The evolution of DKA management


  • Ketan Dhatariya Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, UK



The Joint British Diabetes Societies (JBDS) looked in detail at the evidence based management for diabetic ketoacidosis (DKA) and generated a set of guidelines to support the management of this complex condition. Because of the nature of research into DKA there are some areas which have less of an evidence base, so expert commentary and experience support several of the recommendations. This article describes the historical basis of the development of the management of this condition, how we came to arrive at the present situation and why the ongoing national DKA audit is so important in elucidating what is currently happening across the UK in clinical practice.


Savage MW, Dhatariya KK, Kilvert A et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011;28:508-15.

Dhatariya K, Savage M, Claydon A et al. Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. Second Edition. Update: September 2013. http://www diabetologists-abcd org uk/JBDS/JBDS_IP_DKA_Adults_Revised pdf. 2013. (Accessed September 2014).

Dreschfeld J. The Bradshawe lecture on diabetic coma. Br Med J 1886;2:358-63.

Bliss M. The Discovery of Insulin - the 25th anniversary edition. 2007. University of Chicago Press

Root HF. The use of insulin and the abuse of glucose in the treatment of diabetic coma. JAMA 1945;127:557-64.

Black AB, Malins JM. Diabetic ketoacidosis. A comparison of results of orthodox and intensive methods of treatment based on 170 consecutive cases. Lancet 1949;253:56-9.

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32:1335-43.

Sonksen PH, Tompkins CV, Nabarro JD. Growth-hormone and cortisol responses to insulin infusion in patients with diabetes mellitus. Lancet 1972;300:155-60.

Kidson W, Casey J, Kraegen E, Lazarus L. Treatment of severe diabetes mellitus by insulin infusion. Br Med J 1974;2:691-4.

Page MM, Alberti KG, Greenwood R et al. Treatment of diabetic coma with continuous low-dose infusion of insulin. Br Med J 1974;2:687-90.

Carroll P, Matz R. Uncontrolled diabetes mellitus in adults: Experience in treating diabetic ketoacidosis and hyperosmolar nonketotic coma with low-dose insulin and a uniform treatment regimen. Diabetes Care 1983;6:579-85.

Wolfs JI, Allgrove J, Craig ME et al. Diabetic ketoacidosis and hyperglycemic hypersmolar state. Pediatr Diabetes 2014;15:154-79.

Levetan CS, Passaro MD, Jablonski KA, Ratner RE. Effect of physician specialty on outcomes in diabetic ketoacidosis. Diabetes Care 1999;22:1790-95.

Sampson MJ, Crowle T, Dhatariya K et al. Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service. Diabet Med 2006;23:1008-15.

Price H, Thomsett K, Newton I, Alderson S, Hillson R. Developing best practice tariffs for diabetic ketoacidosis and hypoglycaemia. Pract Diab 2013;30:6-8.

Hockaday TD, Alberti KG. Diabetic coma. Clin Endocrinol Metab 1972;1:751-88.

American Diabetes Association. Urine glucose and ketone determinations. Diabetes Care 1992;15:38.

Dhatariya K. The use of point-of-care blood ketone monitors in the management of diabetic ketoacidosis in adults. Ann Clin Biochem 2014;51:525-7.

Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients? Diabet Med 2012;29:32-35. 03390.x

Savage MW, Kilvert A. ABCD guidelines for the management of hyperglycaemic emergencies in adults. Pract Diab Int 2006;23:227-31.






Current Topics

Most read articles by the same author(s)