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Ketosis-Prone Type 2 Diabetes Clinical Presentation

  • Author: Richard S Krause, MD; Chief Editor: George T Griffing, MD  more...
 
Updated: Jan 06, 2016
 

History

The presentation of DKA does not differ markedly according to the Aß phenotype. Typical features of polydipsia, polyuria, and fatigue are seen. In patients who already require insulin, the onset of DKA can be rapid when, for example, insulin is abruptly discontinued or a major stressor such as acute myocardial infarction occurs.

Patients with previously undiagnosed ketosis-prone type 2 diabetes may have a less abrupt onset of symptoms. Symptoms related to an underlying precipitating event, such as myocardial infarction or infection (eg, pneumonia, urinary tract infection) may be noted. Abdominal pain is also a common complaint associated with DKA, especially in children. The cause of abdominal pain in DKA is not well understood but appears to relate to the severity of the acidosis. Failure of abdominal pain to resolve with treatment of DKA or marked abdominal tenderness should lead to consideration of other causes. Shortness of breath in spite of normal pulse oximetry and clear lungs is common.

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Physical Examination

Physical signs in DKA are associated with the severity of the metabolic derangement and dehydration and may include the following:

  • Tachypnea/hyperpnea
  • Tachycardia
  • Dry mucous membranes
  • Poor skin turgor
  • Altered mental status
  • Nausea, vomiting
  • Hypotension
  • Signs related to a precipitating illness
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Contributor Information and Disclosures
Author

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

References
  1. Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med. Mar 7 2006. 144(5):350-7. [Medline].

  2. Maldonado M, Hampe CS, Gaur LK, et al. Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and beta-cell functional classification, prospective analysis, and clinical outcomes. J Clin Endocrinol Metab. Nov 2003. 88(11):5090-8. [Medline].

  3. Umpierrez GE, Woo W, Hagopian WA, Isaacs SD, Palmer JP, Gaur LK, et al. Immunogenetic analysis suggests different pathogenesis for obese and lean African-Americans with diabetic ketoacidosis. Diabetes Care. 1999 Sep. 22 (9):1517-23. [Medline].

  4. Hampe CS, Nalini R, Maldonado MR, Hall TR, Garza G, Iyer D, et al. Association of amino-terminal-specific antiglutamate decarboxylase (GAD65) autoantibodies with beta-cell functional reserve and a milder clinical phenotype in patients with GAD65 antibodies and ketosis-prone diabetes mellitus. J Clin Endocrinol Metab. 2007 Feb. 92 (2):462-7. [Medline].

  5. Brooks-Worrell BM, Iyer D, Coraza I, Hampe CS, Nalini R, Ozer K, et al. Islet-specific T-cell responses and proinflammatory monocytes define subtypes of autoantibody-negative ketosis-prone diabetes. Diabetes Care. 2013 Dec. 36 (12):4098-103. [Medline].

  6. Balasubramanyam A, Garza G, Rodriguez L, et al. Accuracy and predictive value of classification schemes for ketosis-prone diabetes. Diabetes Care. Dec 2006. 29(12):2575-9. [Medline].

  7. Mauvais-Jarvis F, Sobngwi E, Porcher R, et al. Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin: clinical pathophysiology and natural history of beta-cell dysfunction and insulin resistance. Diabetes. Mar 2004. 53(3):645-53. [Medline].

  8. Ginde AA, Pelletier AJ, Camargo CA Jr. National study of U.S. emergency department visits with diabetic ketoacidosis, 1993-2003. Diabetes Care. Sep 2006. 29(9):2117-9. [Medline].

  9. Bull SV, Douglas IS, Foster M, Albert RK. Mandatory protocol for treating adult patients with diabetic ketoacidosis decreases intensive care unit and hospital lengths of stay: results of a nonrandomized trial. Crit Care Med. Jan 2007. 35(1):41-6. [Medline].

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