Ketosis-Prone Type 2 Diabetes Treatment & Management
- Author: Richard S Krause, MD; Chief Editor: George T Griffing, MD more...
The treatment of patients who present with DKA is fairly standardized and does not differ according to their Aß phenotype. Detailed discussion of DKA treatment can be found in the following Medscape Reference articles: Diabetic Ketoacidosis and Pediatric Diabetic Ketoacidosis.
At the time of initial presentation with new-onset diabetes and DKA, determining what "type" of diabetes is present is not possible or needed; predicting the need for long-term insulin treatment is also impossible. Therefore, after an initial episode of DKA, all patients should be continued on insulin treatment for some period of time (typically weeks to months). Patients who are found to be ß- should be continued on insulin indefinitely.
No generally accepted guidelines are available for disposition of DKA after initial treatment. Clinical experience and practice suggests that patients with mild DKA may be safely discharged with close follow-up after successful initial treatment. One large, multicenter study of US EDs found that 13% of patients were discharged; approximately one fourth were admitted to an ICU. Appropriate initial treatment may decrease length of stay and the need for ICU admission.
Patients who are ß+ need outpatient assessment of the need for long-term insulin treatment. If glucose levels are under control on an insulin regimen, the dose of insulin can be decreased by 50% and the patient reassessed at 1-2 weeks. If glycemic control is maintained, insulin can be discontinued with close monitoring. Other agents can be continued or added as needed. New onset of diabetes, older age at onset and higher levels of ß cell function all are associated with less likelihood of requiring long-term insulin treatment.
For newly diagnosed patients discharged after a first episode of DKA, a typical insulin regimen is a total of 0.6-0.7 units of insulin/kg/d. Typically, two thirds of the total daily dose is given before breakfast, and one third is given before dinner. Two thirds of the dose is given as intermediate-acting insulin (NPH), and one third is given as short-acting (regular insulin).
Long-term management of diabetes is discussed in the following Medscape reference articles: Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Pediatric Type 1 Diabetes Mellitus, and Pediatric Type 2 Diabetes Mellitus.
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