How To Prevent Diabetic Ketoacidosis – Diabetic ketoacidosis (DKA) is a scary complication of diabetes, but fortunately it is preventable. The first step is to check your ketone levels. So if you are living with type 1 diabetes, NICE guidelines recommend that you have access to a blood glucose meter that can also check for ketones.
But what exactly is diabetic ketoacidosis? And how do you interpret ketone levels? The more you understand about DKA, the easier it will be to recognize symptoms early and take precautions to prevent them from getting worse.
When we eat carbohydrates, our body breaks them down. The breakdown of carbohydrates produces glucose, which then enters our blood. Glucose is our main source of energy, but in order for this energy to be released, glucose must be processed in our cells. Insulin acts as a key that allows glucose to enter our cells.
When our cells are deprived of glucose (such as due to a lack of insulin), our bodies will begin to burn fat as an alternative source of energy. As a result of the breakdown of fats, ketones are formed. In people with diabetes, high levels of ketones in the blood can lead to a dangerous condition called diabetic ketoacidosis.
It is important to recognize the risk factors, high-risk conditions, and symptoms of DKA. We list all 3 here:
If you experience any of the above DKA symptoms, or if you have any high-risk conditions, contact your diabetes team and:
Click here for an easy-to-print pocket report for blood β-ketone values. Keep it in your wallet or meter carry bag for quick reference!
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Diabetes Care Smiling as a Living Kidney Donor After her friend’s appeal on Facebook for a kidney donation, NPI colleague Jessica Fields made the selfless decision to donate one of her kidneys and bring a smile to another’s life. article Diabetic ketoacidosis (DKA) is a common and potentially life-threatening complication of type 1 diabetes. Although mortality rates are relatively low today, it is widely recognized that post-hospital mismanagement is a major contributor to in-hospital mortality, morbidity , longer length of stay and high readmission rates. The Joint British Diabetes Society (JBDS) guidelines for inpatient care for the management of DKA are widely accepted across the UK. but now it is more than ten years. The release of the new JBDS guidance published in June 2021 is therefore a welcome update.
Some of the recommendations in the original document were based on expert opinion. Although many of these are now supported in the literature and have become standard practice, others have been modified. The main changes to the document are described below.
The guidelines now say that they are suitable for use in the treatment of young adults aged 16-18 years when they are cared for by adult diabetes teams and are therefore more appropriate to be managed according to local adult guidelines rather than teams. they are familiar rather than using potentially unfamiliar pediatric guidelines.
Conversely, if youth in this age group are treated by pediatric teams, BSPED pediatric guidelines should be followed.
The updated guidelines recommend that if blood glucose levels fall below 14 mmol/L, clinicians may consider (always using appropriate clinical judgment) reducing the rate of intravenous insulin infusion to 0.05 units/kg/ time. This is to reduce the risk of hypoglycemia and hypokalemia. Although these complications can occur if dextrose solution is not added to the treatment in time or if potassium-containing fluids are not administered correctly, the main cause of both of these complications is the use of insulin and several pediatric studies have shown. that reducing the infusion rate to this level does not increase the time to resolution of DKA compared with a rate of 0.1 unit/kg/hour.
Added a short section on the management of DKA in patients with end-stage renal disease or on dialysis. While fortunately this is a relatively rare occurrence, there are some issues to consider, including the possibility that a fluid change may not be necessary. increased risk of hypoglycemia due to reduced renal clearance of insulin. and possible risk of hyperkalemia.
The guidelines include new sections on euglycemic DKA (occurring despite normal or near-normal blood glucose levels) and ketosis-prone type 2 diabetes.
Euglycaemic DKA is a known complication of sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy in people with type 2 diabetes and, increasingly, type 1 diabetes. The condition should be managed identically to hyperglycaemic DKA and an SGLT2 inhibitor should be discontinued at least until recovery. The decision to restart medication should be discussed with the individual and the diabetes team.
Ketosis-prone type 2 diabetes is more common in people of African and Caribbean or Hispanic descent. Treatment for this condition is the same as for others with DKA, but the person will often be able to stop insulin quickly after the DKA and underlying condition resolve.
This new edition aims to update the guidance using the latest evidence available. The document has also been reorganized so that the DKA management algorithm is now near the front for easier access.
All JBDS guidelines are expected to be updated or revised annually to keep the guidelines current. As such, they are ‘living’ documents, designed to be updated based on newly published evidence or experience, and feedback on any of the guidelines is welcome. The updated guideline is available at: https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults
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Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes that is receiving increased attention due to the increased risk of DKA associated with SGLT inhibitors. Sociodemographic and modifiable risk factors with strong evidence for increased risk of DKA were identified, including socioeconomic disadvantage, adolescent age (13–25 years), female sex, high HbA
, previous DKA and psychiatric comorbidities (eg, eating disorders and depression). Potential prevention strategies that include identifying individuals at risk based on unmodified sociodemographic risk factors are suggested. Structured diabetes self-management education that addresses modifiable risk factors can be used as a second risk reduction strategy. Evidence shows that structured training reduces rates of DKA. Knowledge of these risk factors and robust risk reduction strategies are important to identify subgroups of individuals at increased risk for DKA. This knowledge should also be used when considering adjunctive treatment options with an increased risk of DKA. Prevention of DKA in people with type 1 diabetes is an important clinical task that must be addressed even when SGLT inhibitors are part of the treatment. Diabetic ketoacidosis, also known as DKA, occurs when there is a severe lack of insulin in the body. This means the body can’t use sugar for energy and starts using fat. When this happens, chemicals called ketones are released. If left unchecked, ketones can build up and acidify the blood, hence the name acidosis.
Diabetic ketoacidosis (DKA) is a serious condition that affects people with type 1 and sometimes type 2 (although it is more
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