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Management of ketosis-prone type 2 diabetes mellitus

Smolenski, Stefan RN, DNP, AGPCNP-BC (Clinical Instructor)1; George, Nancy M. PhD, RN, FNP-BC, FAANP (Clinical Associate Professor)1

Journal of the American Association of Nurse Practitioners: July 2019 - Volume 31 - Issue 7 - p 430–436
doi: 10.1097/JXX.0000000000000183
Clinical and Case Study Article

ABSTRACT Diabetic ketoacidosis (DKA) has largely been considered unique to type 1 diabetes because of the absolute lack of insulin production secondary to beta-cell dysfunction. However, a relatively new diabetes subtype known as ketosis-prone type 2 diabetes mellitus (DM) may also elicit diabetic ketoacidosis. Ketosis-prone type 2 DM shares a similar pathophysiology as type 2 DM, but presents initially with signs and symptoms consistent with type 1 DM. Patients with ketosis-prone type 2 DM often present with elevated glucose levels of 500–700 mg/dl, elevated ketone levels, and elevations in hemoglobin A1C. Unlike DKA seen in type 1 DM, they do not exhibit autoantibodies to beta cells. The similarity with type 1 DM exists in their impaired insulin secretion, which, when combined with extreme insulin resistance, will lead to ketoacidosis. Despite the initial clinical presentation that resembles type 1 DM, patients may not require lifelong insulin and achieve appropriate glycemic control with oral agents. Nurse practitioners must recognize the clinical picture of ketosis-prone type 2 DM and use a multifaceted approach, encouraging dietary changes, increased physical activity, and medication adherence to build the self-management skills of the patient and ultimately decrease the long-term disease burden.

1Wayne State University College of Nursing, Detroit, Michigan

Authors' contributions: Writing - original draft: S. Smolenski. Writing - review and editing: S. Smolenski, N. M. George.

Competing interests: The authors report no conflicts of interest.

Received October 15, 2018

Accepted November 26, 2018

© 2019 American Association of Nurse Practitioners
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