Ketosis-Prone Type 2 Diabetes Workup

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