Materiały źródłowe

• #1 Prevention of diabetic ketoacidosis 糖尿病酮酸中毒的預防 | 衛教單張 – China Medical University Hospital

  https://cmuh.cmu.edu.tw/HealthEdus/Detail_EN?no=5892

  Prevention of diabetic ketoacidosis 糖尿病酮酸中毒的預防 […] Diabetic ketoacidosis ( DKA ) is a state of insulin deficiency. When the glucose is unable to enter cells and accumulates within bloodstream, it triggers high blood sugar. Since body muscle and vital organs require energy to function, they have to dissolve body fat to provide energy; when a large amount of fat is broken down, it release fatty acids and ketone bodies in the blood. Also DKA develops when the blood has more acid than normal. The possible DKA etiology includes either newly diagnosed diabetes or external precipitating factors, such as infection and trauma, and etc. We strongly recommend you to comply with the following principles to prevent the development of diabetic ketoacidosis. […] Diabetes patients ought to actively follow 3 treatment principles: diet control, adequate exercise, plus medication. […] Collaborate with your physicians and nurses for long term treatment; stopping medication at will is forbidden. […] Look for doctor’s consultation immediately if there is need for diabetic treatment reinforcement for acute disorders and other diseases. […] Familiarize yourself with the symptoms of hyperglycemia: fatigue, rapid breathing, dry mouth and skin, frequent urination, extreme thirst, nausea, vomiting, abdominal pain, confusion or breath that smells fruity with a flushed face. If you are troubled by any of the aforementioned symptoms, visit the hospital as soon as possible. […] When ill, comply the following handling principles: […] Frequently check on blood glucose level and urine ketons when you are infected or feverish; and note, blood glucose level tend to run high as you feel sick. Closely pay attention to the infection symptoms, fever, and partial redness, heat, and skin pain. If the blood sugar level is uncontrollable, visit the doctor immediately. […] Drink more water to avoid dehydration during illness. […] You may take oral antidiabetic drugs or insulin regularly during illness. Check with your doctor if you want to increase or decrease medication dosage. […] During illness, take soft and digestible food. […] When your urine sugar continues 3+ to 4+, or blood sugar remains high, nausea, abdominal pain, dyspnea, and sustained fever; visit the hospital as soon as possible. […] With poor appetite, pay attention to medication usage. Beware: do not take oral anti-diabetic drugs or inject insulin under empty stomach.

• #1 Diabetic Ketoacidosis (DKA): Symptoms, Causes, Treatment

  https://www.healthline.com/health/type-2-diabetes/ketoacidosis

  Diabetic ketoacidosis occurs when a person with diabetes type 1 or 2 has dangerously high levels of ketones in the body. It can be a medical emergency. […] DKA may be the first sign of type 1 diabetes, as people with this disease cant make their own insulin. […] If you use insulin, make sure you discuss the risk of DKA with your healthcare team and have a plan in place. […] People with type 2 diabetes are usually at lower risk of DKA. But the risk can increase when your body is under strain due to injury, infection, or surgery. […] If you receive a diagnosis of DKA but havent yet received a diagnosis of diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from recurring. […] You can lower your risk of DKA with proper management of your diabetes: Take your medications as directed, even if youre feeling fine.

• #1 Diabetic ketoacidosis (DKA) | Ketosis symptoms and treatment | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/complications/diabetic-ketoacidosis

  DKA is more likely to happen to someone with type 1 diabetes, someone with any type who uses insulin, and people taking SGLT2 inhibitors, but can happen to other people on tablets or without a diagnosis too. […] It is important to be able to spot the signs and symptoms of DKA so that it can be treated quickly. […] You can help avoid DKA by monitoring your blood sugar levels regularly and altering your insulin dose in response to your blood sugar levels and what you eat. […] Your blood sugar levels could be higher than normal when you are unwell, putting you at risk of DKA. So, its a good idea to work with your healthcare team to come up with some sick day rules for when you are ill. […] These usually include drinking more sugar free fluids, taking more insulin and checking your blood sugars more often than you usually would.

• #1 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  DKA is a serious condition, but you can take steps to help prevent it: […] Check your blood sugar often, especially if you’re sick. […] Keep your blood sugar levels in your target range as much as possible. […] Take medicines as prescribed, even if you feel fine. […] Talk to your doctor about how to adjust your insulin based on what you eat, how active you are, or if you’re sick. […] If you’re concerned about DKA or have questions about how to manage your diabetes, talk to your diabetes care team. Ask them for a referral to diabetes self-management education and support (DSMES) for individual guidance. DSMES services are a vital tool to help you manage and live well with diabetes while protecting your health.

• #1 Diabetic Ketoacidosis: What It Is and How to Prevent It | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0501/p1721.html

  You should work with your doctor to have a plan if your blood glucose level gets too high. […] Careful monitoring is needed, especially if you are sick. […] Check your blood glucose level at least every three to four hours if you are sick. […] Test your urine for ketones or your blood for beta-hydroxybutyrate every four hours or if your blood glucose is over 250 mg per dL. […] If you are not eating, do NOT stop your insulin completely. […] Call your doctor if you do not know how to change your insulin dose. […] If your blood glucose is high, take extra insulin to control it. […] Drink lots of sugar-free, caffeine-free liquids. […] If your blood glucose is more than 250 mg per dL, do not eat or drink foods that are high in carbohydrates. […] If you have signs of infection, including fever, cough, sore throat, or pain when you go to the bathroom, see your doctor to make sure you are getting the right treatment.

• #1 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter. […] Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality. All people with type 1 diabetes should have a sick day management plan to prevent the development of DKA.

• #1 Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention

  https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones

  Know the warning signs of DKA and check urine for ketones, especially when you’re sick. […] Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly. […] You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. Ask your health care provider when and how you should test for ketones. Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl. […] Also, check for ketones when you have any symptoms of DKA. […] Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

• #1 Ketones, diabetic ketoacidosis, and type 1 diabetes – Breakthrough T1D

  https://www.breakthrought1d.org/news-and-updates/ketones-diabetic-ketoacidosis/

  When a person gets sick, their body is under stress. During times of mental or physical stress, like when sick with the flu or a serious infection, the body makes and releases stress hormones to fight illness. This can affect your blood sugar. On these days, you will need to monitor your blood sugar and ketone levels very closely, usually every 2-4 hours. […] If testing shows you have elevated ketones in urine or blood, follow the plan you and your diabetes care team have in place for treating ketones. Treatment typically includes increasing insulin and fluid intake. […] Many doctors advise checking for ketones if you are ill, especially if you are vomiting, have stomach pain, or have a fever. It’s also important to monitor ketones when blood glucose is above target; for example, higher than 240 mg/dL for three hours if you use an insulin pump or an automated insulin delivery (AID) system, or higher than 300 mg/dL for three hours if you do multiple daily injections (MDI).

