Recommended Follow-up Care After Diabetic Ketoacidosis (DKA)
A structured discharge plan tailored to the individual patient with a follow-up appointment scheduled within 1 month of discharge (preferably within 1-2 weeks if glycemic medications were changed) is essential for patients after DKA treatment. 1
Immediate Discharge Planning
Discharge planning should begin at admission and be updated as patient needs change. Key components include:
Medication Management
- Complete medication reconciliation to ensure no chronic medications were stopped
- Review new prescriptions with patient and family before discharge
- Ensure prescriptions are filled prior to discharge
- Administer basal insulin 2-4 hours before stopping IV insulin to prevent recurrence of ketoacidosis 1
Education Prior to Discharge
The following areas must be addressed before discharge:
- Identification of healthcare provider who will provide diabetes care after discharge
- Patient's understanding of diabetes diagnosis and self-monitoring
- Home blood glucose goals and when to call the provider
- Recognition, treatment, and prevention of hyperglycemia and hypoglycemia
- Making healthy food choices (with referral to dietitian if needed)
- Proper medication administration, especially insulin
- Sick-day management to prevent recurrent DKA
- Proper use and disposal of needles and syringes 1
Structured Discharge Communication
Provider Communication
- Promptly transmit discharge summaries to primary care provider
- Include information on medication changes, pending tests, and follow-up needs
- Schedule follow-up appointments prior to discharge to increase attendance 1
Follow-up Timeline
- An outpatient follow-up visit with primary care, endocrinologist, or diabetes educator within 1 month of discharge is advised
- If glycemic medications were changed or glucose management is not optimal at discharge, an earlier appointment (1-2 weeks) is preferred 1
- More frequent contact may be needed to avoid hyperglycemia and hypoglycemia
Equipment and Supplies
It is crucial that patients be provided with:
- Appropriate durable medical equipment
- Medications
- Blood glucose testing supplies
- Prescriptions
- Educational materials 1
Special Considerations
Transition of Insulin Therapy
- For patients transitioning from IV to subcutaneous insulin, administer basal insulin 2-4 hours before stopping IV insulin to prevent recurrence of ketoacidosis 1, 2
- A discharge algorithm for glycemic medication adjustment based on admission A1C, pre-admission diabetes medications, and in-hospital insulin usage can significantly improve A1C after discharge 1
Prevention of Recurrent DKA
- Identify and address factors that precipitated the DKA episode (infection, missed insulin, etc.)
- Provide education on sick-day management
- Ensure patient has access to medical providers when needed 2
Monitoring for Complications
During follow-up visits, monitor for:
- Adherence to insulin regimen
- Blood glucose patterns
- Electrolyte abnormalities
- Renal function
- Signs of infection or other precipitating factors 2
Common Pitfalls to Avoid
- Failure to schedule follow-up appointments before discharge
- Inadequate patient education on sick-day management
- Not providing sufficient supplies or prescriptions at discharge
- Lack of communication with outpatient providers
- Insufficient transition from IV to subcutaneous insulin therapy
- Not addressing the underlying cause of DKA to prevent recurrence 1, 2
By implementing a comprehensive follow-up care plan after DKA treatment, healthcare providers can reduce the risk of recurrence, decrease hospital readmissions, and improve overall outcomes for patients with diabetes.