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Diabetic coma and medication management

Diabetic coma and medication management

Critical Care Medicine: Principals Diabetc Diagnosis and Management in the Adult. Mearns ES, Sobieraj DM, White CM, et al. Umpierrez GE, Khajavi M, Kitabchi AE. Assess reasons for discontinuation of insulin e. Diabetes Care ;—6.

Diabetic coma and medication management -

If you are familiar with diabetes care, test the unconscious person's blood sugar and follow these steps:. On this page. Preparing for your appointment. Lab tests At the hospital, you may need lab tests to measure: Your blood sugar level Your ketone level The amount of nitrogen, creatinine, potassium and sodium in your blood.

More Information. Blood urea nitrogen BUN test. Creatinine test. High blood sugar If your blood sugar level is too high, you may need: Intravenous fluids to restore water to your body Potassium, sodium or phosphate supplements to help your cells work correctly Insulin to help your body absorb the glucose in your blood Treatment for any infections.

Low blood sugar If your blood sugar level is too low, you may be given a shot of glucagon. Request an appointment. What you can do in the meantime If you have no training in diabetes care, wait for the emergency care team to arrive.

Do not try to give fluids to drink. Do not give insulin to someone with low blood sugar. Don't give sugar to someone whose blood sugar isn't low. If you called for medical help, tell the emergency care team about the diabetes and what steps you've taken, if any.

By Mayo Clinic Staff. Aug 11, Show References. American Diabetes Association. Glycemic targets: Standards of Medical Care in Diabetes — Diabetes Care. Cryer PE. Hypoglycemia in adults with diabetes mellitus. Accessed July 11, Tips for emergency preparedness. Low blood glucose hypoglycemia.

National Institute of Diabetes and Digestive and Kidney Diseases. In addition, they can advise patients about diabetes self-management, help them take their medicines as prescribed, and provide information about lower-cost options for medicines and medical supplies.

People with diabetes can be at high risk for drug-related problems because they often have multiple medical conditions, take multiple medicines, receive medicines from different sources, and see a range of health care providers.

For example, patients may inadvertently take the wrong dose at the wrong time, which can cause serious illness, long-term disability, or even death. CDTM is associated with improved glycemic control in people with diabetes.

You can offer to connect your patients with a pharmacist or ask them if they want more information about recommended medication management approaches for people with diabetes. You can take this action depending on how your patients answer your questions or any other concerns they share during their visit.

Use the following discussion points to help you talk with your patients about their self-care habits and their feelings about managing diabetes:.

DSMES services help people live well with diabetes. Whether a person has just been diagnosed with diabetes or has had it for years, DSMES services will make it possible for them to:.

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How to Promote Medication Management for People With Diabetes 5 Actions for Health Care Teams. Minus Related Pages. Rosiglitazone caused greater increases in weight, peripheral edema, and concentrations of low-density lipoprotein LDL cholesterol.

There was also an unexpected increase in fractures in women taking rosiglitazone. The study was limited by a high rate of withdrawal of study participants. Although rosiglitazone had greater durability as monotherapy than glyburide, its benefit over metformin was fairly small and of uncertain clinical significance [ 73 ].

See "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Safety'. Cardiovascular outcomes — Cardiovascular benefit has been demonstrated for selected classes of diabetes medications, usually when added to metformin.

See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Monotherapy failure'. The cardiovascular effects of diabetes drugs are reviewed in the individual topics. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Insulin therapy in type 2 diabetes mellitus".

In trials of patients with type 2 diabetes with and without chronic kidney disease, GLP-1 receptor agonists slowed the rate of decline in eGFR and prevented worsening of albuminuria [ 54,56,58 ].

These trials and other trials evaluating microvascular outcomes are reviewed in the individual topics. Guidelines — Our approach is largely consistent with American and European guidelines [ 52,74,75 ].

A consensus statement regarding the management of hyperglycemia in type 2 diabetes by the American Diabetes Association ADA and the European Association for the Study of Diabetes EASD was developed in and has been updated regularly, with the most recent revision published in [ 75 ].

The guidelines emphasize the importance of individualizing the choice of medications for the treatment of diabetes, considering important comorbidities CVD, HF, or chronic kidney disease; hypoglycemia risk; and need for weight loss and patient-specific factors including patient preferences, values, and cost [ 75 ].

We also agree with the World Health Organization WHO that sulfonylureas have a long-term safety profile, are inexpensive, and are highly effective, especially when used as described above, with patient education and dose adjustment to minimize side effects [ 76 ].