• #1

  https://journals.lww.com/sjmm/fulltext/2020/08030/management_of_diabetic_ketoacidosis_in_adults__a.1.aspx

  Patient education is a critical part of the prevention of future hospital admissions for DKA. Educational programs should include guidelines on the management of diabetes during periods of illness (sick day management). These programs should include clear information on (1) the importance of continuing insulin, (2) early recognition of the manifestations of DKA, (3) more frequent home blood glucose and ketone (urine or blood) monitoring, (4) adjusting doses of insulin and the use of supplemental insulin, as needed and (5) instances when the health-care provider should be contacted. Self-monitoring of blood ketones, when compared with urine ketone testing, facilitates earlier identification and treatment of ketosis, and can decrease diabetes-related emergency department visits and hospitalizations. The frequency of recurrence of DKA can be reduced with structured patient education, behavioral intervention, providing support for patients and families, improving patients’ access to medical providers, availability of extended access to telephone services and telemedicine. […] In addition, public awareness campaigns focusing on education on the early signs of diabetes have been found to significantly reduce the frequency of DKA in patients with new onset diabetes.

• #1 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes, taking the following actions can help prevent DKA: […] Checking your blood sugar often: Checking your blood sugar with a glucose meter and/or using a CGM is crucial to managing diabetes and preventing complications. Try to at least check your blood sugar before and after meals and before you go to sleep. Its important to treat high blood sugar as soon as possible to prevent DKA. […] Taking your insulin and/or medication regularly: Follow your healthcare providers instructions for taking your insulin and/or medication. Missed doses can lead to DKA. […] Checking for ketones: If youre experiencing sustained high blood sugar, check for ketones using a pee or blood test to be sure youre not close to developing DKA. […] Checking your insulin pump: If you use an insulin pump and are experiencing high blood sugar, be sure to check your pump for issues like a kinked cannula or a disconnected site/tubing. These issues could be preventing you from receiving insulin.

• #1 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  Patient education about management of their diabetes during periods of mild illness (sick-day management) is vital for preventing DKA. This should include information on when to contact a healthcare professional, blood glucose monitoring, use of insulin, and initiation of appropriate nutrition during illness. This information should be reinforced with patients periodically. Patients should be advised to continue insulin and to seek professional advice early in the course of the illness. Close follow-up is very important, as it has been shown that 3-month visits to the endocrine clinic will reduce the number of emergency department admissions for DKA. […] Self-monitoring of ketones is also emerging as a potential strategy. During illness (or when experiencing other stressful events such as trauma or surgery) it may be advisable for ketosis-prone individuals to monitor their ketones, in addition to increasing frequency of blood glucose monitoring.

• #1 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Diabetic ketoacidosis is the most common acute emergency in people with type 1 diabetes mellitus, and can be life-threatening. Education to improve early recognition and appropriate management may avoid the need for presentation to the emergency department and reduce morbidity and mortality. […] The initial management of DKA involves fluid resuscitation and insulin administration. […] On diagnosing DKA in an outpatient setting, subcutaneous rapid-acting insulin should be administered immediately rather than waiting for the person to present to the emergency department. […] Sodium-glucose cotransporter-2 inhibitors should not be prescribed by GPs for people with type 1 diabetes as there is a significantly increased risk of DKA. […] Education on the risk and signs and symptoms of DKA should be delivered, and appropriate sick day management information should be provided, including how and when to measure ketones, and how to treat elevated ketones.

• #1 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  Pregnant individuals with type 1 diabetes should be counseled about the increased risk of DKA during pregnancy, how to avoid and recognize this, and be provided with ketone-monitoring tools (as DKA in pregnancy is associated with a high risk of stillbirth). […] Autoantibody testing may be used to screen family members of those with type 1 diabetes, to detect other individuals at risk of developing the disease: providing these individuals with diabetes and DKA education and follow-up has been demonstrated to result in more prompt diagnosis of diabetes and to prevent DKA. […] Patients treated with SGLT-2 inhibitors (especially those with type 1 diabetes or ketosis-prone type 2 diabetes, and/or on a ketogenic diet) should be educated about the risk of DKA and how to prevent and recognize this, and be provided with the tools to measure their ketones.

• #1 Diabetes Drug Lawsuits | Injuries and Claims

  https://www.drugwatch.com/health/diabetes/diabetic-ketoacidosis/

  The FDA has released several safety warnings linking diabetes drugs in the SGLT2 inhibitor class to increased amputation risk, kidney injury, serious genital infections and diabetes ketoacidosis (DKA). […] FDA warned the public about the risk of DKA with SGLT2 medications and strengthened the drug label warnings. […] The agency also advised health care providers to stop canagliflozin, dapagliflozin and empagliflozin at least three days and ertugliflozin at least four days before surgery.

• #1 Editor’s Pick: Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes – European Medical Journal

  https://www.emjreviews.com/diabetes/article/diabetic-ketoacidosis-in-pregnancy-an-overview-of-pathophysiology-management-and-pregnancy-outcomes/

  The measures to prevent maternal and fetal adverse outcomes due to DKA should begin during preconception counseling. It is imperative to prepare a female with diabetes for pregnancy through adequate education about the importance of diabetes control prior to pregnancy. Close monitoring and regular insulin titration are critical during pregnancy. In addition, females should receive education on precipitating factors, signs, and symptoms of DKA, home monitoring of urine ketones, and how to seek help on time. A multidisciplinary team involving an endocrinologist (trained in managing diabetes in pregnancy), high-risk obstetrician, maternal-fetal medicine specialist, and diabetes educators should ideally be involved in caring for a females who are pregnant with diabetes. […] DKA in pregnancy is an obstetrical emergency associated with poor pregnancy outcomes. Compared with an individual who is not pregnant, a female who is pregnant with diabetes is at higher risk of developing DKA, and the condition can occur with lesser degrees of hyperglycaemia. DKA can also be the first presentation of diabetes in pregnancy. A high index of suspicion along with prompt diagnosis and management are critical to ensure optimal outcomes. Further studies are warranted to develop improved strategies to prevent DKA during pregnancy and clarify the long-term sequelae of ketosis on offspring of females with DKA.

