Approach Considerations
When diabetic ketoacidosis (DKA) is being considered in the acute setting, the following tests are indicated:
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Bedside serum glucose level
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Urine dipstick test
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Basic metabolic profile
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Level of serum ketones
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Venous or arterial blood gas (ABG) (if the serum bicarbonate is severely depressed)
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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]
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Medication Summary
- Antidiabetics, Insulins
- Antidiabetics, Biguanides
- Antidiabetics, Amylinomimetics
- Antidiabetics, Sulfonylureas
- Hypoglycemia Antidotes
- Antidiabetics, Meglitinide Derivatives
- Antidiabetics, Alpha-Glucosidase Inhibitors
- Antidiabetics, Thiazolidinediones
- Antidiabetics, Glucagonlike Peptide-1 Agonists
- Antidiabetics, Dipeptidyl Peptidase IV Inhibitors
- Bile Acid Sequestrants
- Antidiabetics, Intermediate-Acting Insulins
- Antiparkinson Agents, Dopamine Agonists
- Show All
- References
