What is the management and treatment approach for a patient with EuGlycemic (normal blood glucose levels) keratosis, potentially associated with diabetes or insulin resistance?

Clarification: "EuGlycemic Keratosis" Does Not Exist as a Medical Entity

The term "euglycemic keratosis" does not represent a recognized dermatologic or medical diagnosis. Based on the context provided, this appears to be a conflation of two separate concepts:

Most Likely Interpretation: Keratosis in Patients with Normal Glucose

If you are asking about keratotic skin lesions (such as actinic keratosis or seborrheic keratosis) in patients who happen to have normal blood glucose levels, the management is identical to standard keratosis treatment regardless of glycemic status.

For Actinic Keratosis (AK):

• Field-directed treatment with 5-fluorouracil or imiquimod is strongly recommended for multiple lesions 1
• Cryosurgery is recommended for isolated lesions 1
• Treatment decisions should account for extent, duration, symptoms, severity of lesions, and other skin cancer risk factors 1
• Not all AKs require treatment, as less than 1 in 1,000 AKs progress to squamous cell carcinoma annually 1
• UV protection is strongly recommended for all patients with AK 1

For Seborrheic Keratosis:

• Cryosurgery is the standard treatment if removal is desired 2
• No treatment is required unless symptomatic or cosmetically concerning
• In patients with insulin resistance or diabetes, seborrheic keratomas show increased EGFR expression, but this does not change management 3

Alternative Interpretation: Euglycemic Diabetic Ketoacidosis (DKA)

If you meant "euglycemic DKA" (diabetic ketoacidosis with glucose <200 mg/dL), this is a distinct and serious metabolic emergency requiring immediate treatment:

Diagnostic Criteria for Euglycemic DKA:

• Blood glucose <200 mg/dL (11.1 mmol/L) with either prior diabetes history or insulin deficiency 1
• Arterial pH <7.3 4
• Serum bicarbonate <15 mEq/L 4
• Presence of ketonemia or ketonuria 4

Management Protocol:

• Begin with isotonic saline (0.9% NaCl) at 15-20 mL/kg/hour for the first hour 4
• Start continuous IV regular insulin at 0.1 units/kg/hour immediately 4
• Add dextrose-containing fluids (5% dextrose with 0.45-0.75% saline) when glucose falls below 250 mg/dL to prevent hypoglycemia while continuing insulin 4
• Target glucose 150-200 mg/dL until DKA resolution 5, 4
• Continue insulin infusion until resolution criteria are met (pH >7.3, bicarbonate ≥18 mEq/L, anion gap ≤12 mEq/L), regardless of glucose levels 4

Critical Pitfalls to Avoid:

• Never stop IV insulin just because glucose is normal or low—this causes recurrent DKA 5, 4
• Always add dextrose when glucose falls below 250 mg/dL while maintaining insulin therapy 4
• Identify and treat precipitating factors: SGLT2 inhibitors, reduced food intake, pregnancy, alcohol use, or liver failure 1
• Discontinue SGLT2 inhibitors immediately and do not restart for 3-4 days after metabolic stability 4

Potassium Management:

• If K+ <3.3 mEq/L, delay insulin and aggressively replace potassium first 4
• If K+ 3.3-5.5 mEq/L, add 20-30 mEq potassium per liter of IV fluid 4
• Monitor potassium every 2-4 hours during treatment 4

Keratosis Pilaris and Diabetes Connection

If referring to keratosis pilaris in diabetic patients:

• Keratosis pilaris affects 12% of type 1 diabetic patients versus 1.5% of controls 6
• It is significantly associated with acquired ichthyosis in diabetic patients 6
• Treatment is symptomatic with topical keratolytics and emollients
• Glycemic control does not significantly impact keratosis pilaris prevalence

Please clarify which condition you are asking about for more specific guidance.