• #1 Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32333879/

  Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. […] Possible prevention strategies, which include the identification of people at risk based on non-modifiable sociodemographic risk factors, are proposed. […] As a second risk mitigation strategy, structured diabetes self-management education that addresses modifiable risk factors can be used. Evidence has found that structured education leads to reduced DKA rates. […] Knowledge of these risk factors and potent risk mitigation strategies are important to identify subgroups of people with an elevated DKA risk. […] Prevention of DKA in people with type 1 diabetes is an important clinical task, which should also be addressed when SGLT inhibitors are part of therapy.

• #1 Diabetic Ketoacidosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0501/p1705.html

  A diagnosis of diabetic ketoacidosis requires the patients plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. […] Education to prevent recurrence should be offered to all patients, including how to manage sick days and when to call a physician. […] Prevention of another episode should be part of the treatment of DKA. Most patients with DKA will need lifetime insulin therapy after discharge from the hospital. Education about diabetes is a cornerstone of prevention that also has been found to reduce length of stay. […] Strategies for prevention are listed in Table 4. Diabetic education, blood glucose monitoring, sick-day management, home monitoring of ketones or beta-hydroxybutyrate, supplemental short-acting insulin regimens, easily digestible liquid diets when sick, reducing, rather than eliminating, insulin when patients are not eating, guidelines for when patients should seek medical attention, case monitoring of high-risk patients, special education for patients on pump management.

• #1 Diabetic Ketoacidosis – Awareness & Prevention – Kauvery Hospital

  https://www.kauveryhospital.com/news-events/diabetic-ketoacidosis-a-landmine-be-warned/

  Contingency Plans All children with type 1 diabetes should have an ID with emergency contact number. During sick days, we need to keep a closer watch on their sugar levels. Primary caregivers, adult family members, teachers and school staff need to be educated and counselled about the warning signs of DKA. They should know when and where to seek emergency assistance for the same. […] Support and Periodic Follow-Up A diagnosis of type 1 diabetes can be quite overwhelming for the child and family to deal with. Hence, family support, education and regular follow-up are essential to ensure compliance with therapy. This mandates unstinted backing from the right team of doctors with the right resources and knowledge.

• #1 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  Hospital admission with DKA, and recurrent admissions in particular, may be considered a „red flag” for triggering psychiatric assessment so that mental health problems can be addressed and further admissions with DKA prevented. […] Referral to a behavioral health professional is advisable for youth experiencing recurrent hospitalization for DKA. […] Diabetes technology can also be used to reduce DKA risk, such as insulin pump therapy in youth with type 1 diabetes and the use of intermittently-scanned continuous glucose monitoring.

• #1

  https://journals.lww.com/sjmm/fulltext/2020/08030/management_of_diabetic_ketoacidosis_in_adults__a.1.aspx

  Prevention of future incidents of DKA and forthcoming admissions is a very important component of its management. An essential factor in planning the prevention of DKA is the recognition of the precipitating cause. Poor adherence to insulin therapy was found to be a major causative factor for hospital admissions for DKA. Omission of insulin has been found to be associated with lack of patient education, limited access to health care, economic limitations, underlying psychiatric conditions and eating disorders. In addition, social and psychiatric factors such as depression, eating disorders, low socioeconomic status and sexual or physical abuse have been implicated in the occurrence of recurrent admissions for DKA. Another factor associated with recurrent hospital admissions for DKA is substance use, particularly cocaine.

• #1 Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

  https://www.mdpi.com/2227-9067/12/1/110

  Raising professional and public awareness about the early signs and symptoms of hyperglycemia is paramount to prevent severe DKA and its associated complications. […] An 8-year study (1991–1999) conducted in the province of Parma, Italy, demonstrated that an awareness campaign, named “the Parma campaign”, significantly reduced both the incidence and severity of DKA at diagnosis. […] A recent systematic review showed that the reduction in DKA rates due to awareness campaigns ranges from 1% to 65.5%. […] In recent years, screening for T1D has been extensively discussed, aiming to the identification of early stages of T1D, reducing the incidence of severe DKA, its associated morbidity, the economic burden of hospitalization, and the psychological impact on families. […] Education plays a crucial role in raising awareness about the risks of secondary DKA and training patients and their families to manage effectively sick days.

• #1 What Causes Ketoacidosis?

  https://www.verywellhealth.com/what-is-ketoacidosis-5092298

  Diabetes is a chronic condition that requires ongoing care and management. DKA is a serious complication that can occur in people with diabetes and can be triggered by many different causes. […] You can lower your chances of getting DKA by adhering to your treatment and checking your blood sugar and ketone levels regularly. Even though some causes of DKA are not avoidable, you can still prevent it by learning and recognizing the warning signs of DKA early so you can get help as soon as possible when it happens.

• #1 Diabetic Ketoacidosis (DKA): Causes, Symptoms, Treatments

  https://www.webmd.com/diabetes/ketoacidosis

  Your doctor may change your insulin dose, or the kind you use, to prevent DKA from happening again. […] Good blood sugar control will help you avoid ketoacidosis in the future. Make sure you manage your diabetes through your diet, exercise, medications, and self-care. […] Follow these steps to help prevent DKA: Drink lots of water or sugar-free, nonalcoholic beverages. Take your medicines as directed. Follow your meal plan closely. Keep up with your exercise program. Test your blood sugar regularly. Check for expired insulin. Don’t use your insulin dose if it has clumps. Insulin should either be clear or evenly cloudy with small flecks. If you’re on an insulin pump, look closely for insulin leaks, and check your tube connections for air bubbles. Talk to your doctor if your blood sugar levels are often out of your target range. Manage your insulin dose with help from your doctor or diabetes coach. Make adjustments based on your blood sugar levels, diet, activity levels, or during any illness. Create a DKA emergency plan. If your blood sugar levels are too high or your urine has too many ketones, make a plan to go to the hospital.

