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    Clinical Practice Guidelines: Management of Type 2 Diabetes Mellitus (5 Edition) 2015

    Uploaded by

    Azim Abd Razak
    This document provides guidelines for managing diabetic ketoacidosis (DKA). Key points include: DKA is a serious complication with high mortality if unrecognized; diagnostic criteria include high blood glucose, ketones, and low pH; patients meeting criteria for severe DKA should be admitted to the high dependency unit; management involves fluid and potassium replacement over 1-24 hours; once biochemically stable, the patient can be converted to subcutaneous insulin after eating and drinking normally; and calculating the initial subcutaneous insulin regimen is described for insulin-naive patients being discharged.

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    Clinical Practice Guidelines: Management of Type 2 Diabetes Mellitus (5 Edition) 2015

    Uploaded by

    Azim Abd Razak
    159 views13 pages
    This document provides guidelines for managing diabetic ketoacidosis (DKA). Key points include: DKA is a serious complication with high mortality if unrecognized; diagnostic criteria include high blood glucose, ketones, and low pH; patients meeting criteria for severe DKA should be admitted to the high dependency unit; management involves fluid and potassium replacement over 1-24 hours; once biochemically stable, the patient can be converted to subcutaneous insulin after eating and drinking normally; and calculating the initial subcutaneous insulin regimen is described for insulin-naive patients being discharged.

    Original Description:

    Ed note

    Original Title

    Diabetic Emergencies-DKA

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    This document provides guidelines for managing diabetic ketoacidosis (DKA). Key points include: DKA is a serious complication with high mortality if unrecognized; diagnostic criteria include high blood glucose, ketones, and low pH; patients meeting criteria for severe DKA should be admitted to the high dependency unit; management involves fluid and potassium replacement over 1-24 hours; once biochemically stable, the patient can be converted to subcutaneous insulin after eating and drinking normally; and calculating the initial subcutaneous insulin regimen is described for insulin-naive patients being discharged.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    159 views13 pages

    Clinical Practice Guidelines: Management of Type 2 Diabetes Mellitus (5 Edition) 2015

    Uploaded by

    Azim Abd Razak
    This document provides guidelines for managing diabetic ketoacidosis (DKA). Key points include: DKA is a serious complication with high mortality if unrecognized; diagnostic criteria include high blood glucose, ketones, and low pH; patients meeting criteria for severe DKA should be admitted to the high dependency unit; management involves fluid and potassium replacement over 1-24 hours; once biochemically stable, the patient can be converted to subcutaneous insulin after eating and drinking normally; and calculating the initial subcutaneous insulin regimen is described for insulin-naive patients being discharged.

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    Clinical Practice Guidelines:

    Management of
    Type 2 Diabetes Mellitus
    th
    (5 Edition) 2015
    Topic 12
    Management of diabetic
    emergencies:
    Diabetes ketoacidosis
    Diabetic Ketoacidosis
    • Most serious acute complications.

    • High mortality rate if unrecognised. The overall mortality is


    <1%, mortality rate >5% in the elderly.

    • Precipitating factors: infection, missed therapy, acute


    coronary syndrome, CVA, surgery etc.

    • Diagnostic criteria: (All three must be met)


    • Capillary blood glucose >11 mmol/L
    • Capillary ketones >3 mmol/L or urine ketones ≥2+
    • Venous pH <7.3 and/or bicarbonate <15 mmol/L
    High Dependency Unit Care
    • High-dependency unit (HDU)admission and insertion of
    central line in the following circumstances:

    • Elderly

    • Pregnant ladies

    • Heart or kidney failure

    • Other serious comorbidities

    • Severe DKA
    Criteria For Severe Ketoacidosis
    • Venous bicarbonate <5 mmol/L
    • Blood ketones >6 mmol/L
    • Venous pH <7.1
    • Hypokalaemia on admission (<3.5 mmol/L)
    • Glasgow Coma Scale (GCS)<12
    • Oxygen saturation <92% on air (arterial blood gases
    required)
    • Systolic BP <90 mmHg
    • Pulse >100 or< 60 beats/minute
    Principles Of Management – 1st Hour

    Modified from Management of DKA in Adults, NHS Trafford Diabetes, January 2012
    Fluid And Potassium Replacement
    2-6th Hour
    6-12th Hour
    12-24 Hours
    Resolution Of DKA
    What is the next step of management?
    Expectation: Patient should be eating and drinking and
    back on normal insulin

    • If DKA is not resolved identify and treat the reasons for


    failure to respond

    • Convert to subcutaneous regime when biochemically stable


    (blood ketones <0.3 mmol/L, pH >7.3) and the patient is
    ready and able to eat.

    Do not discontinue intravenous insulin infusion until 30


    minutes after subcutaneous short acting insulin has been
    given.
    What is the next step of management?

    Calculating subcutaneous insulin dose in insulin-naïve


    patients; Calculating a Basal Bolus (QID) Regimen.

    • Estimate Total Daily Dose (TDD) of Insulin. The TDD can be


    calculated by multiplying the patient’s weight (in kg) by 0.5 to
    0.75 units.

    • Use 0.75 units/kg for those thought to be more insulin


    resistant e.g. obese, acanthosis nigricans
    Example
    An 80-kg person would require approximately 80 x 0.5
    units or 40 units in 24 hours.

    Give 50% of total dose at bedtime in the form of long


    acting insulin and divide remaining dose equally between
    pre-breakfast, pre-lunch and pre-evening meal.

    E.g. Short-acting insulin 7u tid & 20 units bedtime

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