All cases of recurrent DKA are preventable. Risk factors for DKA occurrence and recurrence in children with known diabetes are related to insulin omission, insulin pump failure, adolescent girls, poor metabolic control, psychosocial turmoil, lower socioeconomic strata and/or lack of healthcare resources including being under- or uninsured, young age and other stressors such as surgery, infection or medication use (steroids, diazoxide, antipsychotics and immunosuppressive drugs). A multidisciplinary approach with social workers, a diabetes nurse educator and a nutritionist would benefit these patients. Written guidelines for sick day management and repeated discussions and review of these guidelines are essential. Discussion of symptoms and monitoring of blood glucose levels and ketones (blood or urine) must be taught. A 24-h helpline is recommended to be in place for emergency advice and treatment recommendations.
Expert Rev Endocrinol Metab. 2012;7(4):433-443. © 2012 Expert Reviews Ltd.