• #1 Diabetic ketoacidosis: Symptoms, causes, treatment, prevention

  https://www.medicalnewstoday.com/articles/325136

  A person with diabetes can take many steps to prevent diabetic ketoacidosis. Preventing DKA usually centers on learning how to manage diabetes well. […] Preventive steps include: routinely testing the blood sugar to make sure that it is not getting too high, taking oral and injected diabetes medication according to the prescription, asking a doctor about adjusting insulin dosage if necessary, particularly if blood sugar is high, checking ketone levels in the urine when ill or after an injury. […] Anyone who suspects that they may have DKA should be prepared to act quickly and seek emergency medical treatment.

• #2 Diabetic Ketoacidosis: Symptoms and Treatment | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/diabetic-ketoacidosis

  The main key to preventing DKA is being able to manage your diabetes. It is important to stay consistent in whatever your treatment plan is. This includes consistent insulin treatments and taking any medications for diabetes management, staying hydrated, following a meal plan that helps to regulate sugar levels, and monitoring your blood sugar levels on a consistent basis. […] The key to prevention is early detection, which is why regular monitoring and testing of blood sugar levels is paramount. Discrepancies in blood sugar levels can indicate testing for ketone levels. Seek medical help immediately if any symptoms of DKA are present, as it can lead to coma or death, if left untreated.

• #2 Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32333879/

  Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. […] Possible prevention strategies, which include the identification of people at risk based on non-modifiable sociodemographic risk factors, are proposed. […] As a second risk mitigation strategy, structured diabetes self-management education that addresses modifiable risk factors can be used. Evidence has found that structured education leads to reduced DKA rates. […] Knowledge of these risk factors and potent risk mitigation strategies are important to identify subgroups of people with an elevated DKA risk. […] Prevention of DKA in people with type 1 diabetes is an important clinical task, which should also be addressed when SGLT inhibitors are part of therapy.

• #2 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  Pregnant individuals with type 1 diabetes should be counseled about the increased risk of DKA during pregnancy, how to avoid and recognize this, and be provided with ketone-monitoring tools (as DKA in pregnancy is associated with a high risk of stillbirth). […] Autoantibody testing may be used to screen family members of those with type 1 diabetes, to detect other individuals at risk of developing the disease: providing these individuals with diabetes and DKA education and follow-up has been demonstrated to result in more prompt diagnosis of diabetes and to prevent DKA. […] Patients treated with SGLT-2 inhibitors (especially those with type 1 diabetes or ketosis-prone type 2 diabetes, and/or on a ketogenic diet) should be educated about the risk of DKA and how to prevent and recognize this, and be provided with the tools to measure their ketones.

• #2 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is a serious complication of diabetes. […] If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care. […] There are many ways to prevent diabetic ketoacidosis and other diabetes complications. […] Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Take diabetes medicines or insulin as directed. […] Monitor your blood sugar level. You might need to check and record your blood sugar level at least 3 to 4 times a day, or more often if you’re ill or stressed. Careful monitoring is the only way to make sure that your blood sugar level stays within your target range. […] Adjust your insulin dosage as needed. Talk to your health care provider or diabetes educator about how to make your insulin dosage work for you. Consider factors such as your blood sugar level, what you eat, how active you are, and whether you’re ill. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.

• #2 Understanding Diabetic Ketoacidosis: Symptoms, Causes, and Prevention

  https://tap.health/diabetic-ketoacidosis-prevention/

  Preventing DKA relies heavily on effectively managing your blood sugar levels. This means consistently keeping your pre-meal blood glucose levels between 80-130 mg/dL, and your post-meal levels below 180 mg/dL. Regular monitoring is crucial. Remember, consistent blood sugar control is key to avoiding dangerous spikes and drops that can lead to DKA. […] Regular blood sugar monitoring is paramount, especially during periods of illness or stress. Maintaining consistent insulin therapy as prescribed by your doctor is essential. Staying hydrated, particularly in hot climates, is crucial, and seeking prompt medical attention at the first sign of symptoms like increased thirst, frequent urination, and fruity-smelling breath is vital. In the Indian and tropical context, raising awareness about DKA prevention through community health programs and accessible educational materials is crucial to improving outcomes.

• #2 Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

  https://www.mdpi.com/2227-9067/12/1/110

  HbA1c reflects long-term blood glucose control and is a critical predictor of diabetes-related complications. […] In recent decades, several advanced technologies, represented by continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID) systems, have been implemented to improve the management of T1D, with the dual goals of achieving optimal glycemic control and reducing the incidence of acute complications such as secondary severe DKA and severe hypoglycemia. […] According to the ISPAD guidelines, ketone monitoring plays a critical role in preventing and detecting secondary DKA, especially during any acute illnesses.

• #2 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Check your ketone level. When you’re ill or stressed, test your urine for excess ketones with a urine ketones test kit. You can buy test kits at a drugstore. If your ketone level is moderate or high, contact your health care provider right away or seek emergency care. If you have low levels of ketones, you may need to take more insulin. […] Be prepared to act quickly. If you think you have diabetic ketoacidosis because your blood sugar is high and you have too many ketones in your urine, seek emergency care. […] Follow your diabetes treatment plan carefully. Ask your diabetes treatment team for help when you need it.

• #2 Prevention of diabetic ketoacidosis and self-monitoring of ketone bodies: an overview – PubMed

  https://pubmed.ncbi.nlm.nih.gov/19327102/

  Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. […] Prevention of DKA – especially in sick day management – relies on intensive self-monitoring of blood glucose and subsequent, appropriate therapy adjustments. […] Education of patients and their social environment to promote frequent testing – especially during sick days – and to lower their glucose levels, as well as to recognize the early symptoms of hyperglycemia and DKA is of paramount importance in preventing the development of severe DKA. […] Both methods for self-monitoring of ketone bodies are safe and clinically reliable.

• #2 Diabetic ketoacidosis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000320.htm

  If you have diabetes, learn to recognize the signs and symptoms of DKA. Know when to test for ketones, such as when you are sick. […] If you use an insulin pump, check often to see that insulin is flowing through the tubing. Make sure the tube is not blocked, kinked or disconnected from the pump.

• #2 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter. […] Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality. All people with type 1 diabetes should have a sick day management plan to prevent the development of DKA.

