Ketosis-Prone Type 2 Diabetes Workup

Updated: Jan 20, 2023
  • Author: Richard S Krause, MD; Chief Editor: George T Griffing, MD  more...
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Approach Considerations

When diabetic ketoacidosis (DKA) is being considered in the acute setting, the following tests are indicated:

  • Bedside serum glucose level

  • Urine dipstick test

  • Basic metabolic profile

  • Level of serum ketones

  • Venous or arterial blood gas (ABG) (if the serum bicarbonate is severely depressed)

  • Complete blood cell (CBC) count with differential

Patients with ketoacidosis-prone type 2 diabetes frequently present with glucose levels in the hundreds (500-700 mg/dL), as well as elevated ketone and hemoglobin A1C levels. [17]

Potentially unique markers of A+β+ ketosis prone diabetes are elevated unmethylated and methylated insulin DNA. [18]

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


Other Tests

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 treatment guidance. However, note that these tests, especially autoimmune testing, may be expensive and are not strictly necessary.

Fasting C-peptide levels are used to classify patients as β+ or β-. β+ status is established when the fasting C-peptide level is 1 ng/mL or more. This testing should not be performed during the acute phase of DKA.

Measuring β-cell function shows a 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. [19]