Use of capillary ketones monitoring in treatment of mild ketotic crisis in adults with ketosis prone atypical diabetes
Christine Ngo Ngai1,&, Eugene Sobngwi1,2,3, Eric Lontchi-Yimagou2,4, Armand Mbanya1,4, Mesmin Dehayem1,3, Martine Etoa Etoga1, Jean-Claude Mbanya1,2,3
1National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon, 2Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon, 3Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon, 4Diabetes Research and Training Center, Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
Christine Ngo Ngai, National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
the utility of capillary ketones monitoring is known in the management of type 1 diabetes and severe diabetic ketoacidosis, but not in adults with ketosis-prone atypical diabetes (KPD) or mild ketosis.
The objective was to assess the potential reduction in duration of intensive diabetic ketoacidosis treatment in adults with KPD when using capillary versus urinary ketones.
from February to end March 2015, a total of 20 (9/20 newly diagnosed) patients, aged 46 ± 12 years and classified as KPD presented at the National Obesity Center of the Yaoundé Central Hospital with marked hyperglycemia and significant ketosis (ketonuria ≥ ++) requiring intensive insulin treatment.. The mean plasma glucose and urinary ketones levelon admission was 22.8 ± 5mmol/L and 2.9± 2.7 mmol/L respectively. No patient had severe acidosis (HCO3 < 14mmol/L). Intensive insulin treatment was initiated at 10 UI per hour with concomitant measurement of capillary and urinary ketones every 2 hours until the absence of ketonuria. Capillary beta-hydroxybutyrate levels were measured by an electrochemical method (MediSenseOptium meter). Ketonuria was measured by a semi quantitative test (Ketodiastix). Time-to-disappearance of urine ketones was compared to the time-to-normalization of capillary ß-hydroxybutyrate concentrations (< 0.5mmol/L).
the time-to-normalization of ketonuria ranged between 2 and 14 hours, and
that of ketonemia between 1 and 10 hours. The mean time-to-disappearance
of ketonuria was 6.3 ± 3.6 hours with a median time of 5 hours, while the mean
time-to-normalization of capillary β-hydroxybutyrate was 4.2 ± 2.7 hours
with the median of 4 hours (p = 0.0002). The absolute difference in time-to-normalization
of ketonuria versus ketonemia was 2[1-3] hours (median [interquartile difference])
and relative time reduction of treatment to 32.5 ± 18.0%.
the use of capillary ketones versus ketonuria would allow a significant reduction in duration of intensive insulin treatment by one third in adults with ketosis prone diabetes and therefore reduce admission rates and costs.