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:
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.
Sodium-glucose co-transporter 2 (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.
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.