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Diabetic Ketoacidosis Management in Adults

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1. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. Full Text available with Trip Pro

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily (...) potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous

2019 BMJ

2. Hospital management of hypoglycaemia in adults with diabetes

of adults with diabetes on the haemodialysis unit April 2016 JBDS 11 Discharge planning for adult inpatients with diabetes October 2015 JBDS 10 The use of variable rate intravenous insulin infusion (VRIII) in medical inpatients October 2014 JBDS 09 Management of hyperglycaemia and steroid (glucocorticoid) therapy October 2014 JBDS 08 Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams December 2013 JBDS 07 The management of the hyperosmolar hyperglycaemic (...) state (HHS) in adults with diabetes August 2012 JBDS 06 Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes June 2012 JBDS 05 Self-management of diabetes in hospital March 2012 JBDS 04 Management of adults with diabetes undergoing surgery and elective procedures: improving standards April 2011 JBDS 03 The management of diabetic ketoacidosis in adults revised September 2013 JBDS 02 These documents are available to download from the ABCD website at https

2018 Association of British Clinical Diabetologists

3. Type 1 diabetes in adults: diagnosis and management

Type 1 diabetes in adults: diagnosis and management T T ype 1 diabetes in adults: diagnosis and ype 1 diabetes in adults: diagnosis and management management NICE guideline Published: 26 August 2015 nice.org.uk/guidance/ng17 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration (...) 21 1.6 Blood glucose management 22 1.7 Insulin therapy 26 1.8 Insulin delivery 28 1.9 Referral for islet or pancreas transplantation 29 1.10 Awareness and management of hypoglycaemia 29 1.11 Ketone monitoring and management of diabetic ketoacidosis (DKA) 32 1.12 Associated illness 34 1.13 Control of cardiovascular risk 34 Type 1 diabetes in adults: diagnosis and management (NG17) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

4. Type 2 diabetes in adults: management

Type 2 diabetes in adults: management T T ype 2 diabetes in adults: management ype 2 diabetes in adults: management NICE guideline Published: 2 December 2015 nice.org.uk/guidance/ng28 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When (...) in adults: management (NG28) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 44Introduction Introduction This guidance updates and replaces 'Type 2 diabetes' (NICE guideline CG87). The recommendations are labelled according to when they were originally published (see update information for details). Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body's inability

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

5. The management of diabetic ketoacidosis (DKA) in adults

The management of diabetic ketoacidosis (DKA) in adults Joint British Diabetes Societies Inpatient Care Group The Management of Diabetic Ketoacidosis in Adults Second Edition Update: September 2013 This document has been endorsed by the Intensive Care SocietyThis document is coded JBDS 02 in the series of JBDS documents Other JBDS documents: The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. August 2012 - JBDS 06 Glycaemic management during the inpatient (...) version of this document at www.diabetologists-abcd.org.uk/JBDS/JBDS.htm or www.diabetes.org.ukThere are several currently available national and international guidelines for the management of Diabetic Ketoacidosis (DKA) in both adults and children 1-6 . In the last decade, however, there has been a change in the way patients with DKA present clinically and in addition there has been rapid development of near-patient testing technology. Until recently there was no easily available assay for ketone

2013 Association of British Clinical Diabetologists

6. The management of diabetes in adults and children with psychiatric disorders in inpatient settings

JBDS 11 Discharge planning for adult inpatients with diabetes October 2015 JBDS 10 The use of variable rate intravenous insulin infusion (VRIII) in medical inpatients October 2014 JBDS 09 Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy October 2014 JBDS 08 Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams December 2013 JBDS 07 The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes August 2012 JBDS 06 (...) Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes June 2012 JBDS 05 Self-Management of Diabetes in Hospital March 2012 JBDS 04 Management of adults with diabetes undergoing surgery and elective procedures: improving standards Revised March 2016 JBDS 03 The Management of Diabetic Ketoacidosis in Adults Revised September 2013 JBDS 02 The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus Revised September 2013 JBDS 01 These documents

