From the Guidelines
DKA treatment should prioritize hospitalization, IV fluids, insulin therapy, and electrolyte replacement, with a focus on individualized care based on careful clinical and laboratory assessment, as recommended by the most recent guidelines 1. The diagnostic criteria for DKA include hyperglycemia, metabolic acidosis, and ketosis, with varying degrees of severity.
- Key management goals include:
- Restoration of circulatory volume and tissue perfusion
- Resolution of ketoacidosis
- Correction of electrolyte imbalance and acidosis
- Treatment of any underlying cause of DKA, such as sepsis, myocardial infarction, or stroke In critically ill patients, continuous intravenous insulin is the standard of care, while subcutaneous rapid-acting analogs may be used in mild or moderate cases, with aggressive fluid management 1.
- Successful transition from intravenous to subcutaneous insulin requires administration of basal insulin 2–4 h before the intravenous insulin is stopped to prevent recurrence of ketoacidosis and rebound hyperglycemia. The use of bicarbonate in patients with DKA is generally not recommended, as it has been shown to make no difference in the resolution of acidosis or time to discharge 1.
- Prevention involves regular insulin use as prescribed, frequent blood glucose monitoring, testing for ketones when glucose is elevated, and seeking medical attention promptly when ill or when glucose remains high despite insulin.
From the FDA Drug Label
Hyperglycemia (High Blood Sugar) and Diabetic Ketoacidosis (DKA) Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With DKA, blood and urine tests show large amounts of glucose and ketones. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death.
The diagnostic criteria for Diabetic Ketoacidosis (DKA) include:
- Hyperglycemia (high blood sugar)
- Presence of ketones in the blood and urine
- Symptoms such as:
- Drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath
- Heavy breathing
- Rapid pulse
- Severe symptoms can include nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death.
The treatment options for DKA are not explicitly stated in the provided drug labels, but it is mentioned that patients should obtain medical assistance immediately if they experience symptoms of DKA. 2, 2, and 2 provide information on the symptoms and risks of DKA, but do not provide specific treatment options.
From the Research
Diagnostic Criteria for Diabetic Ketoacidosis (DKA)
- A diagnosis of DKA is confirmed when all of the three criteria are present:
- 'D', either elevated blood glucose levels or a family history of diabetes mellitus
- 'K', the presence of high urinary or blood ketoacids
- 'A', a high anion gap metabolic acidosis 3
- DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis 4
Treatment Options for DKA
- The mainstays of treatment include:
- Intravenous (IV) insulin infusions are the current standard of care for treatment of DKA, but subcutaneous (SQ) insulin may also be a safe and effective alternative 5
- Adding insulin Glargine to the standard treatment of DKA may reduce the average time of recovery from DKA, without incurring episodes of hypoglycemia and hypokalemia 6
- Treatment should also include identification and treatment of the underlying precipitating event, along with frequent monitoring of the patient's clinical and laboratory states 4
Precipitating Causes and Prevention of DKA
- The most common precipitating causes for DKA include:
- Infections
- New diagnosis of diabetes
- Nonadherence to insulin therapy 4
- Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors 4
- Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers 4