From the Guidelines
Feeding patients with Diabetic Ketoacidosis (DKA) is supported by evidence, particularly once they are stabilized, as it helps prevent starvation ketosis and supports overall recovery. Patients with DKA should initially receive intravenous insulin and fluid resuscitation to correct acidosis, hyperglycemia, and electrolyte imbalances. According to the evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications 1, during acute illness, oral ingestion of 150 –200 g of carbohydrate per day should be sufficient, along with medication adjustments, to keep glucose in the goal range and to prevent starvation ketosis. Some key points to consider when feeding patients with DKA include:
- Initiating oral intake once the patient is stabilized, typically when blood glucose falls below 200-250 mg/dL, pH is >7.3, and bicarbonate is >15 mEq/L
- Starting with easily digestible carbohydrates and advancing to regular meals as tolerated
- Providing necessary calories for recovery and maintaining stable blood glucose levels
- Allowing for appropriate adjustment of insulin therapy based on carbohydrate intake
- Restoring normal metabolic processes disrupted during DKA and supporting overall recovery. The goal of feeding patients with DKA is to provide essential nutrients for healing, prevent hypoglycemia during insulin therapy, and maintain stable blood glucose levels, as supported by the evidence 1.
From the Research
Feeding Patients with Diabetic Ketoacidosis (DKA)
- There is evidence to support feeding patients with DKA, as early nutrition has been associated with decreased hospital and MICU length of stay without increasing the rate of DKA complications 2.
- A study published in 2019 found that early oral nutrition initiated within 24 hours of admission to a medical intensive care unit for DKA was associated with shorter MICU and hospital length of stay, but did not affect 28-day or 90-day mortality 2.
- Another study published in 2024 discussed the challenges and controversies in the treatment of DKA, including the timing of nutrition, and recommended early initiation of oral nutrition to reduce intensive care unit and overall hospital length of stay 3.
- The management of DKA requires a comprehensive approach, including fluid and electrolyte replacement, insulin therapy, and treatment of precipitating causes, as well as close monitoring to adjust therapy and identify complications 4, 5.
- It is essential to note that the goal of nutrition support in patients with DKA is to provide adequate calories and nutrients while minimizing the risk of hyperglycemia and other complications, and that the selection of an enteral formula that diminishes carbohydrate exposure may be beneficial 6.