2017 Association of British Clinical Diabetologists

7. ABCD position statement on standards of care for management of adults with type 1 diabetes

and monitoring 4.1 Treatment 4.2 Targets 4.3 Monitoring 4.4 Unexplained or unpredictable blood glucose results 5. Long term complications: screening and management 5.1 Screening and treatment for microvascular complications 5.1.1 Retinopathy 5.1.2 Nephropathy 5.1.3 Neuropathy 5.2 Screening and risk factor modification for macrovascular disease 3 6. Acute complications 6.1 Hypoglycaemia 6.2 Diabetic ketoacidosis 7. Special circumstances 7.1 Children and young adults 7.2 Older people and care homes 7.3 (...) guideline for the management of Diabetic Ketoacidosis in Adults. https://www.diabetes.org.uk/.../The-Management-of-Diabetic- Ketoacidosis-in -Adults/ 24 Children and young people under the age of 18 years should be treated according to the British Society of Paediatric Endocrinology and Diabetes (BSPED). http://www.bsped.org.uk/clinical/docs/DKAguideline.pdf_ Follow up after resolution of DKA All people with DKA should be reviewed by the diabetes specialist team (an audit criterion) for: ? Education

2017 Association of British Clinical Diabetologists

8. Corrigendum: Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols Full Text available with Trip Pro

Corrigendum: Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols [This corrects the article on p. 106 in vol. 8, PMID: 28659865.].

2017 Frontiers in endocrinology

9. Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols Full Text available with Trip Pro

Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols Diabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs).To review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management (...) protocols and impact of DKA resolution rates on outcomes.Ovid Medline searches were conducted with limits "all adult" and published between "1973 to current" applied. National consensus statements were also reviewed. Eligibility was determined by two reviewers' assessment of title, abstract, and availability.A total of 85 eligible articles published between 1973 and 2016 were reviewed. The salient findings were (i) Crystalloids are favoured over colloids though evidence is lacking. The preferred

2017 Frontiers in endocrinology

10. GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

is recommended discuss with patients the risk factors for and signs and symptoms of diabetic ketoacidosis (see below) and advise them to seek immediate medical advice if these develop report suspected adverse drug reactions on a Background Exenatide ( , ), liraglutide ( , ▼, ▼[combination product with insulin]), and dulaglutide ( ▼) are glucagon-like peptide-1 (GLP-1) receptor agonists (also known as GLP-1 mimetic therapies) and are authorised for use in adults with type 2 diabetes to improve glycaemic (...) control, except for Saxenda, which is indicated for weight management. GLP-1 receptor agonists act by stimulating insulin secretion from the pancreas in a glucose-dependent manner, as well as slowing gastric emptying and suppressing glucagon secretion. GLP-1 receptor agonists are not substitutes for insulin. Review of cases of diabetic ketoacidosis Serious and life-threatening cases of diabetic ketoacidosis have been reported in association with exenatide, liraglutide, and dulaglutide, particularly

2019 MHRA Drug Safety Update

11. Diabetic Ketoacidosis Management in Adults

Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Adults Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Adults Aka: Diabetic Ketoacidosis Management in Adults , DKA Management From Related Chapters II. Management: Phase 1 - Fluids in Adults (Emergent) Stabilize shock and states first! Disconnect Removes the risk of uncalculated additional admininistered from pump (risk of ) Clearly, pump is not working properly if the patient is presenting in Remove needle from insertion site and observe for needle or tubing problem

2018 FP Notebook

12. Management of Diabetic Ketoacidosis with Dengue Hemorrhagic Fever Full Text available with Trip Pro

, and hemorrhage varies from none to life-threatening. Infection is the predominant precipitating factor for diabetic ketoacidosis. In addition to insulin administration, successful management of diabetic ketoacidosis requires fluid resuscitation. We herein report an adult patient with diabetic ketoacidosis complicated with dengue hemorrhagic fever who developed leakage syndrome. Early recognition of leakage and appropriate fluid management was critical in the diabetic ketoacidosis management of this case. (...) Management of Diabetic Ketoacidosis with Dengue Hemorrhagic Fever Viral hemorrhagic fever is one of the most important emerging infectious diseases. Some viral hemorrhagic fevers include dengue, hantavirus, Ebola infection, and yellow fever. Dengue virus infection results in a wide spectrum of clinical diseases, including dengue hemorrhagic fever, characterized by the transient period of plasma leakage and hemorrhagic tendency. Vascular instability ranges from mild to fatal shock

