Case Presentation

A 15 years old girl with type 1 diabetes since three years was taken to the emergency unit of the hospital presented typical symptomsof ketoacidosis on admission such as dehydration, weakness, andabdominal pain, nausea with 2 episodes of vomiting, drowsiness feverand breathlessness. The laboratory results revealed hyperglycemia312mg/dl and urine ketones 4⁺ confirming the diagnosis of diabetic ketoacidosis. She was immediately put on treatment by the doctorafter screening patient’s health status and clinical severity of thecondition. The dietician performed a detailed assessment of dietaryintake by taking 24-hour recall studying her food pattern, dailyschedule with school timings, and amount of carbohydrate permeal with insulin regime followed by the patient to find out thefactors that contributed to the cause of diabetic ketoacidosis. Theinvestigations revealed improper monitoring of blood glucose levelsbecause of the lack of knowledge and proper training to be self-reliantin management, skipping of insulin injection prior to ketoacidosisbeing the major cause that must have impaired glucose utilizationto energy due to the lack of insulin leading to hyperglycemia state,therefore fat is used as a primary source of energy by producingketone bodies from fatty acid oxidation, excess of ketone bodies enterthe blood brain barrier causing unconsciousness and coma hence thedietician emphasized in training the child and the family, drawingtheir attention in learning the necessary skills for maintaining bloodglucose levels and prevent relapse of ketoacidosis [1,3]. Initiation ofintravenous fluid and electrolyte replacement with insulin therapywith continues monitoring for blood glucose and ruling out other possible complications were the immediate medical treatmentand by restoring fluid, glucose uptake in the periphery increasesimproving glomerular filtration rate and reversing acidosis, insulinadministration ceases ketogenesis by reversing proteolysis andlipolysis, stimulating glucose uptake by the cell which is furtherused as energy, thereby normalizing blood glucose concentrationand replacing electrolyte losses and reducing the progression of thecomplication [4]. The patient showed quick recovery after initiatingthe treatment and thus to eliminate all the factors of relapse of DKA asystemic team approach was carried out by the entire team includingan Endocrinologist, RD dietician and nursing.

Patient in recovery was advised healthy balanced diet as perrecommended dietary allowance for Indian adolescent with 2330calories, 51gms of proteins, 40gms of visible fat and 55% of simplecomplexcarbohydrate distributed in all the meals as per insulindose. A detailed counseling was given to the child and parents by thedietician, educating the knowledge in understanding early signs andsymptoms of DKA and taking immediate action in verification andinitial home treatment also the patient was taught correction factorof insulin dose when hyperglycemia or hypoglycemia with the skillsof carbohydrate counting and its choices. The Goal for this patient is to be self- reliant in managing normal blood glucose level with theskills of carbohydrate counting, insulin dose with correction factorand activity pattern was achieved after a one month follow up andnow the patient is independently managed type 1 diabetes suchapproach must be practiced in order to reduce the type 1 emergenciesin hospital.