- October 18, 2016
For patients with type 1 diabetes, one of the most serious medical emergencies is diabetic ketoacidosis (DKA). It can be life-threatening and, in most cases, is caused by a shortage of insulin.
Glucose is the “fuel” which feeds human cells. Without it, these cells are forced to “burn” fatty acids in order to survive. This process leads to the production of acidic ketone bodies which can cause serious symptoms and complications such as passing out, confusion, vomiting, dehydration, coma, and, if not corrected in a timely manner, even death. High levels of ketones poison the body.
DKA can be diagnosed with blood and urine tests and is distinguished from other ketoacidosis by the presence of high blood sugar levels. Typical treatment for DKA consists of using intravenous fluids to correct the dehydration, insulin dosing to suppress the production of ketones, and treatment for any underlying causes such as infections.
Medical history notes that DKA was first diagnosed and described in 1886 and until insulin therapy was introduced in the 1920’s, this condition was almost universally fatal. However, with availability and advances in insulin therapy, the mortality rate is less than one percent when timely treatment is applied.
A Clinical Pharmacist Examines DKA
Ron Fila (RPh) is a clinical pharmacist at McLaren Northern Michigan in Petoskey, MI. He has first-hand experience in treating patients with DKA and, as one of the early adaptors of EndoTool he has seen how this algorithmically-based glucose management software can help physicians save lives and improve patient outcomes.
“We started using EndoTool in 2013, for treating patients in the ICU,” he noted in a recent interview. “Later, we expanded our use of this software for DKA and pediatrics.
“Since DKA is a disease state of hyperglycemia, where blood sugars are out of control and mortality is possible, timely and accurate response is critical. It is typically seen in patients with type 1 diabetes but can also occur in patients with type 2 diabetes. This can occur when the patient’s insulin pump has stopped or malfunctioned. This condition can also occur in patients who are outside a hospital setting as well as those who are currently in-patient.”
Dehydration is the Greatest Concern
“One of greatest concerns for patients experiencing DKA symptoms is dehydration,” Fila said. “We treat DKA patients with large quantities of fluids – sometimes three or four liters over a short time period. This dehydration also results in electrolyte imbalances and the need for large amounts of potassium and sodium in the IV solution.
“DKA treatment is best managed by infusion of considerable fluids at the outset of the treatment,” he said. “It is also important to closely watch the patient’s electrolytes.
“After this initial patient stabilization, we focus on treating the blood sugars and attempt to bring them down at a well-managed rate. If these blood sugars can be restrained at this conservative rate, the patient can avoid dangerous conditions such as cerebral edema, which can have serious results, especially in children.”
Glucose Management and DKA
When asked what role glucose management plays in the emergency treatment for DKA, Fila offered his analysis.
“Glucose management plays a critical role in reduction of acidosis in these patients,” he said. “Once the acidosis is resolved, the patient recovers very quickly. In many cases, the critical condition of DKA patients can be corrected and they can be on their way home within 24-hours.
“Effective glucose management of DKA patients can save the patient and the hospital time and money,” Fila noted.
EndoTool Has Become Invaluable for Treating DKA
“EndoTool does a nice job of managing hypoglycemia with our patients,” Fila said. “We currently treat all of our critical care patients on IV insulin with EndoTool and have seen great results with managing the glucose levels of our DKA patients.
“Our main concern for DKA patients on an insulin drip is to make sure that blood sugar levels do not decreased too quickly. However, after reviewing the DKA patient data where EndoTool was used, we have been very pleased with the outcomes.”
In the treatment of DKA patients, the skills of nurses can make the difference between life and death. Fila explained how this software has been received by this group.
“Initially, the nurses were apprehensive about using this software,” he said. “This was due to a lack of experience with the tool and how it might possibly affect the patient-outcome. As they have become familiar with EndoTool, the nurses no feel very confident in using it for DKA treatment. They realize the drip-rate will be based on sound mathematical basis and this allows them to focus on other critical elements of treatment.”