告知糖尿病患者在出现其他轻微疾病期间如何管理糖尿病(生病期管理)对预防 DKA 至关重要。 应告知患者 DKA 的诱因和早期警告症状。考虑:[2]Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults. June 2021 [internet publication].
https://abcd.care/sites/abcd.care/files/site_uploads/JBDS_Guidelines_Current/JBDS_02%20_DKA_Guideline_amended_v2_June_2021.pdf
[17]Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. 2019 May 29;365:l1114.
https://www.doi.org/10.1136/bmj.l1114
http://www.ncbi.nlm.nih.gov/pubmed/31142480?tool=bestpractice.com
检查他们平时的血糖控制情况
检查他们的注射技术、血糖监测、设备和注射部位
预防复发(例如,提供书面“病期规则 [sick day rules]”)
如需继续使用患者的胰岛素,请首先进行检查(可能已过期或变性)
评估是否需要提供家用手持式血酮检测仪
提供在非工作时间联系糖尿病专科医生团队的联系电话
提供书面诊疗计划,使患者在自身的糖尿病管理中发挥积极作用,并将此计划的副本发送给患者的 GP。
请注意,在英国,基于对一系列因素(包括不稳定血糖是否影响其生活质量)的讨论后,应为所有 1 型糖尿病患者提供实时连续血糖监测(real-time continuous glucose monitoring, rtCGM)或间歇性扫描连续血糖监测(intermittently scanned continuous glucose monitoring, isCGM,或闪光血糖监测)。[43]National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. Aug 2022 [internet publication].
https://www.nice.org.uk/guidance/ng17
2 型糖尿病患者由钠-葡萄糖协同转运蛋白 2(Sodium-glucose co-transporter 2, SGLT-2)抑制剂所致 DKA 的诱因通常为遗漏注射胰岛素或剂量显著减少、严重急性疾病、脱水、剧烈运动、手术、低碳水化合物饮食或大量饮酒。预防 DKA 的策略应包括,当存在诱因时停用 SGLT-2 抑制剂、并避免遗漏注射胰岛素和显著减少胰岛素剂量。[44]Henry RR, Dandona P, Pettus J, et al. Dapagliflozin in patients with type 1 diabetes: A post hoc analysis of the effect of insulin dose adjustments on 24-hour continuously monitored mean glucose and fasting β-hydroxybutyrate levels in a phase IIa pilot study. Diabetes Obes Metab. 2017 Jun;19(6):814-821.
http://www.ncbi.nlm.nih.gov/pubmed/28098426?tool=bestpractice.com
[45]Goldenberg RM, Berard LD, Cheng AY, et al. SGLT2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. Clin Ther. 2016 Dec;38(12):2654-64.e1.
http://www.ncbi.nlm.nih.gov/pubmed/28003053?tool=bestpractice.com
并发的疾病在很多情况下可以通过更好的医疗保健,适当的教育,与卫生保健提供者的有效沟通而预防。家庭成员和医疗卫生服务提供者充分的监督也可降低住院率和死亡率。[1]Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2009 Jul;32(7):1335-43.
http://care.diabetesjournals.org/content/32/7/1335.full
http://www.ncbi.nlm.nih.gov/pubmed/19564476?tool=bestpractice.com
[46]Kitabchi AE. Editorial. Hyperglycemic crises: improving prevention and management. Am Fam Physician. 2005 May 1;71(9):1659-60.
http://www.aafp.org/afp/2005/0501/p1659.html
http://www.ncbi.nlm.nih.gov/pubmed/15887446?tool=bestpractice.com