Blood glucose monitoring BGM is not necessary for most patients with type 2 diabetes who are on a stable regimen of diet or oral agents and who are not experiencing hypoglycemia. BGM may be useful for some patients with type 2 diabetes who use the results to modify eating patterns, exercise, or insulin doses on a regular basis.

See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'Type 2 diabetes'. The balance among efficacy in lowering A1C, side effects, and costs must be carefully weighed in considering which drugs or combinations to choose.

Avoiding insulin, the most potent of all hypoglycemic medications, at the expense of poorer glucose management and greater side effects and cost, is not likely to benefit the patient in the long term.

See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Our approach'. SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately.

See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetic kidney disease". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic.

We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. Weight reduction through diet, exercise, and behavioral modification can all be used to improve glycemic management, although the majority of patients with type 2 diabetes will require medication.

See 'Diabetes education' above. Glycemic targets are generally set somewhat higher for older adults and for those with comorbidities or a limited life expectancy and little likelihood of benefit from intensive therapy.

See 'Glycemic management' above and "Glycemic control and vascular complications in type 2 diabetes mellitus", section on 'Choosing a glycemic target'. In the absence of specific contraindications, we suggest metformin as initial therapy for most patients Grade 2B.

Although some guidelines and experts endorse the initial use of alternative agents as monotherapy or in combination with metformin, we prefer initiating a single agent typically metformin and then sequentially adding additional glucose-lowering agents as needed.

See 'Metformin' above and 'Glycemic efficacy' above. We suggest initiating metformin at the time of diabetes diagnosis Grade 2C , along with consultation for lifestyle intervention.

See 'When to start' above. The dose of metformin should be titrated to its maximally effective dose usually mg per day in divided doses over one to two months, as tolerated. See 'Contraindications to or intolerance of metformin' above.

See 'Established cardiovascular or kidney disease' above. The majority of patients in the cardiovascular and renal outcomes trials had established cardiovascular disease CVD or diabetic kidney disease DKD with severely increased albuminuria, and therefore, these are the primary indications for one of these drugs.

See 'Without established cardiovascular or kidney disease' above. Each one of these choices has individual advantages and risks table 1. Choice of medication is guided by efficacy, patient comorbidities, preferences, and cost.

Sulfonylureas remain a highly effective treatment for hyperglycemia, particularly when cost is a barrier. Side effects of hypoglycemia and weight gain can be mitigated with careful dosing and diabetes self-management education.

For patients who are injection averse, initial therapy with high-dose sulfonylurea is an alternative, particularly for patients who have been consuming large amounts of sugar-sweetened beverages, in whom elimination of carbohydrates can be anticipated to cause a reduction in glucose within several days.

See 'Symptomatic catabolic or severe hyperglycemia' above and "Insulin therapy in type 2 diabetes mellitus". Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1C result and in some settings, the results of blood glucose monitoring [BGM].

See 'Monitoring' above. See "Management of persistent hyperglycemia in type 2 diabetes mellitus" and "Insulin therapy in type 2 diabetes mellitus".

Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Initial management of hyperglycemia in adults with type 2 diabetes mellitus.

Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Author: Deborah J Wexler, MD, MSc Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures.

All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Dec 23, TREATMENT GOALS Glycemic management — Target glycated hemoglobin A1C levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy.

Summary of glucose-lowering interventions. UK Prospective Diabetes Study UKPDS Group. Lancet ; Holman RR, Paul SK, Bethel MA, et al. N Engl J Med ; Hayward RA, Reaven PD, Wiitala WL, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes.

ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes.

Rawshani A, Rawshani A, Franzén S, et al. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. Kazemian P, Shebl FM, McCann N, et al.

Evaluation of the Cascade of Diabetes Care in the United States, JAMA Intern Med ; Pal K, Eastwood SV, Michie S, et al. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus.

Cochrane Database Syst Rev ; :CD Saffari M, Ghanizadeh G, Koenig HG. Health education via mobile text messaging for glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis.

Prim Care Diabetes ; Liang X, Wang Q, Yang X, et al. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med ; Henry RR, Scheaffer L, Olefsky JM.

Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab ; Utzschneider KM, Carr DB, Barsness SM, et al. Diet-induced weight loss is associated with an improvement in beta-cell function in older men.

Wing RR, Blair EH, Bononi P, et al. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care ; Lean ME, Leslie WS, Barnes AC, et al.

