Development and Implementation of a Diabetic Ketoacidosis Protocol for Adults With Type 1 and Type 2 Diabetes at a Tertiary Care Multicampus Hospital

2019 ◽  
Vol 43 (4) ◽  
pp. 256-260.e3 ◽  
Author(s):  
Medina Mohamed ◽  
Angela Assal ◽  
Loree Boyle ◽  
Edmund Kwok ◽  
Filomena DeSousa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care

scholarly journals Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

2021 ◽  
Vol 9 (2) ◽  
pp. e002451
Author(s):  
Emma Ooi ◽  
Katrina Nash ◽  
Lakshmi Rengarajan ◽  
Eka Melson ◽  
Lucretia Thomas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care ◽  
Final Analysis ◽  
Care Hospital ◽  
Hospital Data ◽  
Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

Causes of diabetic ketoacidosis: type 1 diabetes versus type 2 diabetes

2017 ◽  
Author(s):  
Marwa Omri ◽  
Rayene Ben Mohamed ◽  
Imen Rezgani ◽  
Sana Mhidhi ◽  
Aroua Temessek ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis

An Approach to diabetic ketoacidosis in an emergency setting.

2020 ◽  
Vol 15 ◽  
Author(s):  
Dario Pitocco ◽  
Mauro Di Leo ◽  
Linda Tartaglione ◽  
Emanuele Gaetano Rizzo ◽  
Salvatore Caputo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Blood Glucose Concentration ◽  
Diabetic Complication ◽  
Emergency Setting ◽  
Online Activity

Background: Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon. Methods: Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter regulatory hormones. Results: Goals of therapy are to correct dehydration, acidosis and to reverse ketosis, gradually restoring blood glucose concentration to near normal. Conclusion: Furthermore it is essential to monitor potential complications of DKA and if necessary, to treat them and any precipitating events.

scholarly journals A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus

2014 ◽  
Vol 7 (4) ◽  
pp. 174-176 ◽  
Author(s):  
UM Graham ◽  
IE Cooke ◽  
DR McCance
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Plasma Glucose ◽  
Fetal Movement ◽  
Intravenous Dextrose

A 30-year old woman at 30 weeks gestation with insulin-controlled gestational diabetes was admitted with nausea and vomiting. Plasma glucose was 3.3 mmol/l with pH 7.23 and raised capillary ketones at 6.1 mmol/l. She was diagnosed with euglycaemic diabetic ketoacidosis. Cardiotocography showed good fetal movement and accelerations. She was given intramuscular betamethasone and started on intravenous dextrose, insulin and 0.9% saline with potassium chloride with resolution of ketosis. Euglycaemic diabetic ketoacidosis has been reported during pregnancy in patients with type 1 and type 2 diabetes. We believe that this is a report of such an occurrence in a patient with gestational diabetes.

How does age and sex impact on presentation, clinical course and outcome of diabetic ketoacidosis in type 1 and type 2 diabetes?

2021 ◽  
Author(s):  
Lakshmi Rengarajan ◽  
Emma Ooi ◽  
Katrina Nash ◽  
Eka Melson ◽  
Lucretia Thomas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Clinical Course ◽  
Age And Sex

Clinical and biochemical differences in diabetic ketoacidosis in people with type 1 and type 2 diabetes mellitus

2021 ◽  
Author(s):  
Emma Ooi ◽  
Lakshmi Rengarajan ◽  
Eka Melson ◽  
Lucretia Thomas ◽  
Agnes Johnson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Ketoacidosis

scholarly journals Incidence and associates of diabetic ketoacidosis in a community-based cohort: the Fremantle Diabetes Study Phase II

2020 ◽  
Vol 8 (1) ◽  
pp. e000983
Author(s):  
Timothy M E Davis ◽  
Wendy Davis
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Phase Ii ◽  
Negative Binomial ◽  
Study Phase ◽  
Community Based ◽  
Secondary Diabetes

ObjectiveTo assess the incidence and associates of diabetic ketoacidosis (DKA) in a representative community-based cohort.MethodsAll hospitalizations of 1724 participants in the Fremantle Diabetes Study Phase II for/with DKA (plasma glucose >13.8 mmol/L, urinary/serum ketones, serum bicarbonate <18 mmol/L and/or arterial/venous pH <7.30) were identified between study entry from 2008 to 2011 and end-2013. Details of each episode were categorized by chart review as confirmed/probable DKA, possible DKA or not DKA. Incidence rates by diabetes type were calculated. Cox proportional hazards modeling determined predictors of first episode, and negative binomial regression identified predictors of frequency.ResultsThere were 53 coded DKA episodes (41 first episodes, 12 recurrences), of which 19 (35.8%) were incorrectly coded, 9 (17.0%) had possible DKA and 25 (47.2%) had confirmed/probable DKA. Of this latter group, 44% had type 1 diabetes, 32% had type 2 diabetes, 12% had latent autoimmune diabetes of adults (LADA) and 12% had secondary diabetes. The overall incidence of confirmed/probable DKA (95% CI) was 35.6 (23.0 to 52.6)/10 000 person-years (178.6 (85.7 to 328.5)/10 000 person-years for type 1 diabetes, 13.3 (5.7 to 26.1)/10 000 person-years for type 2 diabetes, 121.5 (33.1 to 311.0)/10 000 person-years for LADA and 446.5 (92.1 to 1304.9)/10 000 person-years for secondary diabetes). Baseline ln(fasting serum C-peptide) (inversely), glycated hemoglobin and secondary diabetes predicted both incident first confirmed/probable DKA episode and the frequency of DKA (p<0.001).ConclusionsThese data highlight the contribution of poor glycemic control and limited pancreatic beta cell function to incident DKA, and show that people with types of diabetes other than type 1, especially secondary diabetes, are at risk.

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