education I've ever done with anybody. Well, mainly because they come to me and they already have diabetes. Like, pay attention to this. That's not going to happen unless you are really in DK again.

Scott Benner 11:48
Get used online so frequently that I thought, well now people are saying it out loud. If they don't know what it is it's going to be another it's another tripping point if you don't know what it is right? Yeah, okay. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juice box. And don't forget, there are 44 Other defining diabetes episodes that you can find at juicebox podcast.com. Or by just searching your podcast player. For the words juice box, defining diabetes, they'll all just pop up in front of you.

Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. I want you to know that I got that pop that that cheek pop first trot right in the microphone. If you're lucky, I'll do it for you one more time before I'm done. Thank you again for listening. Please share the show with someone else who you think might also appreciate it. And if you hear teaching yourself definitions because you're newly diagnosed, please don't miss the boat beginning series. It's terrific and great for people who have just learned that they have diabetes. So here sorry. That was pork. That was that was good, right? muttrah too fast. Here we go. Nope. Okay, I'm done. That was terrible. Should I leave that in? Yeah, okay. Oh, shoot. Jenny works at integrated diabetes.com If you want to hire her, she's terrific. Check it out.