Primary care-led weight management for remission of type 2 diabetes DiRECT : an open-label, cluster-randomised trial. Delahanty LM. The look AHEAD study: implications for clinical practice go beyond the headlines. J Acad Nutr Diet ; Evert AB, Dennison M, Gardner CD, et al.

Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial.

Lancet Diabetes Endocrinol ; Niskanen LK, Uusitupa MI, Sarlund H, et al. Five-year follow-up study on plasma insulin levels in newly diagnosed NIDDM patients and nondiabetic subjects. Norris SL, Zhang X, Avenell A, et al. Long-term effectiveness of lifestyle and behavioral weight loss interventions in adults with type 2 diabetes: a meta-analysis.

Am J Med ; United Kingdom Prospective Diabetes Study UKPDS. BMJ ; Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis.

JAMA ; Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Egan AM, Mahmood WA, Fenton R, et al.

Barriers to exercise in obese patients with type 2 diabetes. QJM ; American Diabetes Association Professional Practice Committee. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes Diabetes Care ; S Kobayashi Y, Long J, Dan S, et al.

Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial.

Diabetologia ; Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.

Pillay J, Armstrong MJ, Butalia S, et al. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis. Ann Intern Med ; Johansen MY, MacDonald CS, Hansen KB, et al.

Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial. Lingvay I, Sumithran P, Cohen RV, le Roux CW. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation.

Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Arterburn DE, O'Connor PJ.

Pharmacists do more than just Cellulite reduction therapies prescriptions. They help patients get the Diiabetic benefit mabagement their mediation Diabetic coma and medication management working directly with primary care providers Diabetic coma and medication management identify, medicatuon, and resolve medication-related problems. Medicattion partnership is called collaborative janagement therapy management CDTM. Pharmacists also play a key role manafement administering Anti-allergic nasal sprays vaccines for people with diabetes, including those that protect against influenza, pneumococcal disease, and hepatitis B. In addition, they can advise patients about diabetes self-management, help them take their medicines as prescribed, and provide information about lower-cost options for medicines and medical supplies. People with diabetes can be at high risk for drug-related problems because they often have multiple medical conditions, take multiple medicines, receive medicines from different sources, and see a range of health care providers. For example, patients may inadvertently take the wrong dose at the wrong time, which can cause serious illness, long-term disability, or even death.

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Diabetic Ketoacidosis (DKA) \u0026 Hyperglycemic Hyperosmolar Syndrome (HHS) Contributor Disclosures. Please read the Disclaimer at the end manwgement this Mesication. All of these treatments and goals need to Diaberic tempered medicatiob on Team-building fitness challenges factors, such as Chia seed porridge, life expectancy, and comorbidities. Although studies of bariatric surgery, aggressive mexication therapy, and behavioral interventions to achieve weight loss have mfdication remissions Diabetic coma and medication management type 2 diabetes mellitus that may last several years, the majority of patients with type 2 diabetes require continuous treatment in order to maintain target glycemia. Treatments to improve glycemic management work by increasing insulin availability either through direct insulin administration or through agents that promote insulin secretionimproving sensitivity to insulin, delaying the delivery and absorption of carbohydrate from the gastrointestinal tract, increasing urinary glucose excretion, or a combination of these approaches. For patients with overweight, obesity, or a metabolically adverse pattern of adipose tissue distribution, body weight management should be considered as a therapeutic target in addition to glycemia. Diabetic coma and medication management

Diabetic coma and medication management -

If you are sick and unable to eat, your blood sugar may drop. While you are healthy, talk with your doctor about how to best manage your blood sugar levels if you get sick. Consider storing at least a week's worth of diabetes supplies and an extra glucagon kit in case of emergencies.

Check for ketones when your blood sugar is high. If you have a large amount of ketones, call your health care provider for advice.

Call your health care provider immediately if you have any level of ketones and are vomiting. High levels of ketones can lead to diabetic ketoacidosis, which can lead to coma. Have glucagon and fast-acting sources of sugar available. If you take insulin for your diabetes, have an up-to-date glucagon kit and fast-acting sources of sugar, such as glucose tablets or orange juice, readily available to treat low blood sugar levels.

Drink alcohol with caution. Because alcohol can have an unpredictable effect on your blood sugar, have a snack or a meal when you drink alcohol, if you choose to drink at all. Educate your loved ones, friends and co-workers. Teach loved ones and other close contacts how to recognize the early symptoms of blood sugar extremes and how to give emergency injections.

