What are the safety guidelines for Good Laboratory Practice (GLP) following a recent episode of Diabetic Ketoacidosis (DKA)?

From the Guidelines

Following a recent episode of Diabetic Ketoacidosis (DKA), the safety guidelines for Good Laboratory Practice (GLP) prioritize the restoration of circulatory volume and tissue perfusion, resolution of ketoacidosis, and correction of electrolyte imbalance and acidosis, as outlined in the most recent guidelines from 2024 1. The management goals for DKA include individualization of treatment based on a careful clinical and laboratory assessment, and the use of continuous intravenous insulin in critically ill and mentally obtunded individuals with DKA or HHS.

• Key considerations for GLP following DKA include:
  • Restoration of circulatory volume and tissue perfusion
  • Resolution of ketoacidosis
  • Correction of electrolyte imbalance and acidosis
  • Treatment of any correctable underlying cause of DKA, such as sepsis, myocardial infarction, or stroke
  • Administration of basal insulin 2–4 h before the intravenous insulin is stopped to prevent recurrence of ketoacidosis and rebound hyperglycemia
  • Use of low-dose basal insulin analog in addition to intravenous insulin infusion to prevent rebound hyperglycemia without increased risk of hypoglycemia
• The use of bicarbonate in people 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. The most critical aspect of GLP following DKA is to ensure that the patient is metabolically stable and that adequate insulin therapy is established before initiating any new treatments or therapies, as supported by the guidelines from 2024 1.

From the Research

Safety Guidelines for Good Laboratory Practice (GLP) following Diabetic Ketoacidosis (DKA)

There are no specific research papers provided that directly address the safety guidelines for Good Laboratory Practice (GLP) following a recent episode of Diabetic Ketoacidosis (DKA). However, the following general information can be gathered from the studies:

• The management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement, and identification and treatment of the underlying precipitating event, along with frequent monitoring of the patient's clinical and laboratory states 2.
• The goals of therapy for DKA are to correct dehydration, acidosis, and to reverse ketosis, gradually restoring blood glucose concentration to near normal 3.
• The mainstays of treatment for DKA include restoration of circulating volume, insulin therapy, electrolyte replacement, and treatment of any underlying precipitating event 4.
• DKA is a clinical emergency that requires immediate and effective intervention, and nursing recommendations for management include providing clinical practice guidelines based on the physiopathology and clinical manifestations of the condition 5.
• Treatment of DKA involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications 6.

Key Considerations

• DKA can occur in patients with type 1 or type 2 diabetes, and can be precipitated by various factors such as infections, new diagnosis of diabetes, and nonadherence to insulin therapy 2, 3.
• Early diagnosis and management of DKA are crucial to improve patient outcomes 4.
• Prevention strategies for DKA include identifying diabetes before DKA develops, educating patients to manage high-risk situations, and ensuring uninterrupted access to therapies for diabetes 6.