New recommendations on the management of diabetic ketoacidosis in adults are now available

The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) used newly available evidence and expert consensus to update ‘The management of diabetic ketoacidosis in adults’ guideline.

The revised guidelines continue to classify ketoacidosis as a potentially life-threatening condition, yet latest evidence on the prevalence of hypoglycaemia and hypokalaemia implied that changes were required.

Professor Ketan Dhatariya, first author of the updated recommendations and the Chair of the JBDS-IP, said: “The guideline takes into account new evidence on the use of the previous version of this document, particularly the high prevalence of hypoglycaemia and hypokalaemia.”

Hypoglycaemia is defined as blood sugar (glucose) levels dropping too low (usually below 3.5mmol/L), and hypokalaemia is defined as a serum concentration of potassium dropping too low (usually below 3.5 mmol/L).

The new recommendations clearly state that these guidelines should be used for 16- to 18-year-olds only when they are under the care of an adult team. If they are under the care of a paediatric team, then the paediatric guideline must be used.

Other recommendations in the updated guideline include considering de-escalating the insulin infusion rate from 0.1 to 0.05 units/kg/h when blood glucose decreases below 14 mmol/L.

In addition, the increased risk of euglycaemic ketoacidosis from the use of SGLT-2 inhibitors has been addressed in the new guidance.

A section regarding ketosis prone type 2 diabetes and ketoacidosis in those with end-stage renal failure or on dialysis has also been added.

To read the updated guidance, click here.

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