Primary prevention

Patient education about management of their diabetes during periods of mild illness (sick-day management) is vital for preventing DKA. Counsel patients about the precipitating cause and early warning symptoms of DKA. Consider: [42][17]

  • Review of their usual glycaemic control

  • Review of their injection technique, blood glucose monitoring, equipment, and injection sites

  • Prevention of recurrence (e.g., provide written ‘sick day rules’)

  • Checking the patient’s insulin prior to reuse (this may be expired or denatured)

  • Assessing the need for provision of handheld ketone meters for use at home

  • Provision of a contact number on how to contact the diabetes specialist team out of hours

  • Provision of a written care plan which allows the patient to have an active role in their diabetes management, with a copy of this sent to their GP.

SGLT2 inhibitor-associated DKA in patients with type 2 diabetes is typically precipitated by insulin omission or significant dose reduction, severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets, or excessive alcohol intake. DKA prevention strategies should include withholding SGLT2 inhibitors when precipitants are present, and avoiding insulin omission or large insulin dose reduction.[43][44]

Many cases can be prevented by better access to medical care, proper education, and effective communication with a healthcare provider during an intercurrent illness. Adequate supervision by family and healthcare provider may decrease the rates of hospitalisation and mortality.[1][45]

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