2018 Cureus

13. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Hyperglycemic emergencies in adults

in higher PG levels (typically ≥34.0 mmol/L), plasma osmolality >320 mOsm/kg and greater ECFV contraction, but minimal acid-base disturbance . Pregnant women in DKA typically present with lower PG levels than nonpregnant women , and there are case reports of euglycemic DKA in pregnancy . Table 2 Priorities to be addressed in the management of adults presenting with hyperglycemic emergencies DKA , diabetic ketoacidosis; ECFV , extracellular fluid volume; HHS , hyperosmolar hyperglycemic state. Severity (...) for this condition even if BG is not elevated [Grade D, Consensus]. Abbreviations: BG , blood glucose; CBG, capillary blood glucose; DKA , diabetic ketoacidosis; ECFV , extracellular fluid volume; HHS , hyperosmolar hyperglycemic state; KPD , ketosis-prone diabetes, PG , plasma glucose. Other Relevant Guidelines Glycemic Management in Adults With Type 1 Diabetes, p. S80 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults, p. S88 Type 1 Diabetes in Children and Adolescents, p. S234 Relevant Appendix

2013 CPG Infobase

14. The Two-Bag Method for Treatment of Diabetic Ketoacidosis in Adults. (Abstract)

The Two-Bag Method for Treatment of Diabetic Ketoacidosis in Adults. The "two-bag method" of management of diabetic ketoacidosis (DKA) allows for titration of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates constant.We aimed to evaluate the feasibility and potential benefits of this strategy in adult emergency department (ED) patients with DKA.This is a before-and-after comparison (...) of a protocol using the two-bag method operationalized in our adult ED in 2015. A retrospective electronic medical record search identified adult ED patients presenting with DKA from January 1, 2013 to June 30, 2016. Clinical and laboratory data, timing of medical therapies, and safety outcomes were collected and analyzed.Sixty-eight patients managed with the two-bag method (2B) and 107 patients managed with the one-bag method (1B) were identified. The 2B and 1B groups were similar in demographics

2018 Journal of Emergency Medicine

15. Tiny Tips – Approach to Diabetic Ketoacidosis Full Text available with Trip Pro

. 2003;168(7):859-866. [ ] 2. Cheng AYY. Introduction. Canadian Journal of Diabetes . 2013;37:S1-S3. doi: 3. Whitney W. DKA, “Answers.” DKA, “Answers.” . Published August 23, 2014. 4. Blouin D. Too much of a good thing: management of diabetic ketoacidosis in adults. Can Fam Physician . 2012;58(1):55-57. [ ] Staff Review: Comments on DKA This “DKA” pneumonic and algorithm are a great, simple way to keep the three key parts of diabetic ketoacidosis management straight. Remember that this is one of the most (...) Tiny Tips – Approach to Diabetic Ketoacidosis Tiny Tips - Approach to Diabetic Ketoacidosis - CanadiEM Tiny Tips – Approach to Diabetic Ketoacidosis In , by Larissa Hattin February 24, 2017 Don’t Know Anything about Diabetic Ketoacidosis (DKA)? In Canada, 5 000 – 10 000 patients are admitted to the hospital with diabetic ketoacidosis (DKA) each year. 1 Most of these patients will initially present to the Emergency Department. The initial assessment and management of these patients in the ED

2017 CandiEM

16. Management of adults with diabetes undergoing surgery

Management of adults with diabetes undergoing surgery Management of adults with diabetes undergoing surgery and elective procedures: Improving standards Revised March 2016Lead authorship Dr Ketan Dhatariya – Consultant in Diabetes, Norfolk and Norwich University Hospitals NHS Foundation Trust Dr Nicholas Levy – Consultant in Anaesthesia, West Suffolk NHS Foundation Trust Dr Daniel Flanagan – Consultant in Diabetes, Plymouth Hospitals NHS Trust Louise Hilton – Senior Diabetes Nurse, Bolton PCT (...) . Unfortunately, the NHS is often unable to cope with these individual needs during the hospital stay 19,27 . The guidelines emphasised the importance of allowing the person with diabetes to retain control of diabetes management during their admission unless their medical condition prevents them from doing so. There is also a JBDS14 guideline on self-management of diabetes in hospital 29 . Although the main focus is on elective surgery and procedures much of the guidance applies equally to the management

2016 Association of British Clinical Diabetologists

17. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

of the blood glucose level ? a person not known to have diabetes, presenting with osmotic symptoms, a raised blood glucose and ketones in either blood (3mmol/L or more) or urine (more than 2+) Treatment of DKA Adults with DKA should be treated according to local hospital guidelines or using the Joint British Diabetes Societies Inpatient Care Group guideline for the management of Diabetic Ketoacidosis in Adults. https://www.diabetes.org.uk/.../The-Management-of-Diabetic- Ketoacidosis-in -Adults/ Children (...) ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above The Association of British Clinical Diabetologists (ABCD) Standards of care for management of adults with type 1 diabetes Foreword This position statement is the first ABCD has produced on the subject of type 1 diabetes since 2012, when it ran its 'Lost Tribe' campaign. This arose from concerns that people with type 1 diabetes had inadvertently

2016 Association of British Clinical Diabetologists

18. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm Full Text available with Trip Pro

AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM – 2019 EXECUTIVE SUMMARY | Endocrine Practice | | > > > CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOL... Volume 25, Issue 1 (January 2019) Alerts for the Journal Click to get an email alert for every new issue of Endocrine Practice X Email (...) , Janet B. McGill , Jeffrey I. Mechanick , Paul D. Rosenblit , and Guillermo E. Umpierrez ( 2019 ) CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM – 2019 EXECUTIVE SUMMARY . Endocrine Practice: January 2019, Vol. 25, No. 1, pp. 69-100. AACE/ACE Consensus Statement CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY

2019 American Association of Clinical Endocrinologists

19. Cardiovascular Benefits and Harms of Step Therapy in the Treatment of Type 2 Diabetes in Adults with and without Atherosclerotic Cardiovascular Disease

. Additionally, we did not address dose-specific harms or costs (and cost-effectiveness) of medications.8 References 1. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. NICE guideline [NG28] https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2. Accessed October 12, 2018. 2. Kaiser Permanente National Clinical Practice Guidelines. Adult Diabetes Clinician Guide. http://kpcmi.org/files/diabetes-clinician-guide.pdf. Accessed (...) Cardiovascular Benefits and Harms of Step Therapy in the Treatment of Type 2 Diabetes in Adults with and without Atherosclerotic Cardiovascular Disease Cardiovascular Benefits and Harms of Step Therapy in the Treatment of Type 2 Diabetes in Adults with and without Atherosclerotic Cardiovascular Disease Kaiser Permanente Research Affiliates Evidence-based Practice Center Corinne Evans, MPP; Nicholas Emptage, MAE; Megan Rushkin, MPH; and Jennifer S. Lin, MD, MCR Summary Question 1. In persons

2019 Kaiser Permanente National Guideline Program

20. Pharmacological management of glycaemic control in people with type 2 diabetes

clinical need where appropriate. NICE MTAs deemed valid for NHSScotland supersede extant SMC advice as they are generally underpinned by a larger and more recent evidence base. SMC advice and NICE MTA guidance relevant to this guideline are summarised in section 13. Pharmacological management of glycaemic control in people with type 2 diabetes 1 • Introduction 6 | 2 Key recommendations The following were highlighted by the guideline development group as the key clinical recommendations that should (...) People taking GLP-1 receptor agonists may hold a regular (Group 1) driving licence without restriction, but must notify the DVLA if they hold a Group 2 licence. Pharmacological management of glycaemic control in people with type 2 diabetes 12 • Provision of information34 | 12.1.8 INSULIN When starting insulin therapy in adults with type 2 diabetes, a structured education programme should be used to guide insulin dose titration, including: y injection technique (rotating injection sites) y self

2017 SIGN

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