• #2 Prevention of diabetic ketoacidosis 糖尿病酮酸中毒的預防 | 衛教單張 – China Medical University Hospital

  https://cmuh.cmu.edu.tw/HealthEdus/Detail_EN?no=5892

  Prevention of diabetic ketoacidosis 糖尿病酮酸中毒的預防 […] Diabetic ketoacidosis ( DKA ) is a state of insulin deficiency. When the glucose is unable to enter cells and accumulates within bloodstream, it triggers high blood sugar. Since body muscle and vital organs require energy to function, they have to dissolve body fat to provide energy; when a large amount of fat is broken down, it release fatty acids and ketone bodies in the blood. Also DKA develops when the blood has more acid than normal. The possible DKA etiology includes either newly diagnosed diabetes or external precipitating factors, such as infection and trauma, and etc. We strongly recommend you to comply with the following principles to prevent the development of diabetic ketoacidosis. […] Diabetes patients ought to actively follow 3 treatment principles: diet control, adequate exercise, plus medication. […] Collaborate with your physicians and nurses for long term treatment; stopping medication at will is forbidden. […] Look for doctor’s consultation immediately if there is need for diabetic treatment reinforcement for acute disorders and other diseases. […] Familiarize yourself with the symptoms of hyperglycemia: fatigue, rapid breathing, dry mouth and skin, frequent urination, extreme thirst, nausea, vomiting, abdominal pain, confusion or breath that smells fruity with a flushed face. If you are troubled by any of the aforementioned symptoms, visit the hospital as soon as possible. […] When ill, comply the following handling principles: […] Frequently check on blood glucose level and urine ketons when you are infected or feverish; and note, blood glucose level tend to run high as you feel sick. Closely pay attention to the infection symptoms, fever, and partial redness, heat, and skin pain. If the blood sugar level is uncontrollable, visit the doctor immediately. […] Drink more water to avoid dehydration during illness. […] You may take oral antidiabetic drugs or insulin regularly during illness. Check with your doctor if you want to increase or decrease medication dosage. […] During illness, take soft and digestible food. […] When your urine sugar continues 3+ to 4+, or blood sugar remains high, nausea, abdominal pain, dyspnea, and sustained fever; visit the hospital as soon as possible. […] With poor appetite, pay attention to medication usage. Beware: do not take oral anti-diabetic drugs or inject insulin under empty stomach.

• #2

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221

  To reduce your chance of ketoacidosis: […] Take your insulin and other diabetes medicines on time and in the right dose. […] When you are sick: […] Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. […] Drink extra fluids to prevent dehydration. […] If you know your blood sugar is high, treat it before it gets worse. […] If you missed your usual dose of insulin or other diabetes medicine, take the missed dose or take the amount your doctor told you to take if this happens. […] Drink extra water or sugar-free drinks to prevent dehydration.

• #2 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  Having a sick day plan: Talk with your provider about how to manage diabetes when youre sick. Illness can trigger DKA, so its important to know what to do if you get sick before it happens so that youre prepared. […] Seeing your diabetes provider regularly: Its important to see your diabetes provider regularly to be sure that your diabetes management plan is working. […] Staying educated: Dont be afraid to ask your healthcare team about DKA. The more you know about DKA and your diabetes management, the more likely youll be able to prevent it or catch it in its early stages.

• #2 Diabetes Drug Lawsuits | Injuries and Claims

  https://www.drugwatch.com/health/diabetes/diabetic-ketoacidosis/

  The FDA has released several safety warnings linking diabetes drugs in the SGLT2 inhibitor class to increased amputation risk, kidney injury, serious genital infections and diabetes ketoacidosis (DKA). […] FDA warned the public about the risk of DKA with SGLT2 medications and strengthened the drug label warnings. […] The agency also advised health care providers to stop canagliflozin, dapagliflozin and empagliflozin at least three days and ertugliflozin at least four days before surgery.

• #2 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  To reduce the risk of DKA, it is important to assess, and regularly reassess, susceptibility to DKA in those with type 1 diabetes being treated with an SGLT-2 inhibitor, in addition to providing regular patient education on DKA. […] DKA prevention strategies should include withholding SGLT-2 inhibitors when precipitants are present (e.g., discontinue 3-4 days before scheduled surgery), and avoiding insulin omission or large insulin dose reduction. […] Many cases can be prevented by better access to medical care, proper education, and effective communication with a healthcare provider during an intercurrent illness. Adequate supervision by family and healthcare provider may decrease the rates of hospitalization and mortality. […] Hospitals should ensure that basal insulin doses are not omitted or delayed for admitted patients, particularly during care transitions, through use of electronic alerts and ongoing staff education.

• #2 Diabetic ketoacidosis primary prevention – wikidoc

  https://www.wikidoc.org/index.php/Diabetic_ketoacidosis_primary_prevention

  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: Canagliflozin, Dapagliflozin, Empagliflozin. […] Patients taking SGLT-2 inhibitors should avoid excess alcohol intake and very-low-carbohydrate/ketogenic diets.

• #2 Editor’s Pick: Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes – European Medical Journal

  https://www.emjreviews.com/diabetes/article/diabetic-ketoacidosis-in-pregnancy-an-overview-of-pathophysiology-management-and-pregnancy-outcomes/

  The measures to prevent maternal and fetal adverse outcomes due to DKA should begin during preconception counseling. It is imperative to prepare a female with diabetes for pregnancy through adequate education about the importance of diabetes control prior to pregnancy. Close monitoring and regular insulin titration are critical during pregnancy. In addition, females should receive education on precipitating factors, signs, and symptoms of DKA, home monitoring of urine ketones, and how to seek help on time. A multidisciplinary team involving an endocrinologist (trained in managing diabetes in pregnancy), high-risk obstetrician, maternal-fetal medicine specialist, and diabetes educators should ideally be involved in caring for a females who are pregnant with diabetes. […] DKA in pregnancy is an obstetrical emergency associated with poor pregnancy outcomes. Compared with an individual who is not pregnant, a female who is pregnant with diabetes is at higher risk of developing DKA, and the condition can occur with lesser degrees of hyperglycaemia. DKA can also be the first presentation of diabetes in pregnancy. A high index of suspicion along with prompt diagnosis and management are critical to ensure optimal outcomes. Further studies are warranted to develop improved strategies to prevent DKA during pregnancy and clarify the long-term sequelae of ketosis on offspring of females with DKA.

