A 22-year-old woman with T1DM is admitted with her third DKA in 6 months. How would you manage her?

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Accepted Answer

Firstly I would manage the acute DKA according to JBDS — initiating fixed-rate insulin infusion, fluid resuscitation, potassium monitoring, and identifying any precipitating factor such as infection. However, given this is her third episode in six months, my focus would quickly shift towards understanding the underlying reason for recurrence. I would explore adherence in a non-judgemental way — asking about insulin omission, injection technique, access to supplies, and understanding of sick-day rules. In a 22-year-old woman I would also sensitively consider psychological factors, including diabetes distress, depression, or disordered eating behaviours such as insulin omission for weight control. I would involve diabetes specialist nurses early and consider referral to diabetes psychology if available; if she is on a pump I would review pump function and technique. Before discharge I would ensure a clear follow-up plan with close outpatient review, reinforcement of sick-day education and accessible contact with the diabetes team. The goal would be not just to treat this episode, but to break the cycle of recurrence.

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