If you pass out, someone should be able to call for emergency help. Wear a medical identification bracelet or necklace. If you're unconscious, the bracelet or necklace can provide valuable information to your friends, co-workers and emergency personnel. Continuous glucose monitor and insulin pump.

By Mayo Clinic Staff. Aug 11, Show References. American Diabetes Association. Glycemic targets: Standards of Medical Care in Diabetes — Diabetes Care. Cryer PE. Hypoglycemia in adults with diabetes mellitus. Accessed July 11, Tips for emergency preparedness.

Low blood glucose hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. Insulin pumps: Relief and choice. Continuous glucose monitoring.

Managing diabetes. Hirsch IB. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis.

Inzucchi SE, et al. Clinical presentation, diagnosis and initial evaluation of diabetes mellitus in adults. Castro MR expert opinion. Mayo Clinic, Rochester, Minn. July 24, Hyperglycemia high blood glucose.

Associated Procedures. Blood urea nitrogen BUN test. Creatinine test. Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers.

Sign up for free e-newsletters. About Mayo Clinic. About this Site. Contact Us. Health Information Policy. Media Requests. They will become dehydrated and urgently need intravenous fluids. Without this kind of treatment, they may lapse into hyperosmolar coma. Hyperosmolar coma develops slowly over several days or weeks, so if the high blood glucose levels or dehydration are detected and treated early, coma can be prevented.

Hypoglycaemia , or low blood glucose levels below 3. If the blood glucose falls to very low levels, the person may become unconscious hypoglycaemic coma and seizures may occur. First aid for someone who has lapsed into a diabetic coma includes:. A coma is a medical emergency. The cause of a diabetic coma is diagnosed using a number of tests including:.

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Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.

The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website.

All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.

The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Home Diabetes. Diabetic coma. Actions for this page Listen Print. Summary Read the full fact sheet.

On this page. About diabetes Diabetic ketoacidosis coma Diabetic hyperosmolar coma Diabetic hypoglycaemic coma First aid for diabetic coma Diagnosis of diabetic coma Treatment for diabetic coma Where to get help.

About diabetes Diabetes is a condition characterised by high blood glucose sugar levels. If the serum potassium is greater than 3. The goal is to maintain the serum potassium concentration in the range of 4 to 5 mEq per L 4 to 5 mmol per L. In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy.

Retrospective reviews and prospective randomized studies have failed to identify changes in morbidity or mortality with sodium bicarbonate therapy in patients who presented with a pH of 6.

Therefore, the use of bicarbonate in a patient with a pH greater than 7. Furthermore, bicarbonate therapy carries some risks, including hypokalemia with overly rapid administration, paradoxic cerebrospinal fluid acidosis and hypoxia.

Some authorities, however, recommend bicarbonate administration when the pH is less than 7. If bicarbonate is used, it should be given as a nearly isotonic solution, which can be approximated by the addition of one ampule of sodium bicarbonate in mL of sterile water.

The bicarbonate solution is administered over a one-hour period. A small percentage of patients who have diabetic ketoacidosis present with metabolic acidosis and a normal anion gap. Therefore, they have fewer ketones available for the regeneration of bicarbonate during insulin administration.

Osmotic diuresis leads to increased urinary phosphate losses. During insulin therapy, phosphate reenters the intracellular compartment, leading to mild to moderate reductions in the serum phosphate concentration.

Adverse complications of hypophosphatemia are uncommon and occur primarily in patients with severe hypophosphatemia a serum phosphate concentration of less than 1.

Prospective studies have indicated no clinical benefit for phosphate replacement in the treatment of diabetic ketoacidosis, and excessive phosphate replacement may contribute to hypocalcemia and soft tissue metastatic calcification.

One protocol is to administer two thirds of the potassium as potassium chloride and one third as potassium phosphate. The use of phosphate for this purpose reduces the chloride load that might contribute to hyperchloremic acidosis and decreases the likelihood that the patient will develop severe hypophosphatemia during insulin therapy.

When diabetic ketoacidosis has been controlled, subcutaneous insulin therapy can be started. The half-life of regular insulin is less than 10 minutes. Therefore, to avoid relapse of diabetic ketoacidosis, the first subcutaneous dose of regular insulin should be given at least one hour before intravenous insulin is discontinued.

In patients who are unable to eat, 5 percent dextrose in hypotonic saline solution is continued at a rate of to mL per hour. Blood glucose levels are monitored every four hours, and regular insulin is given subcutaneously every four hours using a sliding scale Figure 2.

