Adult Diabetic Ketoacidosis

DKA reflects clinically consequential insulin deficiency with hyperglycemia, ketonemia, dehydration, acidemia, and electrolyte disturbance. It is classically associated with type 1 diabetes but can occur in insulinopenic type 2 diabetes, ketosis-prone type 2 diabetes, acute illness, missed insulin, and sodium-glucose cotransporter 2 inhibitor exposure. Diabetes JournalsDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

The supplied sources do not provide a complete adult DKA fluid, insulin infusion, potassium replacement, bicarbonate, or transition-to-subcutaneous-insulin protocol. Therefore, institutionally approved hyperglycemic-crisis pathways and current specialty guidance should govern acute resuscitation and monitoring rather than extrapolation from the diabetes-management sources reviewed here. Diabetes JournalsDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

Diabetes classification is often uncertain at presentation. Type 1 diabetes can occur at any age, obesity does not exclude autoimmune diabetes, and approximately 40% of adults with newly diagnosed type 1 diabetes may initially be misdiagnosed as having type 2 diabetes. Diabetes JournalsDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

The most useful clinical features favoring type 1 diabetes are age younger than 35 years, BMI below 25 kg/m2, unintentional weight loss, ketoacidosis, and plasma glucose above 360 mg/dL at presentation. Family history, ketosis without acidosis, osmotic symptoms, and coexisting autoimmune disease are weaker discriminators. Diabetes JournalsDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

For adults with overlapping phenotypic features, standardized islet autoantibody testing is recommended. GAD is the preferred first test; if negative, IA-2 and/or ZnT8 antibodies should be considered where available. A negative antibody test does not exclude type 1 diabetes. Diabetes JournalsDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

For people with type 1 diabetes, uninterrupted basal insulin is essential to prevent hyperglycemia and ketoacidosis during hospitalization, fasting, and procedures. This requirement should be explicit in admission orders, perioperative plans, and handoffs. PubMedPubMedThe Management of Type 1 Diabetes - Endotext - NCBI - NIH

Inpatient self-management may be appropriate only for selected patients who can safely administer insulin, monitor glucose, count carbohydrates, and participate in decisions under supervision from clinicians knowledgeable in glycemic management. PubMedPubMedThe Management of Type 1 Diabetes - Endotext - NCBI - NIH

Hyperglycemia with DKA can also arise in type 2 diabetes during severe illness, insulin omission, or exposure to drugs including SGLT2 inhibitors. Because SGLT2 inhibitors can be associated with DKA, review these agents during every DKA evaluation. Diabetes JournalsDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

Diabetes self-management education and support is a core element of diabetes care. CDC guidance emphasizes ongoing team-based support and notes that structured diabetes self-management education and support is associated with lower A1C and fewer complications. CDCCDCClinical Guidance for Diabetes

A1C monitoring frequency should reflect stability of therapy and glycemic control. CDC advises testing every 3 months when treatment has changed or goals are not met and every 6 months when treatment and glycemic goals are stable. CDCCDCYour Diabetes Care Schedule

For type 2 diabetes treated with metformin plus an SGLT2 inhibitor or GLP-1 agonist, ACP states that routine self-monitoring of blood glucose may be unnecessary in stable patients; this does not apply to insulin-dependent patients or those at risk for hypoglycemia or recurrent ketosis. PubMedPubMedNewer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Clinical Guideline From the American College of Physicians

The provided search results include current diabetes diagnostic and classification guidance, longitudinal type 1 diabetes management, and general diabetes-care resources, but do not include a dedicated adult DKA consensus guideline or FDA labeling for insulin and adjunctive agents. Accordingly, they do not support publishing exact intravenous fluid choice or rate, insulin infusion dose, potassium replacement thresholds, bicarbonate criteria, phosphate therapy, anion-gap transition criteria, or ICU disposition thresholds. PubMed+1PubMedThe Management of Type 1 Diabetes - Endotext - NCBI - NIHDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...

Acute DKA care should therefore follow a current, locally adopted adult hyperglycemic-crisis protocol with endocrine and critical-care consultation as appropriate. Diabetes classification and recurrent-crisis prevention should proceed in parallel with acute stabilization. PubMed+1PubMedThe Management of Type 1 Diabetes - Endotext - NCBI - NIHDiabetes Journals2. Diagnosis and Classification of Diabetes: Standards of Care ...