MMPAD Milan Meeting Report

11 European Roadshow - Milan, 29 June 2018 MEETING REPORT Prevention of DKA It is essential to try to prevent DKA at three different levels: to prevent its onset, to prevent relapses and to prevent its consequences. This can be achieved through a robust treatment protocol; the experience of the doctor is also crucial in prevention. An experiment conducted in the province of Parma in the 1990s drastically reduced the incidence of DKA through an information campaign in schools and recruitment of a random selection of paediatricians who were given a blood glucose and glycosuria measurement kit, a copy of relevant guidelines and a reference telephone number . 13 The ISPAD 2014 guidelines estimate the risk of secondary DKA in children with T1D at around 10% per year and recognise the following conditions as risk factors : 7 • Failure to take insulin treatment • Poor metabolic control or previous episodes of DKA • Gastroenteritis with persistent vomiting and inability to maintain hydration • Psychiatric disorders, including eating disorders • Difficult or unstable family conditions (e.g. domestic abuse) • Puberty and adolescence in girls • Limited access to health services • Insulin pump therapy (CSII) not used correctly (as only rapid or short-acting insulin is used in insulin pumps, interruption for any reason leads rapidly to insulin deficiency) Reflection: Strategy for reducing recurrences of DKA A correct DKA recurrence reduction strategy includes providing the patient and their family with correct instructions on CSII to : 14 • measure ketonaemia at each episode of hypoglycaemia (ketonaemia is preferable to ketonuria) • check the correct intake of insulin, especially: • for adolescent patients with eating disorders, • for people who lose weight, have a high BMI or high levels of HbA1c; • for people suffering from anxiety or depression or with difficult family situations. It is important to provide the patient with clear rules and instructions, preferably in writing, and a phone number for future reference.