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Ketosis-Prone Type 2 Diabetes Workup

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

Approach Considerations

When DKA is being considered in the acute setting, the following tests are indicated:

  • Bedside serum glucose
  • Urine dipstick
  • Basic metabolic profile
  • Serum ketones
  • Venous or ABG (if the serum bicarbonate is severely depressed)
  • CBC count with differential

Other tests should be ordered according to the clinical picture. Most hospitals routinely obtain an EKG and a chest radiograph in most patients with serious illness. The yield is low in the absence of other clinical indications for testing.

After acute treatment and resolution of DKA, patients with new-onset ketosis-prone type 2 diabetes should be considered for additional testing. Evaluating for β cell autoimmunity and functional reserve is useful for prognostication and guiding treatment. These tests, especially autoimmune testing, may be expensive and are not strictly necessary. Fasting C-peptide levels are used to classify patients as ß+ or ß-. ß+ status is established when the fasting C-peptide level is 1 ng/mL or more. This testing should not be done during the acute phase of DKA. Measuring β-cell function shows transient secretory defect of β cells during the acute phase, with 60- 80% improvement in insulin-secreting capacity during remission. Measurement of the GAD65 and IA-2 antibodies is used to establish A+ or A- status.[7]

 
 
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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