• #2 Ketones, diabetic ketoacidosis, and type 1 diabetes – Breakthrough T1D

  https://www.breakthrought1d.org/news-and-updates/ketones-diabetic-ketoacidosis/

  If your blood sugar is above 240 mg/dL, you should test for ketones before exercising. The presence of ketones in someone with T1D shows that there’s not enough insulin in the body to use the sugar. Exercise would only burn more fat, make more ketones, and make hyperglycemia worse, putting you at risk for diabetic ketoacidosis.

• #2 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  Patient education about management of their diabetes during periods of mild illness (sick-day management) is vital for preventing DKA. This should include information on when to contact a healthcare professional, blood glucose monitoring, use of insulin, and initiation of appropriate nutrition during illness. This information should be reinforced with patients periodically. Patients should be advised to continue insulin and to seek professional advice early in the course of the illness. Close follow-up is very important, as it has been shown that 3-month visits to the endocrine clinic will reduce the number of emergency department admissions for DKA. […] Self-monitoring of ketones is also emerging as a potential strategy. During illness (or when experiencing other stressful events such as trauma or surgery) it may be advisable for ketosis-prone individuals to monitor their ketones, in addition to increasing frequency of blood glucose monitoring.

• #2

  https://journals.lww.com/sjmm/fulltext/2020/08030/management_of_diabetic_ketoacidosis_in_adults__a.1.aspx

  Patient education is a critical part of the prevention of future hospital admissions for DKA. Educational programs should include guidelines on the management of diabetes during periods of illness (sick day management). These programs should include clear information on (1) the importance of continuing insulin, (2) early recognition of the manifestations of DKA, (3) more frequent home blood glucose and ketone (urine or blood) monitoring, (4) adjusting doses of insulin and the use of supplemental insulin, as needed and (5) instances when the health-care provider should be contacted. Self-monitoring of blood ketones, when compared with urine ketone testing, facilitates earlier identification and treatment of ketosis, and can decrease diabetes-related emergency department visits and hospitalizations. The frequency of recurrence of DKA can be reduced with structured patient education, behavioral intervention, providing support for patients and families, improving patients’ access to medical providers, availability of extended access to telephone services and telemedicine. […] In addition, public awareness campaigns focusing on education on the early signs of diabetes have been found to significantly reduce the frequency of DKA in patients with new onset diabetes.

• #2 Diabetic ketoacidosis primary prevention – wikidoc

  https://www.wikidoc.org/index.php/Diabetic_ketoacidosis_primary_prevention

  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 of diabetic ketoacidosis (DKA) includes the following measures: […] 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.

• #2 Preventing Diabetic Ketoacidosis: A Team Approach | Texas Children’s

  https://www.texaschildrens.org/content/for-physicians/preventing-diabetic-ketoacidosis-team-approach

  Admissions for diabetic ketoacidosis (DKA) across the United States are increasing (1) and pose significant risk of morbidity and mortality to children with type 1 diabetes. […] As such, the endocrinologists at Texas Children’s Hospital work hard from the beginning to help children with type 1 diabetes live their best lives and stay consistent with their diabetes care. […] Even patients who are not in DKA at the time of diagnosis are admitted so that they can take advantage of the multidisciplinary new onset diabetes team that works in concert to cover every aspect of type 1 diabetes care. […] Social workers in this setting at Texas Children’s Hospital have specialized training to identify familial, social, financial or psychological barriers that will also need to be addressed to prevent subsequent DKA admissions.

• #2 Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

  https://www.mdpi.com/2227-9067/12/1/110

  Raising professional and public awareness about the early signs and symptoms of hyperglycemia is paramount to prevent severe DKA and its associated complications. […] An 8-year study (1991–1999) conducted in the province of Parma, Italy, demonstrated that an awareness campaign, named “the Parma campaign”, significantly reduced both the incidence and severity of DKA at diagnosis. […] A recent systematic review showed that the reduction in DKA rates due to awareness campaigns ranges from 1% to 65.5%. […] In recent years, screening for T1D has been extensively discussed, aiming to the identification of early stages of T1D, reducing the incidence of severe DKA, its associated morbidity, the economic burden of hospitalization, and the psychological impact on families. […] Education plays a crucial role in raising awareness about the risks of secondary DKA and training patients and their families to manage effectively sick days.

• #2 Diabetic ketoacidosis (DKA): symptoms, prevention and management | Dexcom

  https://www.dexcom.com/en-us/all-access/clinical-corner/diabetic-ketoacidosis-symptoms-prevention-and-management

  When living with diabetes, it’s important to not simplify „brush off” when you feel off, unwell or unlike yourself. […] The earlier the detection, the better. Early detection gives you an opportunity to take action to get your glucose and ketone levels back on track as fast as possible, hopefully avoiding DKA and any associated acute complications. […] If you’re concerned about your ketone levels, check your urine ketones or blood ketones every two hours. Ignoring high ketone levels or other DKA symptoms can be fatal. […] Prevention, fast detection, aggressive intervention and proper diabetes management are all keys to avoiding DKA and its complications.

• #2 Understanding Diabetic Ketoacidosis: Symptoms, Causes, and Prevention

  https://tap.health/diabetic-ketoacidosis-prevention/

  Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body doesn’t have enough insulin. This leads to a buildup of ketones in the blood, making it dangerously acidic. Understanding the symptoms and causes is crucial for prevention, particularly in regions like India and other tropical countries where diabetes prevalence is high. Early detection is vital as DKA can be life-threatening. […] Careful management of blood sugar levels through regular monitoring, consistent insulin therapy (if needed), and a healthy lifestyle are essential. Staying hydrated, particularly in hot and humid climates, is crucial. Regular check-ups with your doctor are vital for early detection and management of any complications, including the prevention of kidney disease. In India and other tropical nations, access to affordable healthcare and education on diabetes management remains a critical factor in preventing DKA and its life-threatening consequences. Don’t hesitate to contact your doctor or local diabetes clinic for support and guidance.

• #2 Diabetic Ketoacidosis (DKA): Symptoms, Causes, Treatment

  https://www.healthline.com/health/type-2-diabetes/ketoacidosis

  Test for ketone levels when youre sick. This can help you catch mild to moderate ketone levels before they threaten your health. […] Call your doctor if you detect moderate or high ketones in a home test. If you cant reach your doctor and you suspect you may be progressing to DKA, get emergency help. Early detection is essential. […] DKA is serious, but it can be prevented. Follow your diabetes treatment plan and be proactive about your health.

