Blood Sugar Monitoring

Blood sugar monitoring should be undertaken hourly, as should ketone measurement. A common complication of treatment of DKA is hypoglycaemia. In the patient with poor tissue perfusion there can be a significant difference between capillary and venous glucose, which is why bedside ketone monitoring is now advised. In patients with adequate tissue perfusion, the difference between venous and capillary glucose is less than 1 mmol/L and is adequate for monitoring.

Serum potassium level should be measured on arrival, at 60 minutes, 2 hours, and 2 hourly after that. The most rapid changes occur early in treatment. Bicarbonate should be measured every two hours for the first 6 hours [1]. Urine output should be recorded. Those with a poor urine output, cardiovascular disease or multiple co-morbidities may benefit from catheterisation and further invasive monitoring. These patients and those with a decreased GCS should be referred to HDU/ITU, otherwise refer to the on-call medical team.

Learning bite

A raised white cell count does not always indicate the presence of an infection, as the white cell count is proportional to the blood ketone body concentration.