Diabetic ketoacidosis primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Effective measures for the primary prevention of diabetic ketoacidosis (DKA) include recognition of early signs of DKA, implementation of early and aggressive interventions (especially in patients with recurrent episodes of DKA) and administration of optimum anti-diabetic medications in diabetic patients.

Primary Prevention

Primary prevention of diabetic ketoacidosis (DKA) includes the following measures:^[1]^[2]^[3]^[4]

Recognition of early signs:
- Vomiting
- Hyperglycemia
- Large ketonuria
- Weakness
- Heavy breathing or shortness of breath
Early recognition of inciting event of DKA:
- Missed insulin dose or error in dosing
- Intercurrent illness, especially infection
- Psychologic stress
- Surgery or trauma
Early intervention:
- Enhanced and more frequent monitoring of blood glucose and urine ketones
- Increased fluid intake
- Seek advice from health care team
Aggressive intervention in patients with recurrent episodes of DKA:
- Psychiatric evaluation
- Individual and family evaluation/intervention
- Continuous subcutaneous insulin infusion helpful in some patients
- Possible out-of-home placement
Adjustment of anti-diabetic agents in diabetic patients:
- Patients with diabetes undergoing emergency surgery or a under sudden external severe stress event, the following drugs should be stopped immediately:
- Patients taking SGLT-2 inhibitors should avoid excess alcohol intake and very-low-carbohydrate/ketogenic diets.

References

↑ Vanelli M, Scarabello C, Fainardi V (2008). “Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. “The Parma campaign““. Acta Biomed. 79 (1): 73–8. PMID 18551826.
↑ “Management of Diabetic Ketoacidosis – American Family Physician”.
↑ Zhou HC (1985). “[Preliminary studies of cardiac function in pre-eclamptic patients with echocardiography and systolic time intervals]”. Zhonghua Fu Chan Ke Za Zhi (in Chinese). 20 (5): 266–9, 317. PMID 4085289.
↑ “www.aace.com” (PDF).

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[pmid18551826-1] Vanelli M, Scarabello C, Fainardi V (2008). “Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. “The Parma campaign““. Acta Biomed. 79 (1): 73–8. PMID 18551826.

[urlManagement_of_Diabetic_Ketoacidosis_-_American_Family_Physician-2] “Management of Diabetic Ketoacidosis – American Family Physician”.

[pmid4085289-3] Zhou HC (1985). “[Preliminary studies of cardiac function in pre-eclamptic patients with echocardiography and systolic time intervals]”. Zhonghua Fu Chan Ke Za Zhi (in Chinese). 20 (5): 266–9, 317. PMID 4085289.

[urlwww.aace.com-4] “www.aace.com” (PDF).

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