title: Abnormal insulin treatment behaviour: a major cause of ketoacidosis in the young adult.
abstract: Diabetic ketoacidosis occurs more frequently in the young adult population than in any other age group. In a 3-year retrospective casenote review of all patients admitted with ketoacidosis to this hospital, we have defined the clinical characteristics of ketoacidosis in this age group. Young adults (< 25 years) had worse preceding glycaemic control (median HbA1 14.6 vs 10.1%, p = 0.0001) and more frequent episodes of ketoacidosis in the previous 5 years (3 vs 0, p = 0.0001) than older adults (> 25 years); on admission they had lower blood urea concentrations (p = 0.0001) and had a lower incidence of systolic hypotension (6% vs 32%, p = 0.007). There were fewer complications of ketoacidosis in the young adults, and the duration of hospital stay was less than that in the older age group (4 vs 8 days, p = 0.0003). Young adults were less likely to have a proven underlying infective or other organic precipitant for ketoacidosis, but were investigated and treated in a similar way to older adults. Insulin error or manipulation was identified in 42% of young adults; abnormal insulin treatment behaviour is likely to be the major cause of ketoacidosis in this age group.
authors.affiliation: Diabetes Centre, Ninewells Hospital, Dundee, Scotland.
authors.forename: C J
authors.initials: CJ
authors.lastname: Thompson
authors.forename: F
authors.initials: F
authors.lastname: Cummings
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
authors.forename: R W
authors.initials: RW
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008508:Medication Errors; D010349:Patient Compliance; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin