Diabetic ketoacidosis in type 2 diabetes mellitus

Abstract

Diabetic ketoacidosis is usually associated with type 1 diabetes; however, it is increasingly being recognised in type 2 diabetes. The three main mechanisms suggested are: insulinopaenia, elevation in counter‐regulatory hormones as a stress response, and increase in free fatty acids. This review aims to highlight the mechanism of diabetic ketoacidosis in type 2 diabetes, the difference compared to its occurrence in type 1 diabetes, the main triggers and its management. The most common mechanism is relative insulin deficiency (insulinopaenia) and usual triggers are non‐concordance or infection. Treatment is exactly the same as in type 1 diabetes with intravenous fluid resuscitation and insulin, though the duration of treatment may not be as long. These patients are able to stop insulin following resolution of ketoacidosis and can be managed on oral hypoglycaemic agents. It is important for clinicians to be aware of this condition due to the increasing burden of type 2 diabetes and to avoid unnecessary treatment with insulin in the long term.

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

“…There was a mortality rate of 17.14% with the higher mortality occurring in patients with T2DM. 46 , 47 , 48 This could be accounted for because of the older age and many more comorbidities compared to the T1DM group. Death rates from DKA in other studies were quite low compared to our study with the described range between 2% and 5% 15 but these studies were conducted in HICs that are better resourced in terms of their infrastructure and have dedicated and experienced centres for DKA management.…”

The translational network for metabolic disease – from protein interaction to disease co-occurrence

“…Presence of Diabetic ketoacidosis has been increasingly recognized in patients with T2DM, and a newer entity called ketosis-prone diabetes is also commonly recognized [39, 40]. Diabetic ketoacidosis in patients with T2DM tends to present with a less severe acidosis and patients are more likely to have normal potassium levels [41–43].…”

https://publisher.medfak.ni.ac.rs/AMM_1/2019/2019-1-broj/Abs_eng/18Mike%20Barbeck.pdf

“…The majority of patients with DKA and newly diagnosed type 2 diabetes are able to discontinue insulin after the acute episode and to continue with oral antidiabetic therapy (up to 66% in some studies) (16). This may be related with beta cell recovery after the resolution of the acute hyperglycemic episode (17). The importance of recognizing DKA as the feature of type 2 diabetes lies in this finding, ensuring that patients are not unnecessarily continued with insulin and providing significant cost, economic and emotional benefit to patients (17).…”

“…This may be related with beta cell recovery after the resolution of the acute hyperglycemic episode (17). The importance of recognizing DKA as the feature of type 2 diabetes lies in this finding, ensuring that patients are not unnecessarily continued with insulin and providing significant cost, economic and emotional benefit to patients (17).…”