When patients are able to eat, multidose subcutaneous therapy with both regular short-acting and intermediate-acting insulin may be given. In patients with newly diagnosed diabetes, an initial total insulin dosage of 0.

A typical regimen is two thirds of the total daily dosage before breakfast and one third of the total daily dosage before dinner, with the insulin doses consisting of two-thirds NPH intermediate-acting insulin and one-third regular short-acting insulin.

Patients with known diabetes can typically be given the dosage they were receiving before the onset of diabetic ketoacidosis. Symptomatic cerebral edema occurs primarily in pediatric patients, particularly those with newly diagnosed diabetes. No single factor predictive for cerebral edema has yet been identified.

As noted previously, however, overly rapid rehydration or overcorrection of hyperglycemia appears to increase the risk of cerebral edema. Onset of headache or mental status changes during therapy should lead to consideration of this complication. Intravenous mannitol in a dosage of 1 to 2 g per kg given over 15 minutes is the mainstay of therapy.

Prompt involvement of a critical care specialist is prudent. Adult respiratory distress syndrome ARDS is a rare but potentially fatal complication of the treatment of diabetic ketoacidosis. Patients with an increased alveolar to arterial oxygen gradient AaO2 and patients with pulmonary rales on physical examination may be at increased risk for ARDS.

Monitoring of oxygen saturation with pulse oximetry may assist in the management of such patients. Hyperchloremic metabolic acidosis with a normal anion gap typically persists after the resolution of ketonemia. This acidosis has no adverse clinical effects and is gradually corrected over the subsequent 24 to 48 hours by enhanced renal acid excretion.

No randomized prospective studies have evaluated the optimal site of care for patients with diabetic ketoacidosis. The response to initial therapy in the emergency department can be used as a guideline for choosing the most appropriate hospital site i.

Admission to a step-down or intensive care unit should be considered for patients with hypotension or oliguria refractory to initial rehydration and for patients with mental obtundation or coma with hyperosmolality total osmolality of greater than mOsm per kg of water. Most patients can be treated in step-down units or on general medical wards in which staff members have been trained in on-site blood glucose monitoring and continuous intravenous insulin administration.

Milder forms of diabetic ketoacidosis can be treated in the emergency department using the same treatment guidelines described in this review. Successful outpatient therapy requires the absence of severe intercurrent illness, an alert patient who is able to resume oral intake and the presence of mild diabetic ketoacidosis pH of greater than 7.

With the use of standardized written treatment guidelines and flow sheets for monitoring therapeutic response, the mortality rate for patients with diabetic ketoacidosis is now less than 5 percent. These outcomes have not been altered by the specialty of the primary treating physicians e.

An educational program should include sick-day management instructions i. Patients should not discontinue insulin therapy when they are ill, and they should contact their physician early in the course of illness.

Indications for hospitalization include greater than 5 percent loss of body weight, respiration rate of greater than 35 per minute, intractable elevation of blood glucose concentrations, change in mental status, uncontrolled fever and unresolved nausea and vomiting.

Umpierrez GE, Khajavi M, Kitabchi AE. Review: diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Am J Med Sci. Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE.

Hyperglycemic crises in urban blacks. Arch Intern Med. Ennis ED, Stahl EJ, Kreisberg RA. Diabetic ketoacidosis.

In: Porte D Jr, Sherwin RS, eds. Stamford, Conn. Rosenbloom AL, Hanas R. Diabetic ketoacidosis DKA : treatment guidelines. Clin Pediatr [Phila]. Kitabchi AE, Fisher JN, Murphy MB, Rumbak MJ.

Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. In: Kahn CR, Weir GC, eds. Joslin's Diabetes mellitus. Zammit VA. Regulation of ketone body metabolism: a cellular perspective.

People with type 2 diabetes form a heterogeneous group. Cpma, treatment regimens and therapeutic Injury prevention diet plan should be individualized. The treatment of managemnt 2 Diabetic coma and medication management Diaabetic a multi-pronged approach that aims to treat and prevent symptoms of hyperglycemia, such as dehydration, fatigue, polyuria, infections and hyperosmolar states; and to reduce the risks of cardiovascular CV and microvascular complications 1. This includes healthy behaviour interventions see Reducing the Risk of Diabetes chapter, p. S20; Cardiovascular Protection in People with Diabetes chapter, p. S and antihyperglycemic medications.

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