Education for DKA Patients
Patients recovering from DKA must receive comprehensive sick-day management education that emphasizes never discontinuing insulin during illness, with specific protocols for monitoring blood glucose and ketones, and clear criteria for when to seek immediate medical care. 1
Critical Sick-Day Management Education
Core Principles Patients Must Understand
- Never discontinue insulin during illness - this is the single most important message, as insulin cessation is a common precipitant of DKA 1
- Seek professional medical advice early in the course of any illness, before metabolic decompensation occurs 1
- Understand that infection (particularly urinary tract infections and pneumonia) is the most common trigger for DKA, occurring in 30-50% of cases 2
Specific Monitoring Skills Required
Patients or family members must be able to accurately measure and record the following parameters 1:
- Blood glucose levels - check every 1-2 hours during illness 3
- Ketone monitoring - check urine or blood ketones when blood glucose exceeds 300 mg/dL 1
- Temperature, respiratory rate, and pulse rate 1
- Body weight to assess for dehydration 1
- Insulin doses administered 1
The patient must be able to communicate all these findings to a healthcare professional 1.
Blood Glucose Goals and Insulin Adjustment During Illness
Target Glucose Levels
- Establish specific blood glucose goals during sick days 1
- Teach use of supplemental short-acting insulin when glucose levels are elevated 1
Insulin Dosing Education
- Patients must understand that insulin requirements typically increase during illness due to stress hormones 2
- Provide clear protocols for supplemental rapid-acting insulin doses based on blood glucose readings 1
Infection Management and Supportive Care
Fever and Infection Treatment
- Educate on appropriate means to suppress fever 1
- Teach recognition of common infections (urinary tract infections, pneumonia) that precipitate DKA 2
- Provide guidance on when antibiotics may be needed and when to contact providers 1
Hydration and Nutrition During Illness
- Initiate an easily digestible liquid diet containing both carbohydrates and salt 1
- Ensure adequate fluid intake, as dehydration significantly increases hospitalization risk 3
- Continue carbohydrate intake even when unable to eat solid foods 1
Warning Signs Requiring Immediate Medical Attention
Symptoms of DKA Development
Patients should seek immediate care if they develop 3:
- Nausea and vomiting
- Abdominal pain
- Generalized weakness
- Rapid breathing
- Altered mental status
Specific Criteria for Contacting Healthcare Provider
Educate patients on when to contact their healthcare provider 1:
- Blood glucose persistently above 300 mg/dL despite supplemental insulin
- Presence of moderate to large ketones in urine or elevated blood ketones
- Inability to keep down fluids or food
- Fever that doesn't respond to treatment
- Any signs of infection
Special Populations and Considerations
Elderly Patients and Caregivers
- Adequate supervision and help from staff or family can prevent many admissions for hyperglycemic emergencies in elderly individuals who may be unable to recognize or treat evolving dehydration 1
- Educate caregivers on signs and symptoms of hyperglycemia and dehydration 1
Patients on SGLT2 Inhibitors
- Be aware of euglycemic DKA risk (DKA occurring at blood glucose <250 mg/dL) 3
- Teach patients to monitor for ketones even when glucose levels are not severely elevated 3
- Advise temporary discontinuation of SGLT2 inhibitors during acute illness 3
Structured Educational Programs
Format and Delivery
- Implement structured self-management educational programs, which can be delivered face-to-face (one-on-one or group-based) or via technology platforms 1
- Tailor education to individual preferences, learning styles, and cultural/ethnic health beliefs 1
- Group-based education programs improve biochemical outcomes (HbA1c, fasting glucose) and psychosocial outcomes (self-efficacy, patient satisfaction) 1
Team-Based Approach
- Utilize team-based integrated care involving physicians, nurses, dietitians, and diabetes educators 1
- Ensure regular follow-up and access to medical advice, which has been shown to reduce DKA hospitalization frequency 2
Prevention of Recurrent Episodes
Addressing Common Precipitants
- Insulin non-adherence - address barriers to insulin access, including economic factors that lead to insulin cessation 1, 2
- Provide resources for patients who cannot afford insulin, as economic barriers are a common precipitant particularly in urban populations 1
- Review proper insulin storage and administration technique 2
Long-Term Management Education
- Educate on conditions, procedures, and medications that worsen diabetes control 1
- Teach recognition of signs and symptoms of new-onset or worsening diabetes 1
- Emphasize the importance of regular glucose monitoring and maintaining target HbA1c levels 1
Common Pitfalls to Avoid
Critical Errors in Sick-Day Management
- Stopping insulin because the patient is not eating - this is the most dangerous error 1
- Waiting too long to seek medical attention when glucose or ketones are elevated 1
- Inadequate fluid intake during illness, leading to severe dehydration 3
- Failure to check ketones when glucose exceeds 300 mg/dL 1
Monitoring Mistakes
- Relying solely on glucose monitoring without checking ketones during hyperglycemia 1
- Not recording vital signs and being unable to communicate clinical status to providers 1
Economic and Healthcare System Considerations
- DKA accounts for approximately $1 billion in annual hospital costs in the U.S., with many hospitalizations being preventable through adequate education 1
- Repeated DKA admissions consume approximately 50% of healthcare dollars spent on adult patients with type 1 diabetes 1
- Resources should be redirected toward prevention through better access to care and educational programs 1