• #3 Diabetic ketoacidosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551

  Diabetic ketoacidosis is a serious complication of diabetes. […] If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care. […] There are many ways to prevent diabetic ketoacidosis and other diabetes complications. […] Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Take diabetes medicines or insulin as directed. […] Monitor your blood sugar level. You might need to check and record your blood sugar level at least 3 to 4 times a day, or more often if you’re ill or stressed. Careful monitoring is the only way to make sure that your blood sugar level stays within your target range. […] Adjust your insulin dosage as needed. Talk to your health care provider or diabetes educator about how to make your insulin dosage work for you. Consider factors such as your blood sugar level, what you eat, how active you are, and whether you’re ill. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.

• #3 Editor’s Pick: Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes – European Medical Journal

  https://www.emjreviews.com/diabetes/article/diabetic-ketoacidosis-in-pregnancy-an-overview-of-pathophysiology-management-and-pregnancy-outcomes/

  The measures to prevent maternal and fetal adverse outcomes due to DKA should begin during preconception counseling. It is imperative to prepare a female with diabetes for pregnancy through adequate education about the importance of diabetes control prior to pregnancy. Close monitoring and regular insulin titration are critical during pregnancy. In addition, females should receive education on precipitating factors, signs, and symptoms of DKA, home monitoring of urine ketones, and how to seek help on time. A multidisciplinary team involving an endocrinologist (trained in managing diabetes in pregnancy), high-risk obstetrician, maternal-fetal medicine specialist, and diabetes educators should ideally be involved in caring for a females who are pregnant with diabetes. […] DKA in pregnancy is an obstetrical emergency associated with poor pregnancy outcomes. Compared with an individual who is not pregnant, a female who is pregnant with diabetes is at higher risk of developing DKA, and the condition can occur with lesser degrees of hyperglycaemia. DKA can also be the first presentation of diabetes in pregnancy. A high index of suspicion along with prompt diagnosis and management are critical to ensure optimal outcomes. Further studies are warranted to develop improved strategies to prevent DKA during pregnancy and clarify the long-term sequelae of ketosis on offspring of females with DKA.

• #3 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  If you have diabetes, taking the following actions can help prevent DKA: […] Checking your blood sugar often: Checking your blood sugar with a glucose meter and/or using a CGM is crucial to managing diabetes and preventing complications. Try to at least check your blood sugar before and after meals and before you go to sleep. Its important to treat high blood sugar as soon as possible to prevent DKA. […] Taking your insulin and/or medication regularly: Follow your healthcare providers instructions for taking your insulin and/or medication. Missed doses can lead to DKA. […] Checking for ketones: If youre experiencing sustained high blood sugar, check for ketones using a pee or blood test to be sure youre not close to developing DKA. […] Checking your insulin pump: If you use an insulin pump and are experiencing high blood sugar, be sure to check your pump for issues like a kinked cannula or a disconnected site/tubing. These issues could be preventing you from receiving insulin.

• #3 Diabetic ketoacidosis – Prevention | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/prevention

  Patient education about management of their diabetes during periods of mild illness (sick-day management) is vital for preventing DKA. This should include information on when to contact a healthcare professional, blood glucose monitoring, use of insulin, and initiation of appropriate nutrition during illness. This information should be reinforced with patients periodically. Patients should be advised to continue insulin and to seek professional advice early in the course of the illness. Close follow-up is very important, as it has been shown that 3-month visits to the endocrine clinic will reduce the number of emergency department admissions for DKA. […] Self-monitoring of ketones is also emerging as a potential strategy. During illness (or when experiencing other stressful events such as trauma or surgery) it may be advisable for ketosis-prone individuals to monitor their ketones, in addition to increasing frequency of blood glucose monitoring.

• #3 Diabetic Ketoacidosis | Endocrinology and Diabetes

  https://health.ucdavis.edu/conditions/endocrinology-diabetes/diabetes/diabetic-ketoacidosis

  In many cases, DKA is preventable. If you have diabetes, you can help prevent many episodes of DKA with: […] If you have an insulin pump, make sure it is working correctly. Check the tube connection and look for kinks or blockages. Make sure your pump reservoir does not run out of insulin. […] Check your blood sugar regularly. If your levels are higher than normal, contact your diabetes care team. […] Use a ketone test kit if your glucose is 300 mg/dL or higher. If the test shows you are in ketosis, immediately contact your provider. […] Watch for possible signs of DKA, especially when you’re sick or have missed an insulin dose. […] See your diabetes care team regularly to ensure your treatment is working. […] Take your insulin and other medications exactly as prescribed. If you have questions about your medicines, ask your provider or pharmacist.

• #3 Diabetic ketoacidosis – treatment and prevention | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2024/august/regular-series/diabetic-ketoacidosis-treatment-and-prevention

  Sick day management is a critical aspect of care for people with type 1 diabetes. […] Key elements of sick day management include maintaining adequate hydration, regularly monitoring blood glucose and ketone levels every two to four hours, administering additional insulin for elevated ketones, and taking antiemetic medications. […] Ensure the person with type 1 diabetes has a written sick day management plan and access to ketone strips and a ketone meter. […] Encourage regular insulin administration, particularly emphasising the importance of not omitting long-acting insulin when using pen injections under any circumstance. […] Studies have shown that CGM use reduces the risk of DKA in people with type 1 diabetes by 49 to 56%. […] DKA is a life-threatening emergency; prompt treatment with rapid-acting insulin and fluid hydration can prevent significant morbidity and mortality. All people with type 1 diabetes should have a sick day management plan to prevent the development of DKA.

• #3 Prevention of diabetic ketoacidosis

  https://www.terveyskyla.fi/en/diabeteshub/diabetes/high-blood-sugar-and-diabetic-ketoacidosis-dka/diabetic-ketoacidosis-dka/prevention-of-diabetic-ketoacidosis

  The most important thing to prevent ketoacidosis is to be aware of the risk and potentially dangerous situations in insulin-dependent diabetes. […] If the blood sugar level becomes higher than 14–15 mmol/l for no apparent reason, it is important to keep in mind insulin deficiency and the risk of diabetic ketoacidosis (DKA). […] Sudden diseases, especially fever, increase the need for insulin. […] Checking the blood ketone level is especially important for a person with insulin-dependent diabetes who uses SGLT2 inhibitors because, in that case, blood sugar is not usually as high as normal during DKA. […] Instructions regarding the risk situations related to DKA and what to do about them are discussed in the start of insulin pump therapy. […] In addition to recognizing the symptoms of ketoacidosis, it’s important for people with diabetes and their loved ones to know how to measure ketone levels and understand how to act based on the results.

