Diabetic Ketoacidosis: Brain Morphology and Cognition
Diabetic Ketoacidosis: Brain Morphology and Cognition
The purpose of this study is to assess brain and memory changes in patients with uncontrolled
 diabetes (a condition called diabetic ketoacidosis (DKA))
Diabetic ketoacidosis (DKA) is a common and serious medical problem. Most cases occur when
 patients forget or stop insulin injections. Some patients require frequent admissions to the
 hospital with DKA after stopping insulin. Many patients do not know why they stop insulin
 therapy. The investigators will test if patients with one or more episodes of DKA have poor
 memory and brain changes that may lead to poor management.

 In this study, the investigators will perform memory testing and brain images in subjects
 with initial DKA episode and subjects with more than 3 episodes of DKA. The results will be
 compared to subjects with diabetes and no history of DKA and healthy (non-diabetic) subjects.
 Each subject with DKA will have an MRI and cognitive testing done shortly after hospital
 discharge, 1 month, and 3 months after hospital discharge. Diabetic subjects without DKA and
 healthy controls will only come in for a single baseline visit and have a MRI and cognitive
 testing done.
Inclusion Criteria:

 -  Type 1 or type 2 diabetes with diabetic ketoacidosis (DKA)

 -  Age 18-50 years

 -  Newly diagnosed or history of noncompliance with insulin therapy as precipitating
 cause of DKA

 -  No significant medical or surgical illness as precipitating cause of DKA

 Exclusion Criteria:

 -  Significant medical/surgical illness as precipitating cause of DKA (i.e. myocardial
 infarction, major surgery)

 -  Associated significant medical or surgical condition within 6 months history

 -  History of hypoglycemia unawareness

 -  History of seizures, ischemic stroke or hemorrhage, and severe head trauma

 -  History of symptomatic stenosis of major intracranial vessels

 -  Dementia (mini-mental state examination (MMSE) score (r ≤ 24) or inability to
 cooperate)

 -  Liver or renal failure or transplant

 -  Severe hypertension (systolic blood pressure (BP) >160 mm Hg and/or diastolic BP >100
 mm Hg or subjects taking ≥ 2 antihypertensive medications)

 -  Malignancy

 -  Current recreational drug or alcohol abuse

 -  Magnetic resonance imaging (MRI) exclusions: any metal and bio-implants not compatible
 with 3 Tesla MRI, claustrophobia