Euglycemic DKA

This is the development of DKA in people known to have diabetes but where the glucose is normal, or not particularly raised. Improved education for those with diabetes with increased home capillary glucose and ketone monitoring has led to partial treatment of DKA prior to admission with consequent lower blood glucose levels at presentation. This condition is treated in exactly the same way as hyperglycaemic DKA.

1. Initiate glucose 10% straight away at 125 ml/hr because the glucose is < 14 mmol/L
2. Begin with 0.1units/kg/hr insulin rate
3. If glucose falling despite 10% glucose reduce to 0.05 units/kg/hr to avoid hypoglycaemia

Ketosis prone type 2 diabetes DKA does not exclusively occur in people with type 1 diabetes, and people with type 2 diabetes may also develop DKA so called ketosis prone type 2 diabetes. This most often occurs in people of Afro-Caribbean or Hispanic descent. The treatment for this condition is the same as for others with DKA, but they often come off insulin quickly after the resolution of the DKA and underlying precipitating condition.