Assess DKA prevention and treatment knowledge
STEP 1 — Gather Information
Collect patient’s understanding of sick-day rules, ability to recognize DKA symptoms (nausea, vomiting, abdominal pain, fruity breath, polyuria, polydipsia), knowledge of when to check blood ketones, insulin adjustment strategies during illness, awareness of emergency supplies (ketone strips, glucagon, contact info), and ability to operate/troubleshoot the insulin pump.
STEP 2 — Rule In / Rule Out
Does the patient demonstrate correct knowledge of DKA prevention and treatment?
- Yes → Proceed to Step 3 (adequate knowledge).
- No → Proceed to Step 3 (inadequate knowledge).
STEP 3 — Classify or Stratify
Stratify inadequate knowledge into:
- Partial: knows some elements (e.g., recognizes hyperglycemia) but misses key actions (ketone testing, insulin adjustment).
- Deficient: lacks core knowledge (does not know sick-day rules, when to seek help, or how to adjust insulin).
STEP 4 — Decide
- Adequate: reinforce education at next visit and schedule routine review.
- Partial: provide targeted teaching on missing elements (e.g., ketone testing, sick-day plan) and confirm understanding.
- Deficient: arrange urgent diabetes educator referral, supply written sick-day plan with ketone testing instructions, ensure emergency supplies are available, consider temporary MDI backup, and schedule follow‑up within 48 hours.
Clinical Guardrails / Mimics / Pitfalls
Do not assume knowledge based on duration of diabetes or pump use; avoid overlooking cognitive impairment, health literacy, or reliance on self‑report without demonstration; do not neglect to confirm the patient knows when to seek emergency care (e.g., persistent vomiting, inability to keep fluids down, ketones moderate/large); do not forget to assess ability to troubleshoot pump failures during illness.
Concrete Clinical Example
A 22‑year‑old with T1DM on CSII presents with 2 days of vomiting and hyperglycemia (BG 350 mg/dL). Patient reports never checking ketones, unaware of sick‑day rules, and lacks ketone strips. Assessment reveals deficient knowledge. Educator provides a sick‑day plan, prescribes ketone strips, arranges diabetes educator visit within 24 hours, and ensures emergency supplies are stocked.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2534