• #3

  https://journals.lww.com/sjmm/fulltext/2020/08030/management_of_diabetic_ketoacidosis_in_adults__a.1.aspx

  Patient education is a critical part of the prevention of future hospital admissions for DKA. Educational programs should include guidelines on the management of diabetes during periods of illness (sick day management). These programs should include clear information on (1) the importance of continuing insulin, (2) early recognition of the manifestations of DKA, (3) more frequent home blood glucose and ketone (urine or blood) monitoring, (4) adjusting doses of insulin and the use of supplemental insulin, as needed and (5) instances when the health-care provider should be contacted. Self-monitoring of blood ketones, when compared with urine ketone testing, facilitates earlier identification and treatment of ketosis, and can decrease diabetes-related emergency department visits and hospitalizations. The frequency of recurrence of DKA can be reduced with structured patient education, behavioral intervention, providing support for patients and families, improving patients’ access to medical providers, availability of extended access to telephone services and telemedicine. […] In addition, public awareness campaigns focusing on education on the early signs of diabetes have been found to significantly reduce the frequency of DKA in patients with new onset diabetes.

• #3 Diabetic Ketoacidosis | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602415/all/Diabetic_Ketoacidosis

  DKA can be prevented in many cases, and its occurrence often suggests a breakdown in patient education and communication. Therefore, diabetes education should be reinforced at every opportunity, with special emphasis on (1) self-management skills during sick days; (2) the body’s need for more, rather than less, insulin during illness; (3) testing of blood or urine for ketones; and (4) procedures for obtaining timely and preventive medical advice.

• #3 Preventing Diabetic Ketoacidosis: A Team Approach | Texas Children’s

  https://www.texaschildrens.org/content/for-physicians/preventing-diabetic-ketoacidosis-team-approach

  The involvement of clinic staff continues after discharge with frequent follow-up visits and calls to support the family. […] To address these and other barriers, community support can be helpful. […] With all of the team members who are involved in DKA treatment and prevention, the goal is for the child to feel confident in his or her ability to live a full life with their type 1 diabetes.

• #3

  https://journals.lww.com/sjmm/fulltext/2020/08030/management_of_diabetic_ketoacidosis_in_adults__a.1.aspx

  Prevention of future incidents of DKA and forthcoming admissions is a very important component of its management. An essential factor in planning the prevention of DKA is the recognition of the precipitating cause. Poor adherence to insulin therapy was found to be a major causative factor for hospital admissions for DKA. Omission of insulin has been found to be associated with lack of patient education, limited access to health care, economic limitations, underlying psychiatric conditions and eating disorders. In addition, social and psychiatric factors such as depression, eating disorders, low socioeconomic status and sexual or physical abuse have been implicated in the occurrence of recurrent admissions for DKA. Another factor associated with recurrent hospital admissions for DKA is substance use, particularly cocaine.

• #3 Preliminary Results of Public Health Prevention Program for Diabetic Ketoacidosis in Children and Adolescent | ESPE2019 | 58th Annual ESPE (ESPE 2019) | ESPE Abstracts

  https://abstracts.eurospe.org/hrp/0092/hrp0092p1-310

  Preliminary Results of Public Health Prevention Program for Diabetic Ketoacidosis in Children and Adolescent […] The aim of the prevention program was to reduce the prevalence of DKA in the Southern part of Croatia in children and adolescents with newly diagnosed T1DM. […] Prevention program was started in April 2017 and consists of a series of activities (lectures, TV shows, social networking, public posters, free phone line) aimed to educate the entire public, primarily children and adolescents, parents, employees in pre-school and school facilities and medical workers. […] In conclusion, this study demonstrated a positive trend in reduction of DKA in children and adolescents with newly diagnosed T1DM during the preventive campaign. However, additional studies with long term follow-up are needed to further clarify the impact of public health prevention program on prevalence of DKA.

• #3 Diabetic Ketoacidosis

  https://fpnotebook.com/Endo/DM/DbtcKtcds.htm

  Early diagnosis of new onset Diabetes Mellitus develops symptoms an average of 24 days before DKA presentation. […] Diabetic action plan based on Blood Glucose Monitoring includes home monitoring of beta hydroxybutyrate or Ketones when Serum Glucose 240 mg/dl. […] Plan for adjusting short acting Insulin includes sick day Insulin coverage (reduced dose but not eliminated) and liquid diets when sick. […] Back-up plan for Insulin Pump failure is necessary. […] Early contact with medical provider when Glucose control acutely changes is recommended. […] Consider Continuous Glucose Monitoring and Insulin Pump in established diabetes. […] Make Basal insulin available for times of pump failure. […] Case management should involve a diabetic educator and frequent phone contact.

• #3 Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality — United States, 2000–2014 | MMWR

  https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm

  DKA is a life-threatening but avoidable complication of diabetes. Prevention measures, such as diabetes self-management education, might help reverse the increasing trend in DKA, especially in persons aged 45 years who have the highest DKA rates. […] Evidence-based, targeted prevention measures, such as diabetes self-management education and support might help reverse the trend in this potentially life-threatening but avoidable complication of diabetes.

• #3 Diabetic ketoacidosis (DKA): symptoms, prevention and management | Dexcom

  https://www.dexcom.com/en-us/all-access/clinical-corner/diabetic-ketoacidosis-symptoms-prevention-and-management

  When living with diabetes, it’s important to not simplify „brush off” when you feel off, unwell or unlike yourself. […] The earlier the detection, the better. Early detection gives you an opportunity to take action to get your glucose and ketone levels back on track as fast as possible, hopefully avoiding DKA and any associated acute complications. […] If you’re concerned about your ketone levels, check your urine ketones or blood ketones every two hours. Ignoring high ketone levels or other DKA symptoms can be fatal. […] Prevention, fast detection, aggressive intervention and proper diabetes management are all keys to avoiding DKA and its complications.

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