Patient education about management of their diabetes during periods of mild illness (sick-day management) is vital for preventing DKA. This should include information on when to contact a healthcare professional, blood glucose monitoring, use of insulin, and initiation of appropriate nutrition during illness. This information should be reinforced with patients periodically. Patients should be advised to continue insulin and to seek professional advice early in the course of the illness. Close follow-up is very important, as it has been shown that 3-month visits to the endocrine clinic will reduce the number of emergency department admissions for DKA. Self-monitoring of ketones is also emerging as a potential strategy.
SGLT-2 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 SGLT-2 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 hospitalization and mortality. Hospital admission with DKA, and recurrent admissions in particular, may be considered a "red flag" for triggering psychiatric assessment so that mental health problems can be addressed and further admissions with DKA prevented.
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