Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association

Jane L. Chiang; M. Sue Kirkman; Lori M.B. Laffel; Anne L. Peters


Diabetes Care. 2014;37(7):2034-2054. 

In This Article


DKA (see ref.[70] for definition) is an acute complication of diabetes that can be associated with new-onset type 1 diabetes, insulin omission, and increased levels of counterregulatory hormones/cytokines associated with stress, such as an infection. Mild cases can be safely and effectively treated in an acute care setting with appropriate resources and may not require hospitalization. Education must be provided to individuals with type 1 diabetes in order to help prevent DKA, which can have serious sequelae, particularly in children under 5 years of age. Although DKA and hyperglycemic hyperosmolar state (HHS) may overlap, especially when dehydration is severe, DKA must be distinguished from HHS (serum glucose >600 mg/dL, serum osmolality >330 mOsm/kg, and no significant ketosis and acidosis) because patients with HHS typically are severely dehydrated and require more aggressive fluid management. There are multiple guidelines available for the management of DKA.[84]


  • Individuals and caregivers of individuals with type 1 diabetes should be educated and reminded annually how to prevent DKA, including a review of sick-day rules and the critical importance of always administering insulin and monitoring both glucose and ketone levels. (B)

  • Insulin omission is the major cause of DKA; therefore, individuals with type 1 diabetes must have access to an uninterrupted supply of insulin. (E)

  • Patients with type 1 diabetes and their families should have around-the-clock access to medical advice and support to assist with sick-day management. (C)

  • Standard protocols for DKA treatment should be available in emergency departments and hospitals. (E)