Talk:Diabetic ketoacidosis

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August 4, 2009	Good article nominee	Listed

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Certified Diabetes Educator[edit]

Since when do people in need of medical assistance get told to call a certified diabetes educator instead of a physician, practitioner, or emergency response system? Makes me wonder if the person who wrote that section is a CDE. — Preceding unsigned comment added by 165.214.4.22 (talk) 19:57, 28 December 2012 (UTC)[reply]

Can't remember if I wrote that, but I would not object if a person with DM1 who is feeling unwell gets in touch with someone who can advise when to to got hospital. In the UK, diabetes specialist nurses are often the first port of call for patients. JFW | T@lk 00:22, 30 December 2012 (UTC)[reply]

DKA at presentation in kids[edit]

doi:10.1136/bmj.d4092 is a systematic review as to why some kids get diagnosed and treated before DKA sets in. Might require citation. JFW | T@lk 21:52, 19 February 2013 (UTC)[reply]

Pathophysiology[edit]

The following was added:

“

Normally, the fatty acids are broken down into acetyl-Coa, which then combines with oxaloacetate in the Krebs Cycle. However, there is a paucity of oxaloacetate in the diabetic liver, as the oxaloacetate is consumed in gluconeogenesis. Therefore, two molecules of Acetyl-Coa combine to form ketone bodies.

”

This probably reflects the pathophysiology, but there is no source and I'm not sure if it is necessary for the flow of the text. Opinions welcome. JFW | T@lk 19:53, 1 July 2013 (UTC)[reply]

Doubt in Cause Section[edit]

The populations that are said to be more prone seems to be in US/American sense. I think that information was relevant to US demographics. Some one please look into this and clarify as I'm not an expert on this. Thanks Srikanth Aviator (talk) 15:22, 4 January 2014 (UTC)[reply]

I'm assuming that you are referring to type 1 diabetics when you say "The populations that are said to be more prone." Is my assumption correct? The reason that people with type 1 diabetes are more prone to DKA is because they have an absolute insulin deficiency, whereas those with type 2 do not. The insulin that type 2 diabetics are able to produce is usually sufficient to prevent them from going into DKA. In other words, it has nothing to do with nationality. It has to do with the different characteristics of the two diseases. --T1dme (talk) 20:09, 4 January 2014 (UTC)[reply]

Most of the studies and reports on ketosis-prone diabetes mellitus type 2 have been conducted in the USA. They show strong preponderance in African-Americans. Africans outside the USA seem to be affected also, see doi:10.1210/er.2007-0026.

What exactly is your question? JFW | T@lk 22:33, 4 January 2014 (UTC)[reply]

"Diabetic ketoacidosis may occur in those previously known to have diabetes mellitus type 2 or in those who on further investigations turn out to have features of type 2 diabetes (e.g. obesity, strong family history); this is more common in African, African-American and Hispanic people. Their condition is then labeled "ketosis-prone type 2 diabetes"." As the study was made in USA it will be more appropriate to say "this is more common in African, African-American and Hispanic people in USA" instead of "this is more common in African, African-American and Hispanic people". Right? Srikanth Aviator (talk) 16:16, 10 January 2014 (UTC)[reply]

Not sure. If you look at the Endocrine Reviews article I linked above, you will see that a fair number of reports came out of Africa. We'd be adding an untruth by specifying that it only affects people in the USA. JFW | T@lk 17:33, 12 January 2014 (UTC)[reply]

@JFW: Thanks for the Clarification Srikanth Aviator (talk) 18:41, 13 January 2014 (UTC)[reply]

Respiratory failure[edit]

... can occur as we already discuss. This review discusses it in more detail: doi:10.4239/wjd.v6.i8.1009 JFW | T@lk 06:58, 30 December 2015 (UTC)[reply]

DKA with normal glc[edit]

We should discuss [1] Just had a case. Doc James (talk · contribs · email) 20:10, 31 January 2016 (UTC)[reply]

It's in ADA2009. I have added a pointer. JFW | T@lk 15:37, 4 February 2016 (UTC)[reply]

The link with SGLT2 inhibitors is discussed in this review doi:10.1210/jc.2015-1884 to which I currently have no access. JFW | T@lk 15:40, 4 February 2016 (UTC)[reply]

K will look. Doc James (talk · contribs · email) 15:49, 4 February 2016 (UTC)[reply]

Done Added. JFW | T@lk

More sources[edit]

BMJ doi:10.1136/bmj.h5660 - revew in adults NICE DM1 in children and doi:10.1136/bmj.i139 BMJ summary

More to add, thus. JFW | T@lk 16:56, 10 February 2016 (UTC)[reply]

In fact, NEJM review should be added doi: 10.1056/NEJMra1207788 JFW | T@lk 12:15, 11 February 2016 (UTC)[reply]

Updated the lead based on the BMJ paper. Doc James (talk · contribs · email) 05:35, 27 October 2016 (UTC)[reply]

Evidence is weak[edit]

doi:10.3389/fendo.2017.00106 discusses the evidence for the current recommendations, and the fact that they are based on the tiniest of studies. To what extent should this be cited? JFW | T@lk 15:50, 16 August 2017 (UTC)[reply]

Another recent review: doi:10.1016/j.metabol.2015.12.007 JFW | T@lk 16:38, 16 August 2017 (UTC)[reply]

This editorial reviews weaknesses in the 2009 ADA position statement. More for reference than citation currently. doi:10.1016/S2213-8587(17)30093-1 JFW | T@lk 19:18, 15 August 2019 (UTC)[reply]

BMJ has done a "state of the art" doi:10.1136/bmj.l1114. Need to read, perhaps replacing some older sources.

This one is from Med Clin N Am but is free on PMC doi:10.1016/j.mcna.2016.12.011 JFW | T@lk 19:37, 15 August 2019 (UTC)[reply]

2021 update[edit]

I have just updated the references to the June 2021 update of the JBDS guideline. The ADA seems content to stick with the 12-year old guideline that we still reference. JBDS also addresses DKA in dialysis patients - I have not added this.

On scanning recent reviews, the following stand out:

doi:10.1016/j.ajem.2021.02.015 - review of euglycaemic DKA
doi:10.1016/j.numecd.2020.06.006 - Italian national guidelines for all age groups
doi:10.1038/s41572-020-0165-1 - broad review in Nat Rev Dis Primers
doi:10.1542/pir.2018-0231 - review in paediatrics
doi:10.1016/S2213-8587(20)30042-5 - prevention strategies
doi:10.1136/bmj.l1114 - BMJ state of the art review
doi:10.1080/17446651.2019.1561270 - approach to possible KPD in DKA
doi:10.1111/dme.13519 - role of deprivation (important systematic review)

Just in case I find myself with nothing to do for a few hours! JFW | T@lk 09:21, 10 August 2021 (UTC)[reply]

Also doi:10.1038/nrendo.2016.15 JFW | T@lk 20:18, 2 October 2021 (UTC)[reply]

JBDS update[edit]

doi:10.1111/dme.14788 JFW | T@lk 22:56, 16 March 